후두개와 수술에서 골성형적 개두술

Abstract

Traditional access to the posterior cranial fossa via suboccipital craniectomy has involved the permanent removal of bone and commonly caused the postoperative leakage of cere¬brospinal fluid. The object of this study is to describe the technical aspects of osteoplastic posterior fossa craniotomy and preventive method of cerebrospinal fluid leakage. In our cases, midline and lateral posterior fossa craniotomies have been performed to treat different pathologies which involved the cerebellum, fourth ventricle, and cerebellopontine angle. For further exposure of the superior lateral posterior skull base, the additional craniectomy and drilling of the mastoid temporal bone were also done minimally. Following subdural works, posterior fossa dura was water-tightly closed using pericranium or fascia autograft and augmented with hemostatic sponge, fat graft, pedicled muscle flap, and fibrin glue. The removed bone flap was replaced with titanium plates and screws. Thereafter the reconstructive cranioplasty with autologous bone fragments obtained dur¬ing piecemal craniectmy was done. This technique has not added any additional operative risk, and the cosmetic results were excellent. There were no postoperative complications such as cerebrospinal fluid fistula, pseudomeningocele, and persistent suboccipital headache or discomfort. This simple and safe method restores the normal anatomical planes and the improved protection to the contents of the posterior fossa, and is also effective for prevention of cerebrospinal fluid leakage following posterior fossa surgery.