Matsumoto K, Tomita S, Nakagawa M, Adachi H, Tada E, Maeda Y, Furuta T, Ohmoto T
Department of Neurological Surgery, Okayama University Medical School.
No Shinkei Geka. 1995 Dec;23(12):1093-7.
A twist drill craniostomy is a rapid and relatively simple technique for perforating the skull in order to gain access to the epidural and subdural spaces and the brain. Fifty-eight patients underwent 173 twist drill craniostomies in the stereotactic procedures for the diagnosis and the treatment of brain tumors (brain tumor biopsy, implanting radioactive sources and placement of the catheters for navigation surgery) from September, 1992, through to May, 1995, at our institute. The technique was compared with standard burr hole craniostomy used in 42 patients with brain tumor. In the twist drill craniostomy, the scalp was penetrated directly by hand twist drill (2.7 mm in diameter) and scalp bleeding was able to be be controlled by injecting local anesthetic with epinephrine subcutaneously. The safety stop on the drill was set in advance based on the expected thickness of the skull at its penetration point to provide control of penetration depth as it passed through the skull hole and dura. A hole in the skull was made as the drill was advanced until a change in resistance indicated that the inner table of the skull had been penetrated and the dura lacerated. The cannula with stylet was then inserted through the guide tube to assure the penetration of the skull and dura. As the cannula penetrated the dura, a loss of resistance was noted as it proceeded through the dura toward the pial surface, The time needed in this procedure was less than 3 minutes. Associated with this procedure, there were no complications such as bleeding, or infection in 173 twist drill craniostomies in the 58 patients. Our experience with this procedure proved it to be simple, efficient, safe and superior to conventional burr hole craniostomy.
颅骨环钻开颅术是一种快速且相对简单的颅骨穿孔技术，用于进入硬膜外、硬膜下间隙及脑内。1992年9月至1995年5月，我院58例患者在立体定向手术中接受了173次颅骨环钻开颅术，用于脑肿瘤的诊断和治疗（脑肿瘤活检、植入放射源及放置导航手术导管）。该技术与42例脑肿瘤患者使用的标准钻孔开颅术进行了比较。在颅骨环钻开颅术中，使用手动环钻（直径2.7毫米）直接穿透头皮，通过皮下注射含肾上腺素的局部麻醉剂可控制头皮出血。根据预计颅骨穿透点的厚度预先设置钻头上的安全限位器，以控制钻头穿过颅骨孔和硬脑膜时的穿透深度。随着钻头推进形成颅骨孔，直至阻力变化表明颅骨内板已被穿透且硬脑膜被撕裂。然后将带有探针的套管通过导管插入，以确保颅骨和硬脑膜已被穿透。当套管穿透硬脑膜时，在其穿过硬脑膜朝向软脑膜表面的过程中可感觉到阻力消失，该操作所需时间不到3分钟。在这58例患者的173次颅骨环钻开颅术中，未出现出血、感染等并发症。我们在该手术中的经验证明其操作简单、高效、安全，优于传统钻孔开颅术。
