Objective The surgical treatment for dysembryoplastie neuroepithelial tumors (DNET) was investigated.Methods A total of 12 cases (7 males,5 females,aged 4 ～36 years) of dysembryoplastie neuroepithelial tumors from June 2010 to June 2014 in Shanghai Blue Cross Brain Hospital were analyzed retrospectively,including 9 cases of temporal lobe,2 cases of frontal lobe,and 1 case of parietal lobe.The tumors and epileptogenic foci outside the lesions were resected under the guidance of electrocorticogram (ECoG) in all patients.Results The pathological examination showed that all the tumors were DNET.All the patients had been followed up for 2 to 4 years.The epilepsy seizure in 2 patients and the others were seizure free after the operation.No recurrence occurred in any patients during the follow-up.Conclusion DNET is a benign tumor which often produces intractable epilepsy,which can be controlled by the extended excision of the tumors and epileptogenic foci under the guidance of ECoG.
随着急救医学和重症监护技术的发展,许多以往无法挽救的急危重症患者得到及时救治,但一些昏迷患者可能会转为植物状态和最小意识状态[1].福州空军医院神经外科2014年3月至2015年11月应用脊髓电刺激(spinal cord stimulation,SCS)治疗重度意识障碍患者11例并长期随访,探讨术前电生理评估标准及促醒机制.
血管母细胞瘤(hemangioblastoma,HB)是良性肿瘤,约占所有中枢神经系统肿瘤的0.9％ ～2.1％[1-4],生长部位以颅后窝居多,占颅后窝肿瘤的7.3％[5].实质性血管母细胞瘤较囊性少见,约占全部血管母细胞瘤的22.3％[6-7].肿瘤多为散发或合并身体其他位置病变,如肾脏、胰腺及视网膜等部位,称为yon Hipple-Lindau (VHL)病,为一种常染色体显性遗传疾病[8].随着显微外科技术的进展,血管母细胞瘤的手术死亡率已从50％下降到36％左右[9]及致残率均明显下降,但对位于重要功能区或尤其是血供丰富的实质性血管母细胞瘤手术仍存在一定困难.本文回顾性分析我科2001年至2017年收治的8例颅后窝实质性血管母细胞瘤患者资料,将其临床特征及显微外科手术治疗效果分析总结如下.
目的 探索3D打印导板引导技术在颅颈交界区疾病椎弓根螺钉固定中的应用价值.方法 收集本中心自2015年3月至12月收治的10例病例,在3D打印导板辅助下行椎弓根螺钉内固定术,分别评价患者手术前后的解剖复位水平,椎体骨质融合率,Symon评分、美国脊柱损伤协会神经功能分级及日本骨科协会脊髓疾病评分改善率,同时评估对脊髓、椎动脉等损伤的发生率.结果 患者解剖复位满意,骨质均实现融合,颈髓损伤及上肢活动功能均得到不同程度改善,所有病例均未出现颈髓及椎动脉的直接损伤.结论 3D打印计算机辅助导板设计是颅颈交界区疾病椎弓根螺钉固定良好的辅助方法.
颅脑损伤(traumatic brain injury,TBI)是各种创伤中致死和致残的主要原因,在25岁到44岁之间的人群中死亡率和致残人数是第一位的,在65岁以上的人群中颅脑损伤引起的死亡率位列第五.而如此高的死亡率被认为与外伤后的静脉血管栓塞(venous thrombus embolism,VTE)包括深静脉血塞和肺栓塞有关,尤其在老年颅脑损伤人群中可高达20％.颅脑损伤被认为是发生VTE的独立因素,它的严重程度与VTE的发生率成正比关系[1].VTE一旦发生,其治疗会变得困难,且直接影响患者今后的生活质量,所以防止VTE发生是治疗颅脑损伤后的一个重要环节.
目的 探究大鼠双侧颈总动脉永久性结扎(BCCAO)后,γ氨基丁酸B型受体1(GABABR1)在海马区域表达的时空变化.方法 成年雄性SD大鼠50只随机分为假手术组(n=20)和模型组(n=30).采用双侧颈总动脉结扎制作血管性痴呆大鼠模型,在3d、14 d、28 d三个时间点使用免疫印迹分析整体海马中GABABR1蛋白表达,用间接免疫荧光分析大鼠海马空间表达变化.结果 免疫印迹结果显示,模型组相比假手术组GABABR1表达水平3d即开始下调(P＜0.05),而后(28 d)相较急性期(3 d)有所回升(P＜0.05);免疫荧光结果显示,模型组相比假手术组CA1区域GABABR1表达水平有所下调(3d呈现明显下降,而28 d部分回升)(P＜0.05),但CA3和DG区域并无明显差异.结论 BCCAO可引起海马区域GABABR1表达的下调,并在术后各个时间点呈现时空变化.
Objective The application value of intracranial pressure monitoring (ICP) in selection of operative methods and post-operative dehydration treatment of patients with moderate hypertensive intracerebral hemorrhage were studied.Methods Sixty-four patients with moderate hypertensive intracerebral hemorrhage were selected randomly and then were divided into intracranial pressure monitoring group (n=33) and control group (n =31).The method of operation was chosen according to clinical manifestation and CT of patients in both two groups,however,ICP value of patients in intracranial pressure monitoring group was another important factor which needed to be concerned.In addition,dehydrating agents were used according to ICP value and the result of CT of patients in intracranial pressure monitoring group,but those were used according to clinical experience of doctors and the result of CT of patients in control group.Finally,the operative methods,post-operative complications and prognosis were compared between two groups.Results The rates of decompressive craniectomy,re-operation,renal damage and internal environment disturbance in intracranial pressure monitoring group were significantly lower than those in the control group (P ＜ 0.05).Six months after intracerebral hemorrhage,GOS was used to assess the prognosis of patients and we found GOS in intracranial pressure monitoring group was markedly higher than that in the control group (P ＜ 0.05).Conclusion Intracranial pressure monitoring plays an important guiding role in selection of operative methods of patients with moderate hypertensive intracerebral hemorrhage and it reduces the occurrence of post-operative complications,which are helpful for prognosis of patients with intracerebral hemorrhage.
后颅窝硬膜外血肿是常见的颅脑损伤疾病,血肿往往继发于枕骨骨折以及横窦损伤[1-2].采用枕部开窗清除后颅窝硬膜外血肿,较以往采用枕下旁正中直切口,手术方法简便易行,避开颈部分离肌肉过程,开颅速度快,在冷光源辅助下能够彻底清除血肿.手术疗效好,现报告如下. 一、对象与方法 1.一般资料:本文资料根据我院2013年1月至2016年12月外伤致后颅窝硬膜外血肿病例15例.其中男11例,女4例.年龄8～72岁,平均45.4岁.术前Glasgow评分:8～12分10例,12分以上5例.跌落8例,车祸2例,打击3例,其他2例.
目的 观察颅脑损伤继发创伤性脑梗死的临床特点及发生的相关危险因素.方法 选取2014年1月至2015年6月在我院住院的颅脑损伤患者80例进行研究,按是否继发创伤性脑梗死(TCI)将患者分为TCI组和非TCI组,观察TCI组的临床特点,对患者的年龄、性别、GCS评分、脑疝、颅骨骨折、糖尿病、蛛网膜下腔出血、低血压等因素进行统计学分析,探究颅脑损伤继发创伤性脑梗死的相关危险因素.结果 TCI的临床特点主要是偏侧肢体运动及感觉功能障碍、视功能异常、语言功能异常、反应迟钝,TCI的预后为良好11例、轻度残疾7例、重度残疾5例、死亡3例.单因素分析结果提示TCI主要与年龄、GCS评分、脑疝、低血压、蛛网膜下隙出血、颅底骨折等因素具有相关性(P＜0.05),经由Logistic回归分析表明,低血压、脑疝属于TCI的独立高危因素.结论 低血压和脑疝为颅脑损伤继发TCI的独立危险因素,合理进行干预对预防TCI的发生具有重大临床意义.
目的 深入认识中枢神经细胞瘤,期待提高本病的诊疗水平.方法 回顾性分析总结20例中枢神经细胞瘤的临床表现、影像学检查、病理结果 、预后并结合国内外文献复习.结果 所有20例患者均行显微外科手术治疗,全切8例,次全切4例,部分切除8例,一般术后1月后进行放疗,随访期间未见肿瘤复发、转移.术后患者肢体活动障碍1例,颅内感染5例,行脑室腹腔分流术1例,死亡1例.结论 中枢神经细胞瘤多于侧脑室内发现,手术风险极大,死亡率与致残率较高,运用显微镜神经外科技术、术中导航等技术可有效减轻术后死亡率与致残率,手术全切是治疗CNC的最佳方式,肿瘤全切预后最佳,将复发可能性降至最低.术后联合放疗,可减少复发率,化疗效果有待进一步考究.
Objective The strategy and skills of internal neurolysis as a treatment for special type of trigeminal neuralgia were explored.Methods In 35 patients (12 cases without neurovascular compression,8 cases of venous pressure,5 cases of recurrent cases,10 cases of uncertain of conflict vessel) with special type trigeminal neuralgia received internal neurolysis,the safety,efficacy,and durability of internal neurolysis were evaluated.Results All the patients had a complete pain relief and a moderate facial numbness,and no recurrence was observed during an average 3 years'fllow-up.Conclusion Internal neurolysis is a safe,effective,and durable treatment for TN in the special type.Pain-free outcomes with internal neurolysis appear to be less injury and better results compared with sensory rhizotomy.
脑电双频指数(bispectral index,BIS)是将脑电图信号量化后所得的数字,它能实时反映大脑皮质和皮层下的意识水平,并能迅速反映镇静水平的变化,不仅适用于指导手术患者的麻醉深度及危重症患者的镇静水平,还可应用于早期干预以改善颅脑损伤患者脑缺血缺氧状态、评估预后状态等,在神经外科领域有很好的应用前景.本文主要就BIS技术监测意识水平的基本原理、影响因素及在神经重症监护室(neurological intensive care unit,NICU)的应用进行综述,以促进其在国内神经外科领域的应用发展.
Objective The application of etomidate target controlled infusion for intervened treatment of intracranial aneurysm operation was investigated.Methods A total of 70 cases of intracranial aneurysms which were performed the intervened surgery (American Society of Anesthesiologists Ⅰ ～ Ⅱ) were randomly assigned to etomidate group (Group E) and propofol group (Group P).Both two groups were anesthetized with etomidate and propofol target controlled infusion for induction and maintenance,respectively.The systolic pressure (SBP),diastolic pressure (DBP) and heart rate (HR) were determined before induction,before tracheal intubation,at 5 min after tracheal intubation,at the beginning of operation and after drug withdrawal.In addition,the operation time and extubation time were recorded.During the maintenance of anesthesia,the plasma target concentration of etomidate was measured.Results In Group P,the blood pressure before tracheal intubation,at 5 min after tracheal intubation,at the beginning of operation and after drug withdrawal were lower than those before induction (P ＜ 0.05),while the blood pressure was significantly decreased.In Group E,the blood pressure before tracheal intubation,at 5 min after tracheal intubation,at the beginning of operation and after drug withdrawal were lower than those before induction,but there was no significant difference (P ＞ 0.05).The blood pressure and heart rate before tracheal intubation,at 5 min after tracheal intubation,at the beginning of operation and after drug withdrawal in Group P were significantly decreased as compared to Group E (P ＜ 0.05).During maintenance of anesthesia,the plasma target concentration of etomidate was (0.25 ± 0.08) μg/mL.Conclusion Etomidate target controlled infusion can effectively reduce the circulation variation during anesthesia induction and maintenance in the intracranial aneurysm operation.It is a stable and reliable anesthesia method and the patient gets a rapid recovery after operation.
目的 探讨开颅手术后颅内感染患者脑脊液(CSF)、血清中S-100b蛋白水平的变化及其临床意义.方法 选取郑州大学附属洛阳中心医院行确诊的41例开颅术后并发颅内感染患者(2014年1月至2015年12月)作为感染组,82例开颅术后未出现颅内感染的患者作为对照组,检测并比较感染组和非感染组CSF、血清中S-100b蛋白等指标的水平,并探讨其临床意义.结果 感染组患者CSF中S-100b蛋白、神经元特异性烯醇化酶(NSE)、肿瘤坏死因子-α(TNF-α)的水平均高于对照组(P＜0.05);感染组患者血清中S-100b蛋白、C反应蛋白(CRP)、白细胞介素-10(IL-10)、TNF-α的水平均高于对照组(P＜0.05);感染组患者血清中S-100b蛋白与CRP、IL-10、TNF-α呈显著的正相关性(r值分别为0.561、0.559、0.682,P＜0.05);感染组患者CSF中S-100b蛋白与NSE、TNF-α的水平呈显著的正相关关系(r值分别为0.669、0.517,P＜0.05).结论 开颅手术后颅内感染患者CSF、血清中S-100b蛋白早期即升高明显,并且与其他炎性指标具有良好的相关性.
目的 探讨神经内镜下经鼻蝶入路切除垂体腺瘤时颅底重建时不同鞍底支撑物的临床特点分析.方法 选取2017年1月至2017年9月在陆军军医大学第三附属医院神经外科行经神经内镜经鼻蝶手术治疗的50例垂体腺瘤患者为研究对象,术前两组患者的性别、年龄、肿瘤大小和内分泌功能对比差异无统计学意义(P＞0.05).切除肿瘤过程中采取双鼻孔经鼻蝶窦入路内镜下操作技术,结合4B暴露技术和“假包膜外切除”技术,根据颅底重建时采用鞍底支撑物的不同,随机分为纳吸绵支撑组和纱条支撑组各25例.结果 两组患者术后严重并发症总发生率无统计学差异,术后纳吸绵支撑组无需拔除填塞物,但需在门诊行鼻腔清理;纱条支撑组5d左右拔除鼻腔填塞物.鼻部舒适度评估:纳吸绵支撑组优于纱条支撑组,差异有统计学意义(P＜0.05).结论 蝶窦脂肪+纳吸绵填塞以及碘仿纱条填塞,两种鞍底支撑物在术后早期可抵抗来自于鞍底腹侧脑脊液搏动等对颅底薄弱重建物的冲击,均是重要的鞍底重建辅助技术.但碘仿纱条填塞作为支撑物会增加患者不适感,应根据具体情况来选择不同鞍底支撑材料.
目的 思维能力是世界各国学校教育的主要目标之一,也是医学生综合素质与能力的重要体现,在高等教育尤其是医学院校教育中起着举足轻重的作用.我们拟通过多方位改进生物化学教学设计和实施,以实现培养本科生的思维能力.方法 利用我校医学整合课程和模块化教学改革的条件,结合我教研室多年开展本科生生物化学讨论课的实践基础,我们在生物化学教学中采取拓展延伸物质代谢课、系统优化讨论课、设立指导性自学课、设置发散性问题等,全方位改进教学设计和实施.结果 通过上述举措,我们构建了以思维能力培养为核心的医学生物化学教学模式,该模式能够全面培养与提高学员的思维能力和综合素质,同时极大地促进了教学相长.结论 以思维能力培养为核心的生物化学教学设计与实施是提高教学效果的有效方法和手段,值得进一步完善和推广.
目的 探讨垂体腺瘤经鼻蝶入路显微手术的手术技巧、治疗效果和并发症的处理.方法 对2000年至2010年经鼻蝶窦入路显微镜下切除的1 194例垂体腺瘤患者的临床特征、内分泌、病理结果、手术技巧、肿瘤切除率、术后并发症以及随访情况进行回顾性分析.结果 肿瘤全切除1 037例(86.9％),术后围手术期症状缓解1077例(90.2％).1 128例随访病例中:治愈1 034例(91.7％),复发53例(4.7％),术后再辅以药物或放疗142例(12.6％),二次手术38例(3.4％).术后并发症以尿崩、电解质紊乱、脑脊液漏和垂体功能低下为主.结论 经蝶显微手术切除垂体腺瘤治疗效果好、手术风险小、并发症少,是绝大多数垂体腺瘤患者的首选手术方式.
Objective The etiology,strategies and prognosis of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children were investigated.Methods Thirteen cases of subdural hematomas or hygroma caused by intracranial arachnoid cyst rupture in children in our hospital from September 2011 to December 2016 were analyzed retrospectively.There were 10 males and 3 females with a mean age of 5.1 years old (ranged 1.8 ～ 12.4 years).Results All the patients were followed up with a mean time of 22 months (3 ～ 40 months).The symptoms of intracranial hypertension disappeared in 13 cases.Imaging examination showed that hemorrhage or hygroma approximatively disappeared or was improved including 3 cases of disappearance,7 cases of cyst decrease and no changing in only 3 cases.For the cyst with the diameter ＜5 cm,the clinical prognosis was better than those whose diameter ＞ 5 cm.Conclusion The incidence of subdural hemotoma/effusion induced by intracraninal arachniod cysts rupture was low and the prognosis is good.The surgical treatment is applied to reduce the intracranial hypertension and burr hole evacuation is a preferred choice.Endoscope-assisted cyst-suprasellar cistern fistulation is suggested if evacuation is not satisfactory,but it could not reduce the incidence of hemorrhage.The 0size of cyst is associated with the prognosis.If pre-operative symptoms persist after the evacuation,additional surgery might be considered.The minimally invasive neuroendoscopic approach is safe in our hands and offers good symptom control,but successful treatment may not reduce the risk of haemorrhage post-traumatic head injury.Final outcome of IACs accompanied by subdural hematomas or hygroma may depend on the size of cysts.
WHO Ⅱ级脑胶质细胞瘤是一类由中枢神经系统神经胶质细胞产生的一组异质性神经上皮源性肿瘤,属于低级别胶质细胞瘤(low grade glioma,LGG).主要包括星形细胞瘤,少突胶质细胞瘤和混合少突星形细胞瘤[1].部分LGG为弥漫性浸润性生长,预后不佳[2].多数LGG呈缓慢进展性生长,预后相对较好,但具有恶变的潜力,能够进展成为高级别的胶质细胞瘤.由于其起病时恶性程度相对较低,进展缓慢,因此,在临床上并没有引起足够的重视,相关临床研究也处于初步阶段.
