论文部分内容阅读
1 病例介绍:患者,男性,25岁。主诉:头痛,视力逐渐减退2年,复视6个月,于1996年11月5日入院。查体:神志清楚,合作。视力:右1.2,左1.0,左眼球于内斜位外展不能,复视。眼底:双侧视乳头水肿,左鼻唇沟变浅,伸舌尖偏向左侧。MRI:鞍背及枕骨斜坡后上类圆形占位灶,约4.7cm×3.8cm×3.0cm,肿块占据桥脑、中脑及延髓下方,向后上推压基底A及脑干,使其向后上弧形移位;向前侵犯左侧鞍背斜坡。 2 手术方法步骤:采用气管内插管全身麻醉,取侧卧位,头稍抬高,颈前曲。头颅固定架固定。从外耳道上方5cm、前方2cm处弧形向后下至发际下1cm切皮,翻瓣;以横窦为中心,幕上、下分别钻孔,锯开颅骨,形成颞枕和枕下整块骨瓣。咬除枕鳞部。暴露乙状窦,分别沿横窦上下缘切开硬脑膜。将大脑颞枕叶向上、小脑半球向下牵开;切开小脑幕直到游离缘。安装脑软轴自动牵开器及手术显微镜。在面神经和三叉神经之间,电凝后切开硬膜(肿瘤包
1 case description: patients, men, 25 years old. Chief complaint: headache, vision loss gradually 2 years, double vision for 6 months, on November 5, 1996 admission. Examination: Consciousness, cooperation. Visual acuity: right 1.2, left 1.0, the left eye can not be outreach within the oblique, diplopia. Fundus: bilateral papilla edema, the left nasolabial fold shallow, stretch the tongue to the left. MRI: On the back of the saddle and occipital slope after the class of circular occupying stove, about 4.7cm × 3.8cm × 3.0cm, mass occupy the pons, midbrain and medulla oblongata, and backward push on the basal A and brainstem so that Arc backward shift; invasion of the left saddle back ramp. 2 surgical procedures: the use of endotracheal intubation general anesthesia, take the lateral position, slightly elevated head, anterior cervical song. Fixed skull mount. From the top of the external auditory meatus 5cm, 2cm in front of the arc to the back under the hairline 1cm skin cut, flap; to the transverse sinus as the center, the curtain were drilled, saw the skull, the formation of temporal and occipital pillow Bone flap. Bite in addition to the pillow scales. The sigmoid sinus exposed, respectively, along the transverse sinus incision dural. Temporal occipital lobe of the brain up, cerebellar hemispheres retracted downward; cut the cerebellum until the free edge. Install the brain shaft automatic retractor and surgical microscope. Between the facial nerve and the trigeminal nerve, the dura mater is cut after electrocoagulation (tumor pack