基于解剖学研究的枕下乙状窦后入路精准开颅技术探讨

doi:10.13418/j.issn.1001-165x.2020.06.002

Abstract

Abstract: Objective　To explore the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the skull anatomical landmarks in order to provide the evidence for safe, accurate and fast clinical craniotomy.　Methods 　From April 2016 to June 2019, 15 skull specimens and 8 cadaver head specimens were applied. The anatomical landmarks as followed were identfied on skull specimens: the top point of the digastric groove, mastoidale, asterion and keypoint (corresponding extracracranial point of the transverse-sigmoid sinus junction). The relationship between anatomical markers of skull specimens was studied to develop the craniotomy of suboccipital retrosigmoid approach. 28 patients were performed the craniotomy in the clinical surgery by evaluating relevant indicators to evaluate the feastibility of craniotomy.　Results　(1) Anatomical study and cadaveric test: the distance from keypoint to the top point of the digastric groove was (16.79±3.50) mm (left）and (14.82±2.96) mm (right）；the distance from keypoint to asterion was (19.53±3.84) mm（left）and (22.59±4.08) mm (right）; the distance from keypoint to mastoidale was (33.98±3.87) mm (left) and (32.78±3.29) mm (right). The value of the left distance from keypoint to asterion was smaller than the right side (P=0.020). 8 cadaveric heads specimens were verified the simulate craniotomy of suboccipital retrosigmoid approach. No venous sinus injury was found. (2) Clinical application: 28 patients were performed the craniotomy of suboccipital retrosigmoid approach. Operative area was exposed clearly in 23 patients. No venous sinus rupture occurred. The average craniotomy time was (23.1±2.2) min. The size of bone flap was 1.8 cm×2.0 cm. The diameter of bone window was 2.0~2.5 cm. Bone flap was replaced during the operation.　Conclusions　In order to precisely locate the keypoint in the craniotomy of suboccipital retrosigmoid approach, the center of the burr hole can be exact oriented according to 14 mm (left)/ 12 mm (right) vertically above the top point of mastoid groove based on the line between the supraorbital margin and the upper edge of the external auditory canal. This method can insure safe, accurate and rapid craniotomy with a good vision and avoiding the injury of venous sinus.

Key words: Suboccipital retrosigmoid approach; , , Craniotomy; , Anatomical landmark; , Transverse sinus; , Sigmoid sinus

CLC Number:

SHENG Min-feng, JIANG Lei, LI Xin, ZHANG Yi, CHEN Yan-ming, WANG Zhong-yong, LV Xuan, CHEN Gang. Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study[J]. Chinese Journal of Clinical Anatomy, 2020, 38(6): 629-634.

References 25

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Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study

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