Miyazaki Y
No Shinkei Geka. 1976 Jul;4(7):673-8.
One of the important points in operation of the intracranial supratentorial lesion is appropriate site and size of bony window made by craniotomy and this matter is also important first step in procedure of craniotomy. On the other hand, the site and size of bony window made in craniotomy for supratentorial lesion has relationship with perfectibility of operation. The detail intracranial situation and extent of supratentorial lesion is decided from the datas of various examinations and the findings in cerebral angiogram give a most important and valuable information to the neurosurgeon at present. The neurosurgeons used to decide the area of craniotomy from the findings of cerebral angiogram but there are some difficulty in transfer of findings related with situation of supratentorial lesion in angiogram to the patient's scalp, because the film of cerebral angiography is a projected picture of spheric head by X-ray to the plane. The author devised the planning method of site and size of bony window in craniotomy by transfer the location and extent of supratentorial lesion in cerebral angiogram to the patient's scalp and the author have been recognized for the past five years that this method is simple one and has clinical accuracy. The principle of the author's method are as follows. The film of cerebral angiography in lateral projection and the patient's scalp are divided into nine parts by same manner and the relation of the site and extent of lesion in cerebral angiogram with divided parts transfer to the division of the patient's scalp under special care to make minimize errors due to use the cerebral angiogram which is picture made by projection in a plane from spheric intracranial supratentorial space. Five points and seven lines are used to divide the film of cerebral angiography and the patient's scalp. Five divide points are most upper part of margin of external acoustic meatus, most posterior edge of auricle, upper, lower and lateral edge of orbit. The following divide lines are drawn by use of these five divide points. Two horizontal lines are eye-ear horizontal line and superior eye horizontal line. Three vertical line are external acoustic meatus vertical line, auricular vertical line and temporal orbital margine vertical line. Two oblique lines are anterior and posterior oblique lines. The film of lateral cerebral angiography and patient's scalp are divided into nine parts by these seven divide lines. In the areas above the superior eye horizontal line, following procedure for correction of error due to transfer the point of X-ray film to the patient's scalp is needed because of strong curved brain surface. One end of celluloid or steel scale place closely with the scalp below the superior eye horizontal line and the other end of scale make freely from curved scalp surface. The point of lesion on the divide line of X-ray film marks at correspond point on the scale...
颅内幕上病变手术的要点之一是开颅所做骨窗的合适位置和大小，这也是开颅手术过程中的重要第一步。另一方面，幕上病变开颅时所做骨窗的位置和大小与手术的完善程度有关。通过各种检查数据来确定幕上病变的详细颅内情况和范围，目前脑血管造影的结果能为神经外科医生提供最重要且有价值的信息。神经外科医生过去常常根据脑血管造影的结果来确定开颅区域，但由于脑血管造影的片子是通过X射线将球形头部投影到平面上的图像，所以将血管造影中与幕上病变情况相关的结果转移到患者头皮上存在一些困难。作者设计了一种将脑血管造影中幕上病变的位置和范围转移到患者头皮上，从而确定开颅骨窗位置和大小的规划方法，在过去五年里，作者认识到这种方法简单且具有临床准确性。作者方法的原则如下。将侧位脑血管造影片子和患者头皮以相同方式分为九个部分，在特别注意尽量减少因使用从球形颅内幕上空间投影到平面上的脑血管造影图像所导致误差的情况下，将脑血管造影中病变的位置和范围与划分部分的关系转移到患者头皮的划分上。用五个点和七条线来划分脑血管造影片子和患者头皮。五个划分点分别是外耳道边缘的最上部、耳廓的最后边缘、眼眶的上、下和外侧边缘。利用这五个划分点画出以下划分线。两条水平线是眼耳水平线和上眼水平线。三条垂直线是外耳道垂直线、耳廓垂直线和颞眶缘垂直线。两条斜线是前后斜线。通过这七条划分线将侧位脑血管造影片子和患者头皮分为九个部分。在眼上水平线以上的区域，由于脑表面弯曲度较大，需要按照以下步骤来校正因将X线片上的点转移到患者头皮上而产生的误差。将赛璐珞或钢尺的一端紧密贴在眼上水平线以下的头皮上，钢尺的另一端从弯曲的头皮表面自由抬起。在X线片划分线上的病变点标记在钢尺上对应的点……
