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近三年来,作者采用经乙状窦后方进路行听神经瘤手术共80例。患者取仰卧位。从开颅至手术结束均在手术显微镜下进行,不用自动分开器,不用棉片覆盖小脑,始终都用冻干硬脑膜保护小脑,以免小脑受创伤发生水肿或出血,实际上起到了硬脑膜外进路的作用。手术程序如下。第一步:暴露桥小脑角。尽量使患者头部转向对侧并用胶布固定。术中输注25%甘露醇(500ml)。沿乳突后缘作一长10cm的垂直切口。在乙状窦后方行开颅术,其直径为3cm。垂直切开硬脑膜,并在此切口前加一横切口。于小脑与岩骨内面之间放入一块冻干硬脑膜,用钝器将之推至外侧池处,并打开此池的蛛网膜。第二步:切除听神经瘤。暴露听神经瘤后
In the past three years, the authors used 80 cases of acoustic neuroma surgery via the sigmoid sinus rear approach. The patient is in supine position. From the craniotomy to the end of the surgery were performed under the operating microscope, without automatic separator, do not cover the cerebellum with cotton sheet, always use the freeze-dried dura to protect the cerebellum, in order to avoid edema or hemorrhage of the cerebellum trauma, in fact, played a role outside the dura mater. The role of the approach. The procedure is as follows. The first step: expose the cerebellopontine angle. Try to turn the patient’s head to the opposite side and fix it with tape. Intraoperative infusion of 25% mannitol (500ml). A 10 cm vertical incision was made along the posterior margin of the mastoid. The craniotomy was performed behind the sigmoid sinus and its diameter was 3 cm. The dura was cut vertically and a transverse incision was made before this incision. Place a piece of lyophilized dura between the cerebellum and the inner surface of the petrous bone, push it to the lateral pool with a blunt instrument, and open the arachnoid membrane in this pool. The second step: removal of acoustic neuroma. After exposure to acoustic neuroma