耳后弧形远外侧入路切除颈静脉孔区病变的颅底重建技术  

Skull base reconstruction technique in the resection of lesions in the jugular foramen area through a curved retroauricularfar-lateral approach

作　　者：马顺昌 张岱男[2] 管修东 李江 薛湛 倪明[2] 贾桂军[2] 李德岭[2] 贾旺[1] Ma Shunchang;Zhang Dainan;Guan Xiudong;Li Jiang;Xue Zhan;Ni Ming;Jia Guijun;Li Deling;Jia Wang(Beijing Neurosurgical Institute,Capital Medical University,Bejing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Bejing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070

出　　处：《中华神经外科杂志》2023年第5期480-483,共4页Chinese Journal of Neurosurgery

基　　金：首都医科大学附属北京天坛医院横向课题(HX-A-2022037)。

摘　　要：目的 探讨乙状窦后和乳突皮质骨双骨瓣成形结合肌肉分层复位缝合重建技术在耳后弧形远外侧入路切除颈静脉孔区病变手术中的应用效果.方法 回顾性分析2020年1-12月首都医科大学附属北京天坛医院神经外科学中心采用耳后弧形远外侧入路肿瘤切除术治疗的16例颈静脉孔区肿瘤患者的临床资料,术中均采用肌肉分层法、乙状窦后及乳突皮质骨双骨瓣成形、肌肉分层复位缝合重建技术.观察颅底重建的效果以及是否出现脑脊液漏、皮下积液等并发症.结果16例患者均顺利完成手术,肿瘤均获得全切除;病理学结果显示,神经鞘瘤12例,副神经节瘤3例,软骨肉瘤1例.术后新出现神经功能障碍2例,原有神经功能障碍加重6例;所有患者均未出现皮下积液、脑脊液漏等并发症.所有患者术后头颅CT均显示双骨瓣固定良好,未见任何程度的扭转或者松动,乳突的形态学特征恢复,颅骨缺损较少.16例患者的随访时间为(31.4±3.5)个月(27~37个月).至末次随访,所有患者的伤口均愈合良好,未发现颅骨骨瓣变形或移位的情况,无一例肿瘤复发.结论 乙状窦后和乳突皮质骨双骨瓣成形以及肌肉分层复位缝合技术操作简单,可在保证显露范围的基础上,增加安全性,减少骨性缺损,并且有利于软组织重建;在耳后弧形远外侧入路切除颈静脉孔区病变手术中的应用安全、有效.Objective To explore the application of combined use of the double osteotomy of the retrosigmoid sinus and mastoid cortical bone with muscle layer repositioning and suturing reconstruction technique in the surgical treatment of lesions in the jugular foramen via the retroauricular far-lateral approach.Methods A retrospective analysis was performed on the clinical data of 16 patients with jugular foramen tumors who underwent resection via the retroauricular far-lateral approach at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from January to December 2020.Intraoperatively,all cases were managed using the muscle layer repositioning technique,double osteotomy of the retrosigmoid sinus and mastoid cortical bone and muscle layer suturing reconstruction.The study evaluated the efficacy of skull base reconstruction and the occurrence of complications such as cerebrospinal fluid leakage and subcutaneous fluid accumulation.Results Surgical operations were successfully performed and gross total resection was acquired in all 16 patients.Pathological results showed that there were 12 cases of schwannoma,3 cases of paraganglioma and 1 case of chondrosarcoma.After operation,2 cases had new-onset neurological dysfunctions,and 6 cases experienced aggravation of pre-existing neurological dysfunctions.None of the patients had subcutaneous fluid accumulation or cerebrospinal fluid leakage.All patients had good fixation of the double bone flaps as shown on postoperative head CT without evidence of twisting or loosening.Restoration of the morphological features of the mastoid was shown with minimal skull defect.The follow-up time for the 16 patients was 31.4±3.5 months(27-37 months).At the last followup,all wounds had healed well,and there were no cases of skull flap deformation,displacement or tumor recurrence.Conclusions Double osteotomy of the retrosigmoid sinus and mastoid cortical bone with muscle layer repositioning and suturing reconstruction technique is a simple surgical procedure that incre

关 键 词：颅底肿瘤 颈静脉孔 远外侧入路 双骨瓣 乳突皮质骨 重建 

分 类 号：R651.1[医药卫生—外科学]