[Objective]To investigate the clinical value of noninvasive intracranial pressure monitoring in the treatment of posttraumatic acute diffuse brain swelling (PADBS) and to evaluate its significance to the prognosis.[Methods]A retrospective analysis of the clinical data of 69 patients with PADBS treated by neurosurgery from January 2009 to December 2014 in the 163 Hospital of People's Liberation Army was performed.All patients were in ICU ward within 2~24 hours after injury and were monitored by noninvasive intracranial pressure monitor (MICP-1A, flash visual evoked potential noninvasive intracranial pressure detection analyzer).Patients were divided into mild, moderate, and severe intracranial hypertension according to the value of noninvasive intracranial pressure monitoring and were treated accordingly based on their symptoms and brain CT examination.The Glasgow prognosis scores were evaluated for patients' prognosis among different types of PADBS.[Results]The overall accurate prognosis rate was 43.5% (30/69) and poor prognosis rate was 56.5% (39/69).The mortality rate was 31.8% (22/69).The accurate prognosis rates of mild, moderate, and severe intracranial hypertension patients were 90.1% (10 / 11), 65.22% (15/23), and 14.29% (5/35), respectively.The accurate prognosis of patients with mild intracranial hypertension was significantly higher than that of moderate and severe intracranial hypertension.The difference was statistically significant (P<0.05).The proportion of death in patients with severe intracranial hypertension was significantly higher than that in patients with mild to moderate intracranial hypertension;the difference was statistically significant (P<0.05).[Conclusion]The value of noninvasive intracranial pressure monitor was closely related to the prognosis of PADBS patients.Continuous monitoring can provide an important indicator for the treatment of posttraumatic acute diffuse brain swelling.

Objective To investigate the effect of flash visual evoked potential(FVEP)noninvasive in-tracranial pressure (ICP)monitoring combined with simple invasive ICP monitoring in the treatment of acute traumatic brain swelling. Methods A lot of 39 cases suffered acute traumatic brain swelling carried out non-invasive and simple invasive ICP monitoring admitted from January 2010 to December 2014 were analyzed retro-spectively. The GCS scored 3 to 5 in 8 cases,6 to 8 in 17 cases and 9 to 12 in 14 cases. CT scanning showed midline shift <5 mm in 11,5 to 10 mm in 10,>10 mm in 6 and bilateral diffuse cerebral swelling in 12 ca-ses. According to initial ICP,all cases were divided into three types:11 of mild intracranial hypertension type (ICP l5~25 mmHg),13 of mid intracranial hypertension type (ICP 25~35 mmHg)and 15 of severe intracra-nial hypertension type (ICP>35 mmHg). Results The eusemia rate of mild,mid and severe intracranial hypertension patients was 90. 1%(10/11),61. 5%(8/13)and 20%(3/15),the unfavourable prognosis rate was 9. 1%(1/11),38. 5%(5/13)and 80%(12/15);there was statistic differences between two groups (P<0. 05). Conclusions The initial ICP is correlated to prognosis in the acute traumatic brain swelling pa-tients. The technique of FVEP noninvasive combined with simple invasive ICP monitoring is manipulative and practical,and can be popularized in basic hospital. The ICP monitoring combined with external ventricular drainage can play an important role in the treatment of acute traumatic brain swelling.

Objective To study the application of the annular drilling in the operation of traumatic intracra-nial hematoma.Methods The clinical data of 31 cases of posterior cranial fossa hematoma were analyzed retrospec-tively.Results In 31 patients,the operation was successful and the hematoma was satisfactory.After the injury,the GOS score,22 cases recovered,8 cases of mild disability,1 case of severe disability,no case of plant survival and death.Conclusion It has high hematoma removal rate and a satisfactory recovery after surgery for traumatic posterior cranial fossa hematoma.The size and scope of the posterior fossa craniotomy are restricted by bone window, so we should have a good knowledge of the surgical indications and contraindications.

[Obj ective]To explore the application of microanatomy of petrosal vein in microsurgical decom-pression for trigeminal neuralgia.[Methods]Clinical data of 547 patients with trigeminal neuralgia undergoing microsurgical decompression in our hospital were analyzed retrospectively.[Results]Of 127 patients undergo-ing surgical management of petrosal vein,5 patients died and 1 patient suffered cerebellum and brainstem in-farction.Of 420 patients who did not undergo surgical management of petrosal vein,no one died.[Conclusion]Petrosal vein compressing trigeminal nerve is one of the causes of trigeminal neuralgia.During microsurgical decompression for the treatment of trigeminal neuralgia,the protection and rational management of petroal vein are the important factors of decreasing the mortality.The management of petroal vein should be careful.

Objective To summarize clinical experiences and microsurgical technique for the excision of petroclival meningiomas .[Methods]Clinical data of 90 patients with petroclival meningioma confirmed by sur-gery in our hospital from Jan .1991 to Dec .2012 was analyzed retrospectively .Of these patients ,35 patients with meningioma extending to supratentorium from mid-superior clivus underwent the surgery through the combined supratentorial-infratentorial approach ,and 50 patients with meningioma extending to infratentorium from mid-inferior clivus underwent the surgery through infratentorial sigmoid sinus approach .Five patients with meningioma extending to petrous apex and cavernous sinus underwent the surgery through subtemporal transpetrosal-transtentorial approach .[Results] Of 93 patients(93 operations) ,3 patients underwent re-oper-ation due to postoperative hemorrhage .Endoscopic total resection of the tumor was achieved in 72 patients (80% ) ,and subtotal resection was achieved in 11 patients(12% ) ,and partial resection was achieved in 8 pa-tients(8% ) .The 70 patients got clinical cure and recovered their normal life ,and 18 patients needed the care in life ,and 2 patients died .[Conclusion]Correct operation approach ,skillful microsurgical technique ,inten-sive postoperative observation and active treatment of complications are helpful to improve total resection rate of petroclival meningioma and decrease mortality and disability rate .

[目的]探讨前交通动脉瘤显微手术治疗的手术方案.[方法]回顾性分析显微手术治疗的60例前交通动脉瘤临床资料.[结果]1例术前Hunt-Hess分级为Ⅴ级的患者死亡,余患者出院前GOS(Glasgow Outcome Scale)评分5分30例,4分21例,3分6例,2分2例.本组病例随访3～36个月,均无再次出血.25例患者均复查CTA,未见动脉瘤残留或复发.[结论]翼点入路显微镜下夹闭动脉瘤是治疗前交通动脉瘤的有效手段.

目的 分析重型颅脑伤继发急性呼吸窘迫综合征(ARDS)的高危因素,根据高危因素采取综合治疗措施.方法 对我科近5 年来28 例重性颅脑损伤合并ARDS 的病人资料进行回顾性分析,对患者发病的高危因素及治疗方法 进行讨论.结果 28 例患者均诊断明确,16 例抢救成功,12 例死亡.结论 重型性颅脑损伤后并发ARDS 病死率较高.预防高危因素的发生,早期诊断、早期气管切开以及正确使用呼吸机是其抢救成功的关键.

[目的]探讨前交通微小动脉瘤介入治疗的疗效、安全性及技术要点.[方法]以可解脱弹簧圈栓塞治疗20例患者(20枚)前交通微小动脉瘤.[结果]栓塞治疗后即刻脑血管造影,动脉瘤致密填塞13例,动脉瘤部分栓塞7例.1例Hunt-Hess分级为Ⅴ级患者死亡,余患者出院前GOS(Glasgow Outcome Scale)评分:5分14例,4分2例,3分2例,1分1例.[结论]微弹簧圈血管内栓塞是前交通微小动脉瘤较好的治疗手段.治疗关键是合理选择介入治疗方案.

目的总结显微手术治疗脑侧裂区胶质瘤的经验。方法对43例侧裂区脑胶质瘤患者均采用显微手术治疗,术中在保护重要结构的前提下最大限度地切除肿瘤。结果手术肿瘤全切除30例,次全切除9例,部分切除4例。术后随访37例,能正常工作及生活21例,生活能自理6例,偏瘫生活不能自理2例,复发5例,死亡3例。结论熟悉侧裂区的局部解剖和熟练掌握显微神经外科技术是手术成功的关键;术中注意对侧裂区动静脉血管及肿瘤周围重要功能区的保护可提高手术治疗效果。

目的 研究重型特重型颅脑损伤并侧裂血管损伤的临床特点、手术体会及术后处理.方法 对我科60例重型特重型颅脑损伤伴有侧裂区血管损伤患者的临床资料进行回顾性分析.结果 根据COS预后标准:死亡15例,植物生存2例,重残10例,中残14例,良好19例.结论 术中注意对外侧裂区血管的保护,采用标准外伤去大骨瓣减压手术,能提高手术疗效.

目的 探讨显微外科手术治疗外侧裂区脑动静脉畸形的预后.方法 对1995年2月至2008年2月收治的15例侧裂区脑动静脉畸形患者行显微外科手术切除治疗.结果 显微外科治疗外侧裂区脑血管畸形15例,12例完全切除病灶,3例未完全切除,术后行γ刀辅助治疗.手术效果按格拉斯哥预后评分:恢复良好8例,中度残废5例,严重残废2例,无植物生存和死亡.结论 显微镜下外科治疗侧裂区脑动静脉畸形,切除病灶彻底,手术并发症少,疗效满意。

Objective To investigate the clinical features and microsurgical resection techniques of cerebellopontine angle cholesteatoma. Methods Clinical features, surgical approach and techniques, results and complications were analyzed in 30 cases of cerebellopontine angle cholesteatoma. Results Total resection in 26 cases, subtotal resection in 4 cases ,no operative mortality. Post-operative complications was aseptic encephalitis which was most common after treatment, and all recovered. Conclusion Cerebellopontine angle cholesteatoma was a third category of common tumors, CT, MRI examination can provide diagnosis. According to cholesteatoma involving the site ,selecting a good surgical approach and making good use of microsurgical technique could improve surgical total removal rate and reduce postoperative complications.

目的 探讨颅底胆脂瘤显微外科治疗的临床疗效.方法 回顾性分析以三叉神经痛为首发症状的26例后颅窝胆脂瘤患者的临床资料,根据肿瘤的不同生长部位及大小,采取不同的手术入路予以显微切除.结果 术后三叉神经痛症状均消失.手术全切除22例,次全切除4例,无手术死亡.术后并发症以无菌性脑炎最多见,治疗后痊愈.结论 胆脂瘤导致的三叉神经痛临床表现多不很典型,CT、MRI检查可提供诊断依据.根据胆脂瘤累及的部位,选择好手术入路和运用好显微外科技术可提高手术的全切率,降低并发症.肿瘤切除后三叉神经痛即停止,无需特殊处理.

目的 探讨后颅窝肿瘤术后皮下积液的原因、预防对策及治疗.方法 回顾性分析后颅窝肿瘤术后并发皮下积液21例患者的临床资料.21例中局部穿刺抽吸+局部加压包扎7例(仅限于骨窗区皮瓣下),局部头皮穿刺引流2例,腰椎穿刺持续引流脑脊液辅以局部积液穿刺后加压包扎6例,行分流术3例,再次开颅手术清除积液3例.结果 19例患者获得随访,随访3个月至2.5年,行分流术者1例因堵管予以再次手术调整;腰椎穿刺持续引流者1例复发,再次行开颅手术治疗.其余病例预后良好.结论 后颅窝开颅术后皮下积液是可以预防和治疗的.术中严密缝合硬脑膜及逐层肌肉组织,局部长时间多次加压包扎,拔除引流管后严密缝合引流口等防治措施可预防术后皮下积液.对于并发皮下积液者,应强调综合性治疗.

Objectives To summary the experience in intreating giant meningiomas by microsurgery and the operative technique. Method The clinical data of 102 patients with the giant meningiomas (diameter≥7.0 cm) undergoing microsurgery in our department from June 1990 to June 2006 were analyzed retrospectively. Results According to Simpson grading of minigiomas resection, grade Ⅰ was achieved in 76 cases, grade Ⅱ in 19, grade Ⅲ in 7. Eighty patients recovered well, 18 were improved and 4 died. Conclusion The skillful microsurgical technique, the prompt treatment of the postoperative complications are helpful to enhancing the rate of total resection of the tumor and decreasing disabled rate.

Objectives To explore the operative technique and approach of surgical treatment of anterior cranial base menin-giomas, such as cranioorbital meningiomas, cranionasoorbital meningiomas and sphenoidal ridge meningiomas, and indication of cranial base reconstruction. Methods One hundred and ten cases of the anterior cranial base meningiomas were definitely dignosised by CT and/or MRI. According to their size and site, the different operative approaches were chosen to remove the tumors under a microscope. The cranial base reconstruction was performed in some patients of 110 cases of anterior cranial base meningiomas, of which, 35 were removed through the combined fronto-temporo-orbito-zygomatic approach, 38 through the fronto-naso-ethmo-orbital approach, 4 through the pterional approach and 33 through the crowed craniotomy. Results The tumors were totally removed under a microscope in 88 patients, subtotally in 17 and partly in 5 of 110 patients with anterior cranial base meningiomas. Of 110 patients, 85 were clinically cured, 23 improved and 2 died. Of 79 patients followed up, 5 with recurrent tumors were cured by reoperation, 5 died and the others became better. Conclusion The microsurgical resection of the tumors through different approaches based on the size and site of the tumors is a good method to treat the anterior cranial base meningiomas, but the reconstruction of cranial base is necessary in some patients.

近20年来,由于显微外科技术的提高,影像学及内分泌检测进步,垂体腺瘤诊疗水平获得较大的提高.我院自1986年1月至2001年10月收治垂体腺瘤185例,其中大型及巨型垂体腺瘤共120例.现将其显微手术治疗情况报告如下.

Objectives]To discuss the operative approach and postoperative outcome of petroclival meningioma (PM) treated by microscopic surgery for the aim of improving microneurosurgical techniques and summarize the clinical experiences of treatment.As the anatomical relation of tumor to the region around petroclivus was reviewed, the clinical manifestations, operative appraches, outcome of operation and postoperative management in 65 patients with PM were summarized.Total resection of PM was achieved in 50 cases (77%). Operative death occurred in 4 cases (6.1%). Thirty cases with PM were operated through combined presigmoid retrolabyrinthine approach. Their total removal was achieved in 20 cases (66.7%), with operative death in 3 cases (10%).[Conclusion]Total resection rate can be raised by proper operative approaches and skillful manipulation of microneurosurgical technique. Strengthening of postoperative clinical treatment can reduce mortality of operation.

我院自1986年以来施行显微血管神经减压术治疗三叉神经痛230例,面肌抽搐18例,舌咽神经痛6例,效果较为满意.现将治疗情况报告如下.

目的探讨儿童颅内蛛网膜囊肿的临床特点、手术适应证、手术方法及显微手术需解决的一些问题.方法回顾我院48例儿童颅内蛛网膜囊肿的临床资料,对其进行总结.结果经显微手术治疗的48例中,症状明显改善46例(95.8%),囊肿缩小或消失42例(87.5%).结论显微手术能有效治疗儿童颅内蛛网膜囊肿,对儿童颅内蛛网膜囊肿需采取积极的手术治疗.