神经外科麻醉的基本原理：生理性方法到临床实践部分46.pdf

(a) (b) (c) Figure 17.3 Type I Chiari Malformation. (a) Normal MRI of the posterior fossa for comparison; (b and c) MRI in two dif erent patients with Type I Chiari malformation with tonsillar herniation (hindbrain hernia) below the foramen magnum into the cervical spinal space. Syrinx is absent. S U R G I C A L A P P R OAC H E S A N D transtentorial approaches [1] . Patients undergoing poste- I N T R AO P E R AT I V E P O S I T I O N I N G rior fossa surgery are usually positioned intraoperatively in one of the following ways. h ere are various surgical approaches to the posterior fossa including suboccipital, supracerebellar infratentorial, trans- T H E S I T T I N G P O S I T I O N temporal, and transoral approaches. Indirect routes through the supratentorial fossa include combined supratento- h e sitting position (Figure 17.5) provides optimal surgical rial infratentorial, occipital transtentorial, and temporal access to midline posterior fossa and upper cervical lesions. (a) (b) (c) (d) Figure 17.4 Pineal gland tumor. Sagittal, axial, and coronal views of MRI of the brain with and without contrast showing a pineal gland germinoma. h ere is obstructive hydrocephalus with dilatation of the lateral and third ventricles. A smaller suprasellar mass is also present. Pineal gland tumors are ot en accessed via the supracer