Jian Zhi-Heng, Sheng Min-Feng, Li Jia-Yan, Li Yu, Weng Zhi-Jian, Chen Gang
Department of Neurosurgery, Zhuhai People's Hospital, Jinan University, Zhuhai, China.
Department of Neurosurgery, Second Affiliated Hospital, Soochow University, Suzhou, China.
Front Surg. 2022 Apr 14;9:809098. doi: 10.3389/fsurg.2022.809098. eCollection 2022.
We aimed to explore a method of precise localization within craniotomy based on skull anatomical landmarks via the suboccipital retrosigmoid approach.
Craniometric measurements were taken from 15 adult dry skulls and eight cadaver head specimens. In the anatomical study, the keypoint corresponded to the transverse-sigmoid sinus junction's corresponding point on the external surface of the temporal mastoid process, eight cadaveric heads underwent a simulated craniotomy using the suboccipital retrosigmoid approach. The center of the burr hole is precisely oriented 12 mm vertically above the top point of the mastoid groove based on the line between the infraorbital margin and the upper edge of the external auditory canal. Clinical application was verified in clinical surgery by evaluating the accuracy, safety, rapidity, and minimal invasiveness of the procedure in 29 patients.
No venous sinus injuries were observed. Within clinical application, 29 patients underwent craniotomy using the suboccipital retrosigmoid approach. The operative area was clearly exposed in all patients and the microsurgical anatomy of the intracranial region after the dura mater incision was satisfactory. No venous sinus ruptures were observed. The average craniectomy time was 27.02 ± 0.86 min. The diameter of the bone window was 1.7-2.9 cm.
We conclude that the method can ensure safe, accurate, and rapid craniotomy with good vision while avoiding injury to the venous sinus.
我们旨在探索一种基于颅骨解剖标志，通过枕下乙状窦后入路在开颅手术中进行精确定位的方法。
对15个成人干燥颅骨和8个尸体头部标本进行颅骨测量。在解剖学研究中，关键点对应于颞乳突过程外表面上横窦-乙状窦交界处的对应点，8个尸体头部采用枕下乙状窦后入路进行模拟开颅手术。基于眶下缘与外耳道上缘之间的连线，将骨孔中心精确地定位在乳突沟顶点上方12毫米处。通过评估29例患者手术的准确性、安全性、快速性和微创性，在临床手术中验证了其临床应用。
未观察到静脉窦损伤。在临床应用中，29例患者采用枕下乙状窦后入路进行开颅手术。所有患者的手术区域均清晰暴露，硬脑膜切开后颅内区域的显微手术解剖结构令人满意。未观察到静脉窦破裂。平均颅骨切除时间为27.02±0.86分钟。骨窗直径为1.7 - 2.9厘米。
我们得出结论，该方法可以确保安全、准确、快速地进行开颅手术，视野良好，同时避免静脉窦损伤。
