[1]李云林,秦广彪,谭泊静,等.改良的经“外侧裂-岛周”大脑半球切开术研究[J].临床神经外科杂志,2019,16(3):241-244.[doi:10.3969/j.issn.1672-7770.2019.03.012]
 LI Yun-lin,QIN Guang-biao,TAN Bo-jing,et al.A study of modified hemispherotomy via “sylvian-peri-insular” approach[J].Journal of Clinical Neurosurgery,2019,16(3):241-244.[doi:10.3969/j.issn.1672-7770.2019.03.012]
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改良的经“外侧裂-岛周”大脑半球切开术研究()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
16
期数:
2019年第3期
页码:
241-244
栏目:
论著
出版日期:
2019-06-15

文章信息/Info

Title:
A study of modified hemispherotomy via “sylvian-peri-insular” approach
作者:
李云林秦广彪谭泊静陈倩陈述花马康平易林华姬辛那高志杰王晓飞代金东杨玉成
100020北京,首都儿科研究所附属儿童医院神经外科(李云林,秦广彪,谭泊静,马康平,易林华),神经内科(陈倩,陈述花,姬辛那,高志杰);北京儿童医院神经内科(王晓飞);北京市海淀医院急诊内科(代金东);北京市海淀医院神经内科(杨玉成)
Author(s):
LI Yun-lin QIN Guang-biao TAN Bo-jing et al.
Department of Neurosurgery, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
关键词:
改良大脑半球切开术经“外侧裂-岛周”入路半球性癫痫
Keywords:
modified hemispherotomy via “Sylvian-peri-insular” approach hemispheric epilepsy
分类号:
R742.1
DOI:
10.3969/j.issn.1672-7770.2019.03.012
文献标志码:
A
摘要:
【摘要】目的 研究改良的经“外侧裂-岛周”大脑半球切开的手术方式及其效果。方法回顾性分析16例行改良的经“外侧裂-岛周”大脑半球切开术患儿的临床资料,总结其效果和并发症,分析注意事项。改良术式的要点:(1)皮肤切口为包绕蝶骨棘的“T”型切口;(2)骨窗范围覆盖外侧裂的全长;(3)根据脑组织萎缩程度确定外侧裂上、下皮质切开的位置及范围;(4)暴露大脑前动脉是充分离断眶额水平纤维和胼胝体的解剖基础。结果改良术式可清晰暴露手术区域,术后影像显示大脑半球纤维离断彻底。手术耗时(切皮到缝皮)为126~189 min,平均(150±13.3)min,出血量110~450 mL,平均(233±58)mL。术后出现皮下积液者3例,颅内少量渗血2例,均痊愈。结论与经典“U”或“T”型开颅术相比,改良的经“外侧裂-岛周”大脑半球切开术式具有损伤轻、手术时间短、出血少、愈合快、并发症少等优势,值的在临床进一步推广。
Abstract:
Abstract: ObjectiveTo explore an improved surgical method and effect of hemispherotomy via “Sylvian-peri-insular” approach. MethodsThe clinical data of 16 children underwent sylvian-peri-insular approach were analyzed retrospectively, and the pros and cons of the modified operation were summarized. The main points of the new method were as follows. (1) The skin incision was a “T” shaped enclosing the sphenoid ridge region. (2) The scope of craniotomy mainly covered the whole length of the sylvian fissure. (3) The location and scope of the peri-insular window were determined according to the degree of brain atrophy. (4) The exposure of the anterior cerebral artery(ACA)totally was the anatomical basis for the adequate disconnecting the fibers of orbito-frontal lobe and corpus callosum. ResultsThe new method can expose the operative structures completely and clearly. The disconnected fiber tracts can be seen in the post-operative images. The operative time(from skin incision to suture) ranged from 126 to 179 minutes(150±13.3), the amount of bleeding during operation is from 110 to 450 mL(233±58)and the new method is time-saving, safe and no additional complications compared with the classical “U” or “T” shaped craniotomy surgery. ConclusionsThe modified hemispherotomy has the advantages of less invasion, shorter operation time, less bleeding, faster healing of the incision and fewer complications. It is worth further popularizing in clinical work in the future.
更新日期/Last Update: 2019-06-15