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目的:探讨采取改良的枕颈侧入路切除枕大孔区肿瘤手术的相关技术技巧。方法:8例枕骨大孔区大型肿瘤直径均大于4Cm,其中神经鞘瘤5例,脑膜瘤2例,脊索瘤1例;根据肿瘤同脑干及上颈髓的关系将肿瘤分为:腹正中型3例、腹侧方蛩3例、背侧型2例。采用改良的枕下侧入路,切除肿瘤一般要求从瘤周蛛网膜的界面处进行锐性分离,保留枕骨髁显微镜下从侧方入路,在副神经根间隙切入点分离并分块切除肿瘤。结果:肿瘤全切除6例,脑膜瘤和脊索瘤各1例次全切除。8例均在随访中,7例病人已基本恢复正常,1例脊索瘤手术1年后临床症状逐渐加重。结论:改良的枕下侧入路有利于肿瘤的显露和切除,手术的关键是从蛛网膜的界面处分离,肿瘤侧用细小电流电凝出一间隙后,以副神经根间隙为切入点分离肿瘤。
Objective: To explore the related technical skills of using modified occipitocervical approach to resect the tumor in the large hole area of the occipital lobe. Methods: The diameter of large tumors in 8 cases of foramen magnum was larger than 4Cm, including 5 schwannomas, 2 meningiomas and 1 chordoma. According to the relationship between tumor and brain stem and upper cervical cord, 3 cases of medium, 3 cases of ventral flounder, 2 cases of dorsal type. With an improved suboccipital approach, resection of the tumor typically requires sharp separation from the peritumoral arachnoid interface, posterior occipital condyles under the microscope, lateral appendectomy, and excision of the tumor . Results: Total resection in 6 cases, meningioma and chordoma in 1 case subtotal resection. All 8 patients were followed up, 7 patients had basically returned to normal, and 1 patient had clinical symptoms gradually aggravated 1 year after chordoma surgery. Conclusion: The improved suboccipital approach is helpful for the tumor to reveal and resect. The key of the operation is to separate from the interface of the arachnoid. After the tumor side is electrocoagulated with a small current to a gap, the accessory nerve root gap is taken as the entry point Tumor.