目的 探讨术前多模态影像三维重建技术在神经内镜显微血管减压术(MVD)中的应用价值.方法 回顾性分析2019年4月至2021年12月潍坊市人民医院神经外科收治的行神经内镜MVD治疗的48例患者的临床资料,其中,三叉神经痛(TN)18例,面肌痉挛(HFS)30例.所有患者术前均行头颅MRI三维循环相位稳态采集快速成像(3D-FIESTA)和三维时间飞跃法磁共振血管成像(3D-TOF-MRA)检查,并对神经、血管等结构进行影像学三维重建;采用Kappa 一致性检验评价术前多模态影像三维重建与神经内镜MVD术中所见的责任血管、责任血管的走行及其与神经或神经根进/出脑干区(REZ)的接触关系、责任血管对神经压迫程度的一致性;根据TN疼痛分级或HFS强度分级评估患者术后1、3、6个月症状的改善程度.结果 48例患者术前多模态影像三维重建显示,除3例无法确认责任血管外,其余45例均有明确的责任血管;所有患者的神经内镜MVD手术均顺利完成,其中46例均有明确的责任血管;多模态影像三维重建判断责任血管的准确率为91.3％(42/46);判断责任血管走行及其与神经或REZ接触关系的准确率为93.8％(45/48);判断责任血管对神经压迫程度的准确率为100％(21/21).Kappa一致性检验结果显示,多模态影像三维重建与神经内镜MVD术中责任血管、责任血管走行及其与神经或REZ接触关系、责任血管对神经压迫程度均具有中等一致性(Kappa值分别为0.63、0.74、0.68,均P＜0.001).48例患者均无颅内感染、症状复发等情况发生,中位随访时间为4个月(1～6个月);至末次随访,18例TN患者中,17例疼痛消失,1例部分缓解;30例HFS患者中,29例痊愈,1例明显缓解.结论 术前多模态影像三维重建技术可较为准确地评估责任血管、责任血管走行及其与神经或REZ的接触关系、责任血管对神经的压迫程度,提高神经内镜MVD的准确率及成功率,有效改善脑神经激惹症状.

目的 探讨重症颅脑损伤颅骨缺损合并脑积水患者行颅骨修补术联合脑室腹腔分流术对神经功能恢复的影响.方法 选择我院颅脑外科2011年2月～2015年2月收治的重症颅脑损伤颅骨缺损合并脑积水患者62例作为研究对象,依据不同的治疗方法分为实验组和对照组.其中实验组30例,采用脑室腹腔分流术同期联合颅骨修补术进行治疗;对照组32例,先行脑室腹腔分流术,3～6个月后再行颅骨修补术.观察对比两组术后恢复情况,并发症发生情况以及神经功能恢复情况.结果 实验组术后恢复良好和轻度残疾的例数明显优于对照组,差异具有统计学意义(P=0.005,0.010),而重度残疾、植物状态和死亡例数两组相近(P＞0.05);两组手术前、手术15d后和手术30d后实验组神经功能缺损评分分别为(27.38±2.56)分、(15.26±2.14)分和(10.30±1.58)分,对照组为(27.24±2.37)分、(21.27±2.28)分和(15.08±1.87)分,手术前两组评分相近(P＞0.05),且手术后均明显降低,组间差异具有显著统计学意义(P=0.000,0.000);实验组并发症发生率和脑积液及血肿发生率(20.00％,3.33％)和对照组(56.25％,31.25％)差异均具有显著统计学意义(P=0.008,0.011).结论 采用脑室腹腔分流术同期联合颅骨修补术对重症颅脑损伤颅骨缺损合并脑积水患者疗效显著,且并发症发生率低,术后神经功能恢复迅速.

目的比较持续腰大池引流与甘露醇在治疗出血后脑水肿的效果。方法选取80例高颅压患者,持续腰大池引流组(后简称腰池引流组)40例和甘露醇组40例,观察两组患者脑水肿的治疗效果及GCS改善情况。结果腰池引流组的平均甘露醇使用量,平均治疗时间,治疗后GCS评分改善情况,及腰池引流组低血容量等并发症发生例数,与对照组相比,(P<0.05),差异有统计学意义,低颅压、颅内感染发生例数,与对照组相比,(P>0.05),差异无统计学意义。结论持续腰大池引流治疗出血后脑水肿的效果显著,并发症少。

OBJECTIVE To explore the application value of positron emission tomography (PET) in the localization of magnetic resonance imaging (MRI)-negative epileptogenic focus. METHODS Brain images of 18fluoro-2-deoxy-D-glucose (18F-FDG) and 13N-NH3·H2O-PET, MRI and video electroencephalography (VEEG) were obtained in 65 patients. Preoperative and postoperative localizations were compared in MRI-negative patients. And the results of PET and VEEG were compared between the MRI-positive and MRI-negative groups. RESULTS MRI scans were normal in 26 cases and abnormal in 35 cases. Sixty-one patients had interictal epileptiform discharge on VEEG (brain regions, n = 12; multiple brain areas, n = 16; hemisphere, n = 13; unspecified location, n = 20) and interictal PET imaging (brain regions, n = 23; multiple brain areas, n = 28; hemisphere, n = 5; unspecified location, n = 6). And 17 MRI-negative patients underwent operations and 12 of them reached the Engels I-II level standard. Both PET and VEEG were compared between the MRI-positive and MRI-negative groups. No significant differences existed between two group (P < 0.05). A comparison of PET and VEEG showed statistical significance in two group (P > 0.05). CONCLUSIONS PET imaging is both sensitive and effective in the detection and localization of epileptogenic foci. Especially for MRI-negative cases, it is an indispensable tool of localizing epileptogenic foci.

Objective: To discuss the application of awaking anesthesia and neurophysiological techniques in epilepsy surgery involved in language areas. Methods: The epileptogenic lesions and the relationship between epileptogenic focus and language areas were estimated and confirmed by preoperative assessments in 9 patients. Electrocardiography recordings were adopted to confirm the epileptiform discharge area, and then cortical electrical stimulation(CES)was performed to locate the language areas. According to the relationship between language areas and epileptogenic lesions and (or) eileptogenic focus, the appropriate surgical approach was chosen to protect the language areas and remove epileptogenic lesions and (or) eileptogenic focus. The bipolar coagulation on functional cortex(BCFC) or multiple subpial transection(MST) was used to deal with epileptiform discharge area. The language function and epileptic control were estimated after surgery. Results: In 9 patients, there were 4 patients with language dysfunction after operations,in which 1 patient appeared language dysfunction and moderate motor aphasia 1 d after surgery, 3 patients appeared language dysfunction 2 d after surgery and recovery occurred in one week, the dysfunction returned to the normal state in two weeks. Epilepsy control was EngelⅠin 7 of 9 patients, and 2 were EngelⅡ. Conclusion: Awaking anesthesia and intraoperative neurophysiological techniques were reliable and precise in epilepsy surgery involved in the language areas, which allowed a maximum resection of the epileptogenic lesions and (or) epileptogenic focus and improved the life quality of patients.

临床颅脑转移癌发生率约占15％～39％,主要以幕上占绝大多数,尤其是额、颞、顶叶皮质及皮质下,少见于颅骨和脑膜[1-2],而同时累及帽状腱膜下、颅骨、硬脑膜、海绵窦更为罕见,我科发现1例.现报告如下.病例报告患者 女,54岁.2010年11月主因左顶部头疼进行性加重1个月余.入院查体:昏睡,双眼睑水肿;左额顶较右侧隆起且皮肤呈紫色,约5 cm×7 cm,压痛;左侧额部痛觉减退,结膜水肿,眼球固定;右Babinski征阳性.腰穿初压为250mmH2O,血象、脑脊液化验无异常.头颅薄扫CT检查:左侧筛窦、上颌窦软组织影.头颅MRV检查:左侧横窦、乙状窦不显影.头颅MRI检查:左额顶帽状腱膜下软组织肿胀,左半球硬脑膜弥漫强化,右侧硬脑膜部分强化,左海绵窦明显受侵蚀.综上检查,高度怀疑感染,颅内压增高,给予抗感染,脱水治疗,2 d后体温下降(37℃).为明确病因请全院会诊,一致认为感染可能性大,确诊需活检。

目的 报道1 例成人ChiariⅠ型畸形伴脊髓空洞自然消退的病例,探讨ChiariⅠ型畸形和脊髓空洞自然消退的原因.方法 复习1 例成人ChiariⅠ型畸形伴脊髓空洞自然消退患者的临床资料和影像学资料,并结合相关的文献进行分析.结果 男性患者,33 岁,于2000 年开始出现颈部和上肢的麻木和疼痛,有不察觉的烫伤经历,2002 年MRI 检查显示为ChiariⅠ型畸形伴C2 ～T10 脊髓空洞,患者拒绝手术治疗;2010 年MRI 检查显示脊髓空洞有所消退,ChiariⅠ畸形也有所缓解,患者的麻木和疼痛的程度有所减轻,一般状况保持良好,查体发现右上肢和右侧三叉神经分布区轻触觉和痛温觉减退,右手骨间肌有萎缩.结论 小脑组织的萎缩、枕骨大孔区蛛网膜的破裂和脊髓的撕裂可能是成人ChiariⅠ型畸形伴脊髓空洞自然消退现象的原因,当ChiariⅠ型畸形伴脊髓空洞的患者临床症状较轻微或者没有进展时,可先采取观察和随访的方法,一旦出现临床症状进展,再行外科手术治疗.

Objective To investigate the clinical curative effect of recurrent malignant brain gliomas by microsurgical excision combined with interstitial chemotherapy and sensitive radiotherapy.Methods In 21 patients with recurrent malignant brain gliomas,the tumor was microsurgically removed and 125I and 5-FU were embeded in the tumor bed during operation.The patients were followed up for 6-25 months,and the results were compared with 32 cases with the recurrent malignant brain gliomas who received operation,chemotherapy and radiotherapy.Results A patient died in 4 weeks.In 6 months,12 months,18 months,the effective rate was 85.7%,66.7% and 47.6%;the mortality rate was 14.3%,33.3% and 52.4%.All patients had no apparent side-effects.Conclusions Microsurgical resection combined with interstitial chemotherapy and sensitive radiotherapy is an effective method for the treatment of recurrent malignant brain gliomas.

Objective To explore the application of cortical sensory evoked potential (Co ⁃SEP), motor evoked potential (Co⁃MEP) and electrocorticogram (ECoG) for locating functional area to enhance the effectiveness and safety of glioma resection. Methods Eighteen cases of glioma located in or adjacent to the gyri centrales were screened by iconography. fMRI and magnetoencephalography (MEG) were used to locate functional area. During operation, the Co⁃SEP and Co⁃MEP were performed to further define the functional area, and ECoG was performed to detect the epileptogenic focus. The glioma was removed as much as possible, avoiding the invasion of brain functional area. 125I and 5⁃FU were embeded in the tumor bed during operation. Results In 18 cases, one case was total resected; 13 cases were subtotal resected; 4 cases were partial resected. The curative effect was evaluated at 6 months, 12 months, and 24 months after operation. Progression⁃free survival (PFS) was 11 months on the average. Objective effective rate was 13/18, 9/18 and 6/18, respectively. Disease control rate (DCR) was 15/18, 13/18 and 10/18, respectively. Karnofsky Performance Scale Score at preoperation and 6 months, 12 months and 24 months after operation was (84.13 ± 12.88), (78.20 ± 15.13), (62.35 ± 13.21) and (46.57 ± 16.93) respectively, and the differences were all significant (P < 0.01). Incidence rate for post ⁃ operative complication was 6/18 (2 cases with hypomyodynamia, 3 case with hypoesthesia, and one case with both). Conclusion Neuro ⁃ electrophysiologic monitoring guided surgery of glioma located in or adjacent to the gyri centrales is effective for the resection of glioma as much as possible, avoiding the invasion of important functional area, and can improve patient's quality of life. After gloma resection, application of interstitial radiotherapy combined with chemotherapy may extend patient's life span, and decrease the recurrence of glioma. DOI：10.3969/j.issn.1672-6731.2011.06.007

目的观察氧驱动雾化吸入异烟肼加利福霉素治疗复治菌阳肺结核的疗效与安全性。方法治疗组60例要求无咯血患者,在传统抗结核药物治疗基础上加入异烟肼0.1g+利福霉素0.125g雾化吸入,1次/d,每次20min,雾化时间1～2个月。对照组:50例给予传统抗结核治疗。观察两组患者的总有效率,并对低热、乏力、痰结核菌、空洞等分别在治疗前及治疗后进行评价。结果观察半年,治疗组,显效55例,总有效率91.7%,对照组,显效38例,总有效率为76%,治疗组总有效率明显优于对照组,差异有统计学意义(P<0.05),治疗组治疗后病灶吸收情况优于对照组,差异有统计学意义(P<0.05),治疗组未出现明显不良反应。结论氧驱动雾化吸入异烟肼加利福霉素治疗复治菌阳肺结核,应用较为安全有效。

目的结核性脑膜炎(TBM)伴发脑积水是结核病的一种常见发病形式。如何提高治愈率是我们课题组近几年研究和探讨的主要方向,通过研究生理、病理、药理和神经外科手术,改进脑室引流穿刺方法、延长置管时间、增加脑室内注药种类从而提高其治愈率,降低病死率。方法从2002年开始,根据诊断标准选取60例TMB伴脑积水患者,随机分为观察组和对照组,两组各30例,均进行常规抗痨、脱水、激素及营养支持等内科治疗和神经外科钻孔引流加雷米封、卡那霉素、地塞米松等三联药物脑室注入。结果观察组30例患者21例治愈,6例显效,2例好转,1例无效,总有效率96.7%,而对照组30例,10例治愈,3例显效,9例好转,8例无效,总有效率74.4%。统计学上有显著差异。结论通过改进的脑室穿刺引流技术及脑室三联注药,脑室引流能迅速的降低颅内压,解除脑疝的发生,排除大量脑室系统的炎性渗出物,减少粘连堵塞,减轻变态反应和进一步感染。同时脑内注药有利的抑制炎症反应,杀灭结核杆菌,减少脑脊液生成,增加脑膜渗透性,有利药物渗入病脑组织,解决了部分药物难透过血脑屏障的难题。是一种治疗TBM脑积水的有效方法,它创伤小,疗效好,既安全又经济,值得我们推广和进一步研究。

目的探讨慢性硬膜下血肿(CSDH)形成机制、影像学特点及诊疗注意问题。方法对52例CSDH患者的临床资料,进行分析总结。结果本组患者均在基础加局麻下行钻颅冲洗引流,术后头低位,充足补液,不用脱水利尿剂。出院时43例痊愈,9例好转。颅脑CT复查36例血肿消失,脑皮层膨起,16例血肿腔处有少许液体。结论正确认识本病的发病机理影像特点,可最大程度减少误诊和漏诊。正确的术中操作,术后治疗和护理能尽量减少血肿复发和残留积液,提高治愈率。

<正>我院自1998年7月至2006年7月共收治张力性气颅12例,均经手术治愈,现报道如下。1临床资料1.1一般资料本组共12例,男性11例,女性1例;年龄18～65岁,平均31岁;病程2h～16d。原发病均为头面部外伤,患

颅脑损伤是神经外科常见急症之一,其特点是病情重且复杂多变,并发症多、病死率及致残率高,治疗困难.因此,做好颅脑损伤病人的急救处理、争取时间及早手术以及做好术后病人的护理和康复指导,是提高治愈率,降低病死率的关键.我院于1991年1月-2005年1月收治颅脑损伤双测瞳孔散大病人120例.现将临床分析与护理总结如下.