额颞开颅颞前叶切除术中颞肌处理的技术问题  

Management of temporal muscle in anterior temporal lobectomy during fronto-temporal craniotomy

作　　者：苏崇德[1] 常鹏飞[2] 

机构地区：[1]空军航空医学研究所附属医院癫痫中心,北京100089 [2]首都医科大学宣武医院北京功能神经外科研究所,北京100053

出　　处：《中华神经外科疾病研究杂志》2011年第3期227-229,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的额颞开颅、颞前叶切除术是外科治疗颞叶癫痫的基本术式,开颅术中颞肌的处理是一个关键环节,如果手术操作不当会产生颞肌萎缩等并发症。本文总结了我们手术的经验,根据额颞区的解剖特点,提出额颞开颅术中颞肌处理的一些基本原则和手术技巧,以预防术后颞肌萎缩等并发症的发生。方法通过对尸头的额颞区解剖研究和文献复习对颞肌的解剖特点进行分析,对手术进行改进:①额颞皮瓣成型时避免损伤颞浅动脉、面神经额支和颞支;②保留颞肌筋膜在颞骨颞上线上的附着点以便术后颞肌复位固定;③颞肌的剥离要自下而上在骨膜下逆向完整剥离;④保留较宽的肌蒂,不要横断太多的颞肌;⑤避免用单极电刀从颞骨上剥离颞肌。结果用以上手术技术开颅行颞前叶切除术68例,有3例术后发生颞区疼痛,特别是在咀嚼时疼痛。术后6个月至2年,43例获得随访,无一例发现颞肌萎缩。结论额颞开颅术中正确处理颞肌及其相关的血管和神经,不仅有利于手术的顺利进行,也可有效的预防颞肌萎缩等并发症的发生。Objective Anterior temporal lobectomy and fronto-temporal craniotomy are the traditional surgical method for temporal lobe epilespy,in which management of temporal muscle is crucial.Any improper management of temporal muscle may result in the atrophy of post-operative temporal muscle.The study aims to put forward the surgical principles and techniques for the management of temporal muscle in fronto-temporal craniotomy according to our experiences and the anatomic study.Methods On the basis of anatomic study of fronto-temporal region and the literature review,the following surgical principles were put forward： firstly,during the incision and elevation of fronto-temporal scalp flap,the superficial temporal artery and the branches of facial nerves should be well preserved;secondly,preservation of temporal fascia attachment on the superior temporal line was helpful for the anatomic restoration of the temporal muscle;thirdly,retrograde dissection of the temporal muscle together with the temporal fascia was important;fourthly,wider stem of temporal muscle flap should be preserved and the transection of the muscle should be avoided;lastly,monopolar cautery was not suggested in the dissection of temporal muscle.Results Sixty-eight patients underwent the craniotomy according to the above-mentioned principles.Only 3 patients suffered the postoperative chewing ache in temporal region.No case of temporal muscle atrophy was found in 43 cases during 6 months to 2 years＇ follow-up.Conclusion Proper management of the temporal muscle and innervated nerves and arteries is helpful for the exposure and important for the prevention of complication,such as atrophy of temporal muscle.

关 键 词：额颞开颅术 颞肌 癫痫 手术 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R651.11[医药卫生—基础医学]