目的探讨枕下乙状窦后入路手术中改咬骨窗为骨瓣成形开颅并复位的应用。方法回顾性总结我院自2003年6月至2006年12月26例枕下乙状窦后入路骨瓣开颅患者临床资料。具体操作方法:取乙状窦后人路,在后颅窝钻3个孔,铣刀锯下骨瓣,术毕严密缝合硬脑膜,骨瓣复位,用蛇牌颅骨锁2枚同定,不放置外引流。结果骨瓣开颅顺利,骨瓣成形过程中出血量少,未发生横窦和乙状窦损伤,均获得满意的手术显露,骨瓣切除平均用时36min。脑组织保护好,术后无脑脊液漏、皮下积液、皮下血肿和颅内感染.未见手术部位硬膜外和硬膜下血肿发生,枕大神经解剖保存率达80%。结论在显微神经外科基础上,枕下乙状窦后入路骨瓣成形开颅和复位是安全、快捷、可行的方法,值得推广应用。 Objective To investigate the application of modified craniotomy for craniotomy and reduction in posterior trans-sigmoid sinus surgery. Methods The clinical data of 26 patients who underwent transocostal sinus approach craniotomy for traumatic craniotomy were retrospectively reviewed in our hospital from June 2003 to December 2006. Specific methods of operation: take the sigmoid sinus descendants, drilling three holes in the posterior fossa, saw cut the bone flap, surgery was tight suture dura mater, flap reduction, with snake skull lock 2 with the same set, do not place Drainage. Results The craniotomy was successful and the amount of bleeding during the process of forming the flap was small. There was no injury of the transverse sinus and sigmoid sinus, and satisfactory surgical findings were obtained. The average time for the resection of the bone flap was 36 minutes. Brain tissue protection was good, no postoperative cerebrospinal fluid leakage, subcutaneous effusion, subcutaneous hematoma and intracranial infection. No epidural and subdural hematoma occurred in the surgical site. The preservation rate of the occipital nerve was 80%. Conclusion On the basis of microsurgical neurosurgery, craniotomy and reduction of the posterior portion of the sigmoid sinus posterior approach are safe, quick and feasible methods, which are worth popularizing and applying.