NeurosurgicalProcedures神经外科手术 CN课件

,Craniomaxillofacial,Craniomaxillofacial,NeurosurgicalProcedures,神经外科手术,Acoustic Neuroma,听神经瘤,Aneurysm,动脉瘤,Arteriovenous Malformation (AVM),动静脉畸形（,AVM,),Chiari Malformation,小脑扁桃体下疝畸形,Deep Brain Stimulation,深部脑刺激,Epilepsy,癫痫,Frontal Bone Contouring,重塑前额成形术,Meningioma Removal,脑膜瘤切除术,Microvascular Decompression (MVD),微血管减压术（,MVD,）,Pituitary Tumor Removal,垂体肿瘤切除术,Cases,病例,Acoustic Neuroma,听神经瘤,Condition:,条件：,An acoustic neuroma is a benign, slow-growing tumor that arises from the covering of the vestibulocochlear nerve.,听神经瘤是一种由于前庭耳蜗神经被遮盖引起的良性、生长缓慢的肿瘤。,As the tumor grows it can expand into the area between the brainstem and temporal bone,随着听神经瘤的扩散，它可以扩展到脑干和颞骨之间的区域。,The tumor can compress the trigeminal nerve causing loss of facial sensation and can also compress the brainstem.,肿瘤可压迫三叉神经，从而造成面部感觉丧失，也可以压迫脑干。,Overview:,概述：,An acoustic neuroma is a tumor that grows on the nerves responsible for balance and hearing. Although the tumor is typically benign, they can cause gradual hearing loss, ringing in the ear, and dizziness. If surgery is required, there are three approaches the surgeon can take to expose the tumor:,听神经瘤是一种生长在神经上的影响大脑的平衡和听觉作用的肿瘤。虽然听神经瘤通常都是良性肿瘤，但是它们也可以导致渐进性听力损失、耳鸣和头晕。如果需要手术的话，外科医生可以采取三种入路方式摘除肿瘤：,Middle Fossa,经中颅窝手术入路,Suboccipital,经枕骨下手术入路,Translabyrinthine,经迷路手术入路,经中颅窝穿颅术,经枕骨下穿颅术,经迷路穿颅术,Acoustic Neuroma,听神经瘤,Surgery:,外科手术：,Surgical removal is the most common treatment and especially with large tumors. The prioritites the surgeon has when conducting surgery are: preserving the facial nerve, preserving useful hearing in the affected ear, and complete tumor removal. Complete tumor removal carries a higher risk of hearing loss. The approach to the surgery is based off of tumor size, position and the hearing status of the patient.,手术切除是最常用的治疗方式，特别是针对较大的肿瘤。外科医生进行手术时要优先考虑：保护面神经；尽量保留受影响耳朵的听觉，切除全部肿瘤。全部肿瘤的切除具有高风险性，可能引起听力受损。手术方法根据肿瘤大小，位置和患者的听力状况决定。,Suboccipital (retrosigmoid):,craniotomy made behind the ear, exposing the bone overlying the internal auditory canal. This is the oldest approach and is widely used when hearing preservation is attempted.,枕下（窦）,：自耳后进行穿颅术，露出覆盖在内耳道的骨骼。这是最传统的方法，广泛应用于试图保留听力功能的治疗。,Translabyrinthine:,craniotomy is made through the ear in the mastoid bone. The semicircular canals are removed to expose the tumor this resulting in complete hearing loss. This approach provides direct exposure to the tumor without cerebellar retraction and is commonly used when preservation of hearing is not possible.,迷路：,穿过耳乳突骨进行穿颅术。移除半规管以便暴露导致听力彻底丧失的肿瘤。这种方法提供了直接的暴露，而不需要影响小脑，通常用于听力丧失时的治疗。,Middle Fossa:,craniotomy is performed in the temporal bone and requires elevation of the temporal lobe and drilling of the temporal bone. This approach is typically used for small tumors and when hearing preservation can be attempted.,中颅窝,：穿颅术通常在颞骨进行，并要求抬高颞叶以及对颞骨钻孔。这种方法通常适用于小肿瘤以及在尝试保留听力的情况下使用。,Translabyrinthine Approach,经迷路手术入路,Sub-occipital Approach,经枕骨下手术入路,Aneurysm,动脉瘤,Condition:,条件：,Aneurysms are a balloon-like bulge of an anterial wall.,动脉瘤是动脉壁气球状的膨胀。,As it enlarges it can put pressure on surrounding structures causing headaches or vision problems and can potentially rupture leading to a subarachnoid hemorrhage.,当它扩大时，会对周围结构施加压力，引起头痛或视力问题，也有可能破裂而导致蛛网膜下腔出血。,Most aneurysms do not have any symptoms until they rupture.,大多数动脉瘤在破裂之前没有任何症状。,Overview:,概述：,Aneurysms are a cerebrovascular disease that typically develop from a weakness or abnormal artery wall. They typically occur on larger blood vessels where an artery branches. A ruptured aneurysm can release blood into the spaces of the brain causing a hemorrhage as blood in the subarachnoid space increases pressure. Locations of aneurysms can vary: 80% form in anterior circulation of the brain and 20% for in posterior circulation of the brain.,1,Types of aneurysms include:,动脉瘤是脑血管疾病，通常由动脉壁的脆化和异常发展而来。它们通常发生在较大血管的动脉分支处。一个破裂的动脉瘤可以将血液释放到大脑间，增加蛛网膜下腔的压力而导致脑出血。动脉瘤的位置有所不同：,80,动脉瘤在大脑的前循环，,20,在大脑的后循环。动脉瘤的类型包括：,Saccular: Most common. Bulges from one side with distinct neck,囊型：最常见的。一侧的凸起并带有明显的颈部。,Fusiform: Bulges in all directions with no distinct neck,梭型：在各个方向凸起，无明显的颈部。,Giant: Measures more than 2.5cm in diameter,巨大型：测量直径超过,2.5cm,。,Traumatic: Caused by trauma to the head,外伤：由脑部的外伤引起。,动脉瘤,蛛网膜下腔血液,冲程区,血液,囊型,梭型,巨大型,Aneurysm,动脉瘤,Surgery:,外科手术：,There are several different options for surgical treatment of aneurysms and the technique and approach involves many factors, such as the location, size, type, and overall health of the patient. The two most common surgical techniques are surgical clipping and endovascular coiling. Coiling is performed during an angiogram where a catheter is inserted into an artery in the groin and is then passed through the blood vessels to the aneurysm in the brain. The aneurysm is packed with platinum coils or acrylic glue which prevents blood flow into the aneurysm. Surgical clipping utilizes a craniotomy that provides access to the aneurysm. A clip is placed on the neck of the aneurysm to block blood flow from entering. The surgeon then will puncture the dome to ensure blood is not filling the aneurysm. The location and size of the craniotomy depends on the location for the aneurysm. Aneurysms in the anterior circulation typically utilize 4 approaches:,动脉瘤的外科手术治疗有几种不同的选择。方法和技术选择涉及到很多因素，如位置、大小、类型以及患者的整体健康状况。两种最常见的手术方式是手术夹闭术和血管内弹簧圈栓塞术。血管内弹簧圈栓塞术中，血管造影期间将导管插入腹股沟动脉，然后穿过血管到达脑部的动脉瘤。动脉瘤用铂丝线圈或丙烯酸胶塞满以防止血液进入。手术夹闭术采用的是能够进入到动脉瘤的穿颅术。夹子放在动脉瘤颈部以阻止血流进入。然后外科医生对凸圆的部分进行穿刺，以确保血液不会充盈动脉瘤。穿颅的位置和钻孔大小取决于动脉瘤的位置。前循环中的动脉瘤通常使用,4,种手术方法：,Pterional Approach,翼点入路,Pterional,翼点入路,Supraorbital (keyhole),眶上（锁孔）入路,Orbitozygomatic,眶颧弓入路,Interhemispheric,纵裂入路,伯尔孔,穿颅术,动脉瘤,骨瓣,Arteriovenous Malformation (AVM),动静脉畸形（,AVM,）,Condition:,条件：,AVMs are an abnormal tangle of blood vessels in the brain.,动静脉畸形是指脑部血管的异常缠结。,Some may cause no specific symptoms while others can be severe and can have devastating effects if they bleed causing hemorrhage in the brain.,有些可能没有特定的症状，有些可能会有严重的症状，如果它们的流血造成了脑出血，那么可能造成毁灭性的后果。,Treatment options will vary depending on type, symptoms, and location of the AVM.,根据动静脉畸形的类型、症状和位置的不同，治疗方案会有所不同。,Overview:,概述：,AVMs cause arteries to directly connect to veins without a capillary bed in between. This causes a high pressure shunt or fistula and the veins are unable to withstand the pressure of blood coming directly from the arteries. The veins then stretch and enlarge as they try to accept the extra blood flow. There are four types of AVMs:,AVM,会导致动脉和静脉直接连接，而无毛细血管床在它们之间衔接。这将导致高压分流或瘘管以及静脉无法承受的直接来源于动脉的血液压力。静脉试图接受这些额外的血流，所以不断延伸和扩大。,AVM,有四种类型：,Arteriovenous Malformation: abnormal tangle of blood vessels (high pressure),动静脉畸形血管的异常缠结（高压）。,Cavernoma: abnormal cluster of enlarged capillaries (low pressure),海绵状血管瘤：扩大的毛细血管异常集群（低压） 。,Venous Malformation: abnormal cluster of enlarged veins (low pressure),静脉畸形：异常扩大的的静脉集群（低压）。,Capillary Telangiectasia: abnormal capillaries with enlarged areas (very low pressure),毛细管的毛细血管扩张症：异常毛细血管并带有扩大区（非常低的压力）。,AVMs can form anywhere in the brain and symptoms vary on location. If they form within the dura, they are often called Arteriovenous Fistulas (AVF). AVFs and carotid-cavernous fistulas are the most common AVMs.,AVM,可以形成于大脑中的任何位置，并且各个位置的症状不同。如果它们在硬脑膜内形成，通常被称为动静脉瘘（,AVF,）。动静脉瘘和颈内动脉海绵窦瘘是最常见的动静脉畸形。,额骨,顶骨,颞骨,小脑,静脉,导静脉,动静脉畸形病灶,供养动脉,动脉,Arteriovenous Malformation (AVM),动静脉畸形（,AVM,）,Surgery:,外科手术：,Treatment for AVMs can include surgery, endovascular therapy, and radiosurgery. Endovascular therapy uses a small catheter to deliver glue or coils so that blood no longer flow through the malformation. During surgery a craniotomy will be performed in order to gain access to the location of the AVM. The brain is then gently retracted and a variety of techniques may be used to remove the AVM such as laser and electrocautery. After, the AVM is dissected from the normal brain tissue. The benefit of surgery is that the cure is immediate of the entire AVM is removed.,AVM,的治疗包括外科手术、血管内治疗和放射治疗。血管内治疗采用的是小血管导管来输送流胶或线圈，使血液不再流过畸形处。手术过程中将进行开颅手术以探测动静脉畸形的位置。然后大脑被轻轻地伸缩，可使用多种技术移除动静脉畸形，如激光和电灼。然后，将动静脉畸形从正常的脑组织中切除。手术的优势是动静脉畸形被切除后病情可以马上治愈。,Interhemispheric Approach,纵裂入路,Chiari Malformation,小脑扁桃体下疝畸形,Condition:,条件：,Result of a small or misshaped posterior fossa,由,小型或畸形的后颅窝所导致。,Compression of the cerebellum can push the cerebellar tonsils into the foramen magnum,压迫小脑可以将小脑扁桃体推入枕骨大孔。,The herniation of the cerebellar tonsils can put pressure on the brainstem and spinal cord that can block CSF flow that can result in:,小脑扁桃体下疝可以对脑干和脊髓施加压力，阻止脑脊液流动，可能导致：,Hydrocephalus,脑积水,Headaches,头痛,Pain in the back of the skull,头骨后部疼痛,Overview:,概述：,The pressure of the herniation can cause a variety of symptoms that range from mild to severe. Chiari malformations can also be presented at birth and are categorized into different types: Type 1 is the most common and mildest and develops as the skull grows. Type 2 and 3 are present at birth and typically require immediate surgery.,疝压力能引起不同程度的症状。小脑扁桃体下疝畸形也可在出生时就存在，并分为不同类型：,1,型是最常见也是最温和的，随着头骨的生长而发展。,2,型和,3,型在出生时就存在,，通常需要立即手术。,颅外切除术,枕骨大孔,椎扳切除术,硬脑膜补片,扁桃体疝,硬脑膜,Chiari Malformation,小脑扁桃体下疝畸形,Surgery:,外科手术：,The goal of surgery is to relieve the progression of symptoms caused by compression of the spinal cord and brainstem. The most common procedure is a posterior fossa decompression. A skin incision is made through the neck muscles to provide access to the skull and top of the spine. The surgeon will then create a craniectomy to remove a portion of the posterior fossa. The craniectomy relieves the crowding and helps restore normal flow of CSF. The dura is then opened to create more space for the herniated tonsils. After, the duraplasty is repaired with a dural graft. DMO can be used to repair the defect created in the dura. The defect in the skull can be replaced with a special titanium plate or is left off and secure by the strong neck muscles and skin.,手术旨在减轻因脊髓和脑干压迫所引起的症状加重。最常见的手术方式是后颅窝减压术。在颈部肌肉开一个皮肤切口，以创建接近头骨和脊椎顶部的通道。然后医生会进行颅骨切除术取出一部分后颅窝。颅骨切除术缓解了大脑空间的拥挤，有助于恢复脑脊液正常的血流。然后打开硬脑膜，为扁桃体疝开辟,更多空间。之后，应用硬脑膜移植进行硬脑膜补片修补。,DMO,可用于修复硬脑膜缺损。颅骨缺损处可以用一个特殊的钛板替换，并用强有力的颈部肌肉和皮肤进行保护。,Deep Brain Stimulation,深部脑刺激术,Condition:,条件：,Deep Brain Stimulation (DBS) is a neurosurgical treatment which stimulates the brain with mild electrical signals,脑深部刺激术（,DBS,）是一种应用轻度的电信号来刺激大脑的神经外科治疗方法，,DBS is used to treat patients with essential tremor, Parkinsons disease and dystonia.,脑深部刺激术（,DBS,）用于治疗原发性震颤、帕金森氏病和肌张力障碍的患者。,Surgeons are planning on using DBS as a treatment for people with depression, obsessive-compulsive disorder and chronic pain,外科医生计划使用,DBS,作为一种治疗抑郁症、强迫症和慢性疼痛患者的手术方法,。,Overview:,概述：,The DBS system typically consists of three components: the implanted generator, the lead, and the extension. The implanted generator is a battery-powered neurostimulator, similar to a pacemaker. The lead is a coiled wire with four platinum iridium electrodes that is placed in different areas of the brain. The extension is an insulated wire that runs from the generator to the lead that typically runs from the head, and down the side of the neck. The electrodes are placed in the brain according to the type of symptoms being addressed. The electrode is placed under local anesthesia while the generator is implanted under general anesthesia.,DBS,通常由三部分组成：植入发生器，刺激电极以及导线。植入发生器是一个由电池供电的神经刺激器，类似心脏起搏器。刺激电极是一个带有四个铂铱电极的线圈形金属丝，安置在大脑的不同区域中。导线是一个绝缘电线，连接发生器与刺激电极，通常从头部连接到脖子的一侧。根据正在处理的症状类型将电极放置在大脑的不同位置。刺激电极在局部麻醉的情况下植入，而发生器则在全身麻醉的情况下植入。,深部脑刺激,电极,丘脑底核,黑质,联合线,起博器,Deep Brain Stimulation,深部脑刺激术,Surgery:,外科手术：,The surgery can be performed in two steps: one placing the generator, and another for implanting the electrodes. To implant the electrodes, a stereotactic head frame and MRI are used to map the brain and pinpoint the problem area. The frame allows the surgeon to find the exact placement for the electrode by putting the brain into an X,Y, & Z axis. Once the incision has been made, the surgeon will create a burr hole, typically around 14mm in diameter, for placement of the electrode. Once the electrode is placed, a cap, titanium plate or HA is used to hold and keep the electrode in place. The patient is kept awake during placement of the electrode to report side effects as it is passed and to ensure it is in the correct place. DuraMatrix Onlay is cut with a space for the electrode to pass and is either sutured or onlayed over the defect created in the dura.,手术可以分为两个步骤：一个是植入发生器，另一个是植入电极。为了植入电极，立体定向头,架和,MRI,用于对大脑进行定位，并指出问题区域。立体定向头架通过把大脑置于,X,，,Y,，,Z,轴的立体平面中，允许外科医生发现安置电极的确切位置。一旦切好了切口，外科医生将进行钻孔，通常孔的直径为,14,毫米便放置电极。放置了电极后，用盖子、钛板或透明质酸（,HA,）来维持和保持电极所在的位置。在安置电极的过程中，患者应保持清醒，以便随时报告被传递时的副作应，并确保它在正确的位置。为了取得电极通过的更大的空间，要切除一部分硬脑膜，硬脑膜的补片嵌体以缝合或嵌入的方式覆盖在硬脑膜的缺损处。,Decompressive Craniectomy,去骨瓣减压术,Condition:,条件：,Decompressive craniectomy is typically used to relieve the patient of high intracranial pressure (ICP).,去骨瓣减压术通常用于缓解患者的颅内高压（,ICP,）。,Typically the bone flap is large to allow for sufficient decompression. The craniectomy can be unilateral, bilateral, or bifrontal.,通常骨瓣很大，允许进行足够的减压。颅骨修补术可以是单边的、双边的或双额的。,The bone flap is stored in a freezer or in the patients abdomen until the cranioplasty is performed.,骨瓣在进行颅骨修补术前存放在于冰箱或患者腹部。,Time between craniectomy and cranioplasty is on average 133 18.2 days.,1,颅骨切除术和颅成形术之间相隔的时间平均为,13318.2,天。,Overview:,概述：,Decompressive craniectomy and expansive duraplasty is often required when brain swelling can not be controlled or when severe head injury occurs. The craniectomy minimizes intracranial mass and can reduce the risk of transtentorial herniation, this helping to prevent secondary brain injury, distortion of the brainstem and possibly death. After the craniectomy is performed the flap can be stored in a freezer or under the abdominal fat of the patient. Replacement of the bone or cranioplasty is often performed 6-20 weeks later after the swelling has resolved.,1,Options for replacement include sutures, titanium plates and screws, methylmethacrylate, custom implants or HA cements.,当脑部膨胀不能控制或发生严重的头部损伤时，通常需要施行去骨瓣减压术和扩大成形术。去骨瓣减压术最大限度地降低了颅内占位，可以减少小脑幕切迹疝的风险，这有助于防止继发性脑损伤、脑干变形甚至死亡。去骨瓣减压术后的骨瓣可以存放在冰箱或患者腹部脂肪中。更换骨骼或颅骨修补术通常在肿胀被移除以后的,6-20,个星期执行。置换选择包括缝线、钛金属板和螺钉、甲基丙烯酸甲酯、定制的植入物或透明质酸水泥。,Decompressive Craniectomy,去骨瓣减压术,Surgery:,外科手术：,A large incision in the skin is made depending on the location of the craniectomy. The pericranium is then elevated to provide access to the bone. The craniectomy is then performed that typically involves the frontal, temporal, and parietal bones. It is important to make a large enough craniectomy because if the defect is too small the brain can herniated through the skull opening due to lack of space for decompression. Large incisions are then used in the dura to allow for the brain protrude out (see right). An expansive duraplasty is then performed using a dural substitue or pericranial tissue. The skin flap is then closed and the bone flap is stored in a freezer or in patients abdominal fat.,皮肤上大切口的位置取决于开颅手术的位置。然后升高颅骨膜以提供进入骨头的通道。然后施行去骨瓣减压术，通常包括额叶、颞及顶骨。切除足够大的颅骨很重要，因为如果太小，大脑在颅骨的开放处可能会由于缺乏减压而导致疝的形成。然后在硬脑膜伤切一个大的切口以便大脑的凸出（见右图）。之后，使用硬脑膜的替换物或颅骨膜组织来进行扩大成形术。最后关闭皮瓣，骨瓣存放在冰箱或患者腹部脂肪中。,Epilepsy,癫痫,Condition:,条件：,Epilepsy is a chronic condition that are marked by recurrent epileptic seizures,癫痫是一种以经常性癫痫发作为标记的慢性疾病。,Seizures are caused by abnormal or excessive electrical discharges from brain cells.,癫痫发作是由脑细胞异常或过量放电引起的。,There are many locations, types, and causes for epilepsy, including:,癫痫有许多部位、类型和原因，包括：,Brain tumors,脑肿瘤,Stroke,中风,Overview:,概述：,A seizure can also be known as a fit, spell, convulsion or an attack. Seizures are a visible sign of a problem in the electrical system that controls your brain. Even a single seizure can have many causes but those who suffer from unprovoked seizures may be considered to have Epilepsy. Diagnosis is made using:,癫痫，也可以被称为痉挛、抽风、抽搐或发作性疾病。癫痫是控制大脑的神经系统出现问题的明显标志。即使单一的癫痫也可以有很多原因，但只有那些癫痫无端发作的人才可能被视为癫痫症患者。使用的诊断包括：,Electroencephalogram (EEG): Records elective patterns in your brain (electrodes),脑电图（,EEG,）：记录大脑的电信号（电极）。,Magnetic resonance imaging (MRI): radiofrequency used to view brain in detail,磁共振成像（,MRI,）：射频用于详细地观察大脑。,Positron emission tomography (PET) and Single-photon emission computed tomography (SPECT): Scans showing how the brain metabolizes glucose,正电子发射断层扫描（,PET,）和单光子发射计算机断层显像（,SPECT,）扫描，显示大脑如何代谢葡萄糖。,硬膜下电极,开颅手术,癫痫位点,前颞叶切除术,Epilepsy,癫痫,Surgery:,外科手术：,Epilepsy surgery is a procedure to:,癫痫手术过程旨在：,.,Remove seizure-producing area of the brain (curative),切除大脑的癫痫发作区（治疗）,.,Limit the spread of seizure activity (palliative),限制癫痫活动的传播（缓和剂）,The type of surgery depends on where the seizures are occurring in your brain, and the types of seizures that are occurring.,手术的类型取决于癫痫在大脑发作的部位以及癫痫发作的类型。,Curative procedures include:,治疗程序包括：,Temporal lobectomy: This is the most common type of procedure and typically removes a limited part of the anterior temporal lobe, the amygdale and hippocampus. 70-80% of the time, it leads to complete or significant reduction of seizure control. A lobectomy can be broken into 5 main steps:,颞叶切除术：这是最常见的治疗手段，通常用来移除前颞叶、杏仁核和海马的受限部分。有,70,-,80,的几率，它会导致完全控制或显着减少癫痫发作。颞叶切除术分成,5,个主要步骤：,Patient is given anesthesia,麻醉患者。,A craniotomy is performed to provide access to the seizure focus area,进行穿颅术，提供通往癫痫发作中心区域的通道。,Brain mapping is performed on the patient with subdural electrodes to confirm the focus area of the seizures,使用硬膜下电极进行脑部定位，以确认患者癫痫发作的中心区域。,The seizure focus area is removed,切除癫痫发作的中心区域。,Closure: The dura, bone flap, muscles and skin are closed .,封闭：封闭硬脑膜、骨瓣、肌肉和皮肤。,Frontal Bone Contouring,重塑前额造型术,Condition:,条件：,Typically during frontal sinus surgery, an osteotomy is made to allow access to the anterior and posterior,tables,as well as the anterior skull base.,通常在额窦手术期间进行，施行截骨术以便进入到前囟和后囟,表,以及前颅底。,After surgery the flap is put back and typically fixated with titanium plates and screws. Bone cement can be used to fill the cuts and help contour the flap to the native curvature of the forehead.,手术后放回皮瓣，通常用钛板和螺钉固定。骨水泥可用于填补切削部位并帮助皮瓣成型达到最初的前额曲率。,Overview:,概述：,Open frontal sinus surgery is performed for the following reasons: plastic (reshaping the forehead), fracture, or sinusitis. In most cases an craniotomy is performed that allows the surgeon to shape and contour the flap to the desired shape. The craniotomy also allows access to the sinus and anterior skull base. When the mucosa or tissue within the sinus is inflamed the surgeon will obliterate the frontal sinus (remove the lining and diseased tissue.) Often times the sinus is then packed with fat typically from the abdomen.,由于以下原因要进行开放性额窦手术：塑型（重塑前额）、骨折或鼻窦炎。在大多数情况下进行开颅手术，以便外科医生把皮瓣塑形成所需的形状。穿颅术也允许进入到额窦和前颅底。当窦口内粘膜或组织发炎，医生会摘除额窦（切除内壁和病变组织）。包裹额窦的脂肪通常来自于腹部。,Frontal Bone Contouring,重塑前额造型术,Surgery:,外科手术：,A bicoronal incision is performed to provide access to the frontal bone. The skin is held back with hooks allowing clear access to the frontal bone. After the pericranium is elevated, the craniotomy is performed. The flap is then removed and the surgeon is able to contour the flap to the desired shape. The craniotomy provides access to not only the frontal sinus but also the anterior skull base and superior orbital rims as well. In this case, mesh is used to help restructure the superior orbital rim and anterior skull base. Once the flap is replaced, it is fixated with titanium plates. Bone cement is then applied over the plates and into the cuts allowing the surgeon to give the flap a curvature similar to the native forehead.,做一个发迹切口以提供接入到额骨的通道。用拉钩向后钩住皮肤，明确进入额骨的入口。颅骨膜升高后，进行开颅手术。然后医生取出皮瓣，并按照所需的形状轮廓对皮瓣进行整形。开颅手术不仅提供了通向额窦的通道，而且也为前颅底和眶上缘提供了通道。在这种情况下，补片用来帮助重组眶上缘和前颅底。替换皮瓣后，使用钛板对其进行固定。骨水泥用来覆盖板并填充到切削处，以便医生对皮瓣进行重塑以达到与原来的前额相似的曲率。,Meningioma,脑膜瘤,Condition:,条件：,Meningiomas are tumors that arise from the meninges, the membranes surrounding the brain and spinal cord,脑膜瘤是由围绕在大脑和脊髓周围的脑膜和细胞膜引起的一种肿瘤。,They be found over the surface of the brain, at the base of the brain, or along the folx, a fibrous sheath dividing the