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中国人民解放军第三〇九医院神经外科
汤可
神外世界朗读者专栏--点击下面收听语音版
(手术细节2)小脑卒中和枕下外伤的外科治疗
FigureProceduralStepsPearls
Fig.5.5Thebonyexposureshouldextendfromtheiniontotheforamenmagnum.Awideexposureisneededforcerebellarinfarcts,extendinglaterallytoacentimeterfromthemastoidprocess.Thisessentiallymeansincorporatingthewholeofthewidebonyexposureintothecraniotomy.Asmallerexposure(eitherunilateralorbilateraldependinguponthepathology)isneededforhematomas.AdditionalexposurecanbeobtainedifnecessarybasedontheCTscanndings.
TheC1posteriorarchisalwaysexposed(20mmoneachside)butneednotberesected.Deepcerebellarretractorsspreadtheskinanddissectedmusclesatthislevel.
Pearls
?CareshouldbetakentoavoidstrippingthemusclesothespinousprocessandlaminaofC2asthisisamajorinsertionpointformanyofthestabilizingmusclesoftheneck.
FigureProceduralStepsPearls
Fig.5.6(a)Burholesareplacedatthelevelofthetransversesinus(approximately1cmbelowtheinion),toeithersideofmidline.Wetypicallyuseaperforatordrill;alternately,amatchstickoracornburmaybeemployed.Asecondsetofburholescanbemadeatthelateraledgeofthecraniotomyiftheduraisverystucktothebone,buttypicallyonlytwoarerequired.(b)Foraparamedianapproach,oneburholeisplacedinthemidlinepositionandoneatthelateraledgeoftheplannedopening.
?Protectthedrillfromslippingintotheforamenmagnumregionduringinitialstagesofthedrilling
FigureProceduralStepsPearls
Fig.5.7An8-mmacornburisusedtothinthethickbonebuttressesoverthetransversesinusesandcerebellarconvexities.Whenathinshellofboneremains,a白癜风可以生姜擦吗北京哪个医院治疗白癜风最好
