Skull fibrous dysplasia surgery

The cause of skull fibrosis is unclear. Some people think it is related to abnormal bone interstitial growth, but some people think it is related to metabolism, inflammation, nutritional nerve, blood supply or endocrine disorders. Bone fibrous dysplasia can occur in the skull alone, and occurs in the calvarial and cranial base, and can also affect the maxilla and other skeletal systems. Common in adolescents, both men and women can develop disease. The disease is multi-directional extracranial growth, thickening of the skull, can make the head external deformity, and there are few symptoms of brain compression. However, the skull base is involved, and involves the bones around the tarsal plate and the iliac crest, which can cause the eyeball to protrude, involving the optic nerve hole, causing visual impairment, and even blindness. If the saddle is reduced, it can affect the pituitary function, involving other bone holes or paranasal sinuses, and may have symptoms such as nerve paralysis and nasal obstruction. There is a mild or moderate increase in alkaline phosphatase in the blood, which is useful for diagnosis. X-ray examination of the skull, bone has been replaced by fibrous tissue. Often divided into 3 types, that is, cyst type, more common in the skull cover; hardening type, more common in the skull base; mixed type, more involving the skull and skull base. The disease develops rapidly in adolescence, tends to be stable in adulthood, and can even stop on its own, with a good prognosis, most of which do not require surgery. Treatment of diseases: cranial fibrosis Indication 1. It is located in the calvarial area, affecting the appearance, or having symptoms of brain compression. 2. Invade the tibia, causing the eyeball to protrude and affect the visual acuity. 3. There are obvious deformities in the craniofacial lesions, affecting the appearance. Contraindications The lesion is small, asymptomatic, and does not affect the appearance. Preoperative preparation Prepare a variety of sharp osteotome, high-speed micro drills, and necessary skull forming materials. Surgical procedure Incision According to the location, size, growth direction and nature of the lesion, an "S" shaped incision, a valvular incision or a coronary valved incision is selected. The steps are the same as osteoma resection. 2. Lesion revealed Push the periosteum, fully expose the skull invaded by the lesion, have bone bleeding, and then apply the bone wax to stop bleeding. 3. Lesion removal If the lesion range is small, only a localized chisel is required. After the lesion is revealed, a sharp osteotome can be used to cut the convex portion of the lesion along the tangential direction of the outer skull plate to restore the local shape. After achieving the intended purpose, a circle of dry brain cotton can be covered around the lesion to protect healthy tissue. The lesion was coated with a 10% formaldehyde solution (or a little stone carbonate) prepared in advance. Subsequently, it was washed with physiological saline to remove brain cotton. 4. Ankle decompression Need to perform optic nerve decompression, take the internal coronary incision, or with the pituitary adenoma through the amount of resection, the craniotomy and the general cranial anterior fossa surgery. After craniotomy, the dura mater was firstly incision through the dura mater, turned to the sagittal sinus side, and the brain cotton was protected. The forehead lateral meningeal margin was suspended by a fine needle suture number, and the frontal lobe was properly protected with a brain cotton. The frontal lobe was gently lifted with a brain pressure plate to reveal the sphenoid winglet and the inner port of the optic canal, and the serpentine fixed retractor was used to fix the surgical field. The cerebrospinal fluid was aspirated, and the dura mater was cut along the direction of the optic nerve, and the periosteum was peeled off with a periosteal stripper. Use the micro drill to patiently and carefully remove the upper wall and the two side walls of the optic canal. If the lesion involves the ankle bone, the eyeball may protrude and the eyeball may be deflected. Bone thickening involves the sphenoid ridge sputum passing through the third, fourth, and sixth cranial nerves of the supracondylar sulcus, causing ocular dyskinesia, and all of the above should be considered for decompression. Generally, the combined method of dural and intracranial combined method is used to remove and remove the diseased bone of the dome and sphenoid ridge, and relieve the oppression of the eyeball and nerve. complication Vision loss: The optic nerve harassment in the open surgery of the optic canal is mostly temporary, and vasodilators and neurotrophic drugs can be administered.