患者女性,42岁,因突发头痛、头晕5天,加重半天于2019年9月26日收住我院神经内科.既往体健.查体见神志清,言语流利,脑神经检查未见异常,颈部有抵抗感,四肢肌力5级,双侧腱反射对称(++),病理反射未引出,深浅感觉检查正常.颅脑CT:小脑见团块状高密度影,占位效应明显,第四脑室下部受压变窄,余脑室扩大,考虑小脑出血(图1a).头颈部CTA:左侧胚胎性大脑后动脉,余未见明显异常(图1b).血生化检查:无高血脂及高胆固醇.会诊后认为:小脑出血诊断明确,出血量约13 ml,第四脑室受压,有轻度脑积水表现,手术指征明确,建议行小脑出血开颅清除术.患者及亲属3天后同意手术,全麻下以血肿为中心做后枕部旁正中直切口,颅骨铣骨瓣成型,上方暴露至横窦下缘,硬脑膜张力高,"十"字切开硬膜,皮层造瘘直达血肿腔,血肿主体为褐色血性液体,夹杂部分凝固血块,清除血肿后,见血肿腔有黄白色珍珠样新生物及钙化,有包膜,血运极不丰富,新生物及钙化约占整个血肿的1/3,清除所有新生物,并留取标本行病理检查.术后复查CT较满意(图1c).常规病理:镜下见出血坏死组织,伴钙化及胆固醇结晶形成,局部见微量短梭形细胞,细胞性质及类型待定;免疫组化结果:短梭形细胞Vimentin(+),GFAP(+),CD56(+),Syn(+), NSE(+),结合颅脑CT的出血性表现考虑为小脑陈旧性出血、坏死组织伴含铁血黄素沉着、钙化及胆固醇结晶性肉芽肿形成(图2).
Objective To evaluate the treatment results of stereotactic 186Re intracavitary irradiation in the patients with craniopharyngioma. Methods Nineteen patients were treated with stereotactic 186Re intracavitary irradiation, including 12 males and 7 females (average age, 37. 2 years). Among them 12 patients had a solitary cyst, whereas 7 patients with mixed structure (e. g. , a large cyst with a small solid portion). The mean volume of the cystic portion of the tumor before irradiation was 8390 mm3. Results The patients were followed up for 6 months to 3 years. The retraction of the cyst was complete in 7 patients, cyst volume decreased more than 50% in 5 patients and less than 50% in 7 cases. Among the 8 patients with visual acuity deficit before irradiation, 5 were improved. No hypopituitarism occurred in patients with normal pituitary function before treatment. One of the 4 patients with hypopituitarism was improved, 3 of the 5 patients with diabetes insipidus was improved. Conclusion Stereotactic 186Re endocavitary irradiation for the treatment of cystic craniopharyngioma is a safe and effective procedure.
目的探讨重型颅脑损伤去骨瓣减压术后早期颅骨修补的可行性。方法对2002年至2005年23例去骨瓣减压病人进行早期颅骨修补,应用前瞻性随访方法探讨早期颅骨修补对去骨瓣减压病人预后的影响。结果早期颅骨修补使病人的意识及神经系统症状得到了不同程度的改善,部分病人原有硬膜下积液消失,病人术后无1例感染。结论只要病人颅骨修补时机及修补材料选择适当,大骨瓣减压术后早期行颅骨修补对病人神经功能及预后的改善将是有帮助的。
目的探讨小骨窗显微手术综合治疗基底节区高血压脑出血的临床效果。方法246例基底节区脑出血患者均经小骨窗开颅,在显微镜下解剖侧裂池,切开岛叶皮质,清除血肿;术后采取综合治疗。结果随访3个月,按日常生活能力分级法评估预后:Ⅰ级58例,Ⅱ级62例,Ⅲ级76例,Ⅳ级24例,Ⅴ级14例,死亡12例。结论经小骨窗显微手术治疗基底节区脑出血手术路径短、创伤小、疗效确切;结合术后综合治疗,可更好地恢复神经功能。
