翼点入路开颅及侧裂显露范围研究.ppt

入路原则: 1,动脉瘤原位暴露,无脑组织损伤;2,充分暴露动脉瘤,载瘤动脉和周围结构;3, * * A frontotemporal flap centered at the pterion (pterional craniotomy) may be used for internal carotid artery aneurysms; The flap may be enlarged posterosuperiorly for reaching aneurysms of the middle cerebral artery and of the internal carotid artery bifurcation, forward for approaches to the anterior communicating area; posteriorly to provide a pterional-pretemporal or anterior subtemporal approach for an aneurysm of the basilar apex. * Method of opening the scalp； Location of aneurysm: at the level of the ophthalmic or superior hypophyseal artery; In one layer, the skin and galea are elevated; In a second layer, the temporalis muscle and fascia are elevated. The two-layer scalp opening provides a lower exposure and better access for removing the anterior clinoid process and adjacent part of the orbital roof than the single-layer flap. which are commonly needed to manage aneurysms that arise proximal to the posterior communicating artery. * Method of opening the scalp Location of aneurysm: at the level of or above the posterior communicating artery, as a single layer, the skin, galea, pericranium, and temporalis muscle and fascia are reflected; * commonly selected with slight modifications: for approaching all of these aneurysms arising from the anterior circle of Willis; for some originating from the upper basilar artery; * ３。８ * Modified frontotemporal approach ３。１６ * 宣武医院神经外科 谌燕飞 2010年12月26日 动脉瘤原位暴露,无脑组织损伤; 充分暴露动脉瘤,载瘤动脉和周围结构; 显微外科不是显微开颅,锁孔无法充分暴露; 翼点开颅 纵裂入路 眶颧开颅 以翼点为中心，额颞骨瓣开颅； 颈内动脉系统动脉瘤，鞍旁结构； 翼点入路 上半身抬高15-20度 双下肢微屈曲并抬高5-10度 病人身体呈V字形。 病人的头部高于心脏水平，利于颅内的静脉回流 取决于动脉瘤的部位、病人的发际以及手术方式。 通常的原则： 起自颧弓上耳屏前1cm，尽可能的贴近耳屏，避开颞浅动脉主干及面神经额支，起自颧弓上，止于中线发迹缘的弧形切口 垂直向上达颞线水平后，即转向前内侧，终止于发际内、中线旁开1-2cm。 切口设计3 双层皮瓣（标准) 翼点入路 单层皮瓣 （适用于大脑中动脉瘤和简单的后交通动脉瘤） 翼点入路 弧形切口相对标准切口有所扩大，必要时采取拐至耳后的扩大翼点切口（问号），例如患者术前意识及生命体征均不稳定（大于等于III级），大脑中动脉瘤合并巨大血肿需要清除血肿，或者脑疝需要大骨瓣减压的。 骨窗范围内侧可达中线，外侧颞部骨质靠近中颅凹底处尽量去除，以备术中颅压高术后需要去除骨瓣减压时，达到使脑组织在颞肌下充分减