颅内动脉瘤(IA)破裂出血是造成致命性脑损伤的主要原因之一,筛查是IA在未破裂之前被发现的唯一办法.最新的研究显示至少有一个直系亲属患有动脉瘤性蛛网膜下腔出血(ASAH)、常染色体显性遗传多囊肾病(ADPKD)、≥35 岁的吸烟者或/和高血压的患者是IA筛查的受益群体,但对这一群体进行筛查的频率、成本效益等方面仍存在一些争议.筛查之前应详尽告知患者筛查的利弊,以便患者做出决定.对于存在高危因素的患者,建议尽早启动筛查流程,并且首选CTA或MRA.

目的:探讨恶性脑胶质瘤中氢质子磁共振波谱(1H-MRS)与5-氨基乙酰丙酸(5-ALA)荧光强度的相关性.方法:选择2012年9月至2018年1月在我院神经外科诊治的恶性脑胶质瘤患者32例,进行1H-MRS检查与5-ALA荧光强度检测,对检测数据进行回顾性分析.结果:在32例患者中,常规MRI表现为不均匀强化,周围T2上高信号,肿瘤边界不清,瘤周水肿显著.胶质瘤的肿瘤实质区典型波谱表现为胆碱(Choline,Cho)峰显著升高,N-乙酰天门冬氨酸(N-acetylaspartate,NAA)峰显著降低,肌酸(Creatine,Cr)峰降低不显著,NAA/Cr比值降低,Cho/NAA、Cho/Cr比值升高,与对侧正常区对比差异有统计学意义(P<0.05).低级别组瘤体区的Cho/NAA、Cho/Cr、NAA/Cr比值与高级别组对比差异也有统计学意义(P<0.05).胶质瘤的肿瘤实质区PpIX荧光强度值为2.79±0.49,对侧正常区为1.84±0.51,肿瘤实质区显著高于对侧正常区(t=6.398,P=0.008).Pearson系数分析显示肿瘤实质区的PpIX荧光强度与NAA/Cr呈显著负相关性(P<0.05),与Cho/Cr、Cho/NAA成显著正相关性(P<0.05).结论:恶性脑胶质瘤中1H-MRS与5-ALA荧光强度有显著相关性.

目的 探讨吲哚菁绿(ICG)荧光血管造影在颅内动脉瘤手术中的应用价值.方法 选择2013年8月至2017年2月自贡市第一人民医院收治的24例颅内动脉瘤患者为研究对象,患者均行动脉瘤夹闭术,术中给予ICG荧光血管造影,术后随访3 ～68个月,记录患者的预后.结果 ICG荧光血管造影能明确辨认动脉瘤大小、瘤体指向,术中确认动脉瘤颈残留3例,载瘤动脉分支血管闭塞2例,穿通支血管误夹1例.供血动脉阻断后引流静脉的最大荧光强度显著低于动脉瘤切除前(P＜0.05),动脉瘤切除后引流静脉的最大荧光强度显著低于供血动脉阻断后(P＜0.05).动脉瘤切除前和供血动脉阻断后引流静脉显影延迟时间比较差异无统计学意义(P＞0.05),动脉瘤切除后引流静脉显影延迟时间显著长于动脉瘤切除前和供血动脉阻断后(P＜0.05).患者均顺利完成手术,无手术相关死亡病例,术后随访期间死亡5例(20.8％,5/24).结论 术中ICG荧光血管造影在颅内动脉瘤手术中具有重要的应用价值,能够提供高质量、高分辨率的图像,提高手术安全性,改善患者预后.

目的：探讨采用后路钉棒系统内固定融合技术治疗上颈椎不稳的效果。方法对13例上颈椎不稳行后路钉棒系统内固定融合术，其中11例行钉棒系统枕颈融合术，2例行钉棒系统环枢椎融合术，术后随访3~24个月，平均6.5个月。结果术中无脊髓、神经根及椎动脉损伤，术后神经症状均得到不同程度的改善；影像学复查钉棒位置均良好，均形成良好骨性融合，脊髓无受压。术后3个月日本骨科协会评分改变率为（65.5±35.5）%。结论后路钉棒系统内固定融合术是治疗上颈椎不稳安全而有效的手术方式。

Aim of the study: Recent studies have revealed that ginsenoside Rb1 (GRb1) is neuroprotective for cerebral ischemia. However, the mechanism underlying of this function is unclear. We assessed whether this neuroprotective effect of GRb1 was mediated by the levels of brain-derived neurotrophic factor (BDNF), by the levels of caspase-3 proteins and by induced neurogenesis in rats following transient cerebral ischemia or not.Materials and methods: Cerebral ischemia was prepared by a 2 h occlusion of the middle cerebral artery and reperfusion, followed by infusion of GRb1 (40 mg/kg) and saline (GRb1 and ischemia groups, respectively). All rats were sacrificed at 3 and 12 h, 1, 2, 3, 5, and 10 days after reperfusion. Normal and sham-operated rats were used in control group. Modified Neurological Severity Scores (mNSS) test and hematoxylin and eosin staining were respectively performed to evaluate neurological function and histological feature. Immunohistochemistry was used to identify intrinsic neurogenesis by nestin antibody. Western blotting was used to detect BDNF and caspase-3 protein content.Results: GRb1 infusion after cerebral ischemia significantly promoted recoveries of neurological functions at 3 and 5 days after reperfusion compared to ischemic rats. The number of nestin-positive cells was apparently increased after GRb1 infusion compared to ischemia rats at given time. Moreover, BDNF was significantly increased in GRb1-treated rats compared to ischemia rats at different time points. In contrast, GRb1 infusion after the onset of reperfusion, caspase-3 at a given time was significantly reduced compared to ischemia rats, but still significantly increased compared to control rats.Conclusions: Promotion of the neurogenesis and regulation of the expressions of BDNF and caspase-3 may be involved in GRbl-induced neuroprotection against cerebral ischemia. (C) 2010 Published by Elsevier Ireland Ltd.