应用复合手术室治疗颅脑穿通伤手术经验总结

doi:10.3877/cma.j.issn.2095-9141.2021.06.010

目的

总结在复合手术室经鼻神经内镜和开颅治疗颅底穿通伤的手术经验。

方法

选取北部战区总医院神经外科自2015年11月至2019年10月在复合手术室行手术治疗的6例颅底穿通伤患者，其中2例行经鼻神经内镜手术，1例行经鼻经口联合神经内镜手术，3例行开颅手术。对手术技术、术后并发症及伤后6个月的GOS评分进行回顾性分析和经验总结。

结果

6例患者均手术成功去除异物，术中DSA均显示无脑血管损伤。术后出现脑脊液漏合并颅内感染1例，肺部感染3例。伤后6个月随访，死亡1例，长期昏迷1例，轻度残疾2例，无神经功能缺陷2例。

结论

复合手术室DynaCT和DSA系统可为颅底穿通伤手术提供实时精确和安全的影像引导。部分颅底穿通伤病例可选择经鼻神经内镜下微创手术治疗。

关键词: 复合手术室, 神经内镜, 穿通伤, 颅脑损伤

Objective

To summarize the experience of using hybrid operating room in the surgical treatment of penetrating skull base injury with transnasal neuroendoscopy or craniotomy.

Methods

Six patients with penetrating skull base injury were surgical treated in the Neurosurgery Department of General Hospital of Northern Theater Command within a hybrid operating room from November 2015 to October 2019. Among them, 2 cases were treated by transnasal neuroendoscopic surgery, 1 case by transnasal-oral combined neuroendoscopic surgery, 3 cases by craniotomy. Surgical technique, postoperative complications and GOS scores at 6 months after injury were retrospectively analyzed and summarized.

Results

Foreign bodies were successfully removed and intraoperative DSA showed no cerebral vascular injury in all 6 cases. Postoperative cerebrospinal fluid leakage combined with intracranial infection were detected in 1 case and pulmonary infection in 3 cases. After 6 months of follow-up, 1 case died, 1 case had a long-term coma, 2 cases had mild disability, and 2 cases had non-neurologic defects.

Conclusion

Hybrid operating room equipped with DynaCT-angiography and DSA system can provide real-time, accurate and safe imaging guidance for surgical treatment of penetrating skull base injury. Minimally invasive transnasal neuroendoscopic surgery can be used to treat penetrating skull base injury in some cases.

Key words: Hybrid operating room, Neuroendoscopy, Penetrating injury, Brain injury

图1 经口经鼻联合入路刀刺伤患者术前术中影像学资料A：术前CT轴位；B：术中DynaCT矢状位；C：拔刀前神经剥离子探及刀尖后再次DynaCT及DSA三维重建检查；D：拔刀后DSA三维重建

图2 经鼻蝶入路刀刺伤患者术前术中影像学资料A：术前CT颅骨三维重建；B：术中刀拔除前DynaCT颅底三维重建；C：内镜下探查及刀身；D：内镜下拔刀后清除血肿

图3 经鼻蝶入路笔芯伤患者术前术中影像学资料A：术前CT轴位；B：术前CT三维重建；C：内镜下见笔芯穿透鞍底；D：笔芯拔出后的鞍底漏口

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Experience of surgical treatment of penetrating skull base injury within hybrid operating room

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Experience of surgical treatment of penetrating skull base injury within hybrid operating room