目前治疗外伤后脑积水(Post-traumatic hydro-cephalus,PTH)的主要手术方式为分流术,包括脑室腹腔分流术(Ventriculoperitoneal shunt,VPS)、脑室心房分流术、脑室胸骨柄分流术及腰大池腹腔分流术(Lumboperitoneal shunt,LPS)等.脑室腹腔分流术为经典的分流方式.近年来,LPS由于其操作简单、安全性高,其应用越来越多[1].本科对2019年12月—2022年3月收治的35例PTH患者行LPS,效果较好.

Objective:To explore the clinical efficacy and experience of mini-invasive surgery for traumatic progressive intracerebral hematoma in children.Methods:The clinical data were retrospectively analyzed for 22 children with traumatic progressive intracerebral hematoma undergoing mini-invasive surgery from January 2010 to March 2019. There were 14 boys and 8 girls with an average age of (8.45±5.27) years. The procedures included pore cranial drilling and drainage of hematoma through fine hole-drilling under local anesthesia (drilling & drainage group, n=14) and endoscopic hematoma evacuation through small incision under general anesthesia (endoscopic group, n=8). The progress of hematoma volume, clinical symptoms, consciousness states, surgical outcomes, complications and early prognoses were evaluated and the clinical characteristics of two groups were compared.Results:CT re-examination within 12 hours showed that intracerebral hematoma formed on the basis of small contusion and laceration on initial CT scan and hematoma enlarged after formation in 5 cases. In 3 cases, no obvious intracerebral hematoma was detected on two initial CT scans while the third CT scan showed the formation of hematoma upon an aggravation of symptoms. Fourteen children had a decreased preoperative GCS as compared with that at the time of admission and 2 of them showed brain hernia. Among 7 cases of epileptic seizure, there were hematomas in temporal lobe (n=5), frontal lobe (n=1) and basal ganglia (n=1). The operative duration of endoscopic group was (7.13±3.04) h post-injury and it was earlier than (18.43±6.19) h in drilling & drainage group. The frequency of CT re-examination was (1.75±0.46) in endoscopic group versus (3.14±0.66) in drilling & drainage group. The inter-group differences of the above parameters were statistically significant ( P<0.05). CT scans after mini-invasive surgery confirmed a satisfactory removal of hematoma and the space-occupying effect was relieved. During follow-ups, all children recovered well. Conclusions:Disturbance of consciousness and epileptic seizure are common manifestations of intracerebral hematoma progression after traumatic brain injury in children. Temporal lobe hematoma is more likely to co-exist with seizures. Some children's progressive intracerebral hematoma appears after two CT examinations so that clinicians should pay more attention to bedside observations. Drilling and drainage with fine hole is quick and simple. It is suitable for children with stable hematoma. However, CT should be re-examined more times to confirm the drainage effect. Endoscopic neurosurgery is indicated for children with quick hematoma progression. Intraoperative removal of hematoma is accurate and it reduces the need of CT re-examinations. Reasonable use of mini-invasive surgery may achieve a better recovery in children with progressive intracerebral hematoma.

OBJECTIVE:Glioblastoma (GBM) is a common type of cancer with high mortality. Epithelial to mesenchymal transition (EMT) plays a vital role in the development of glioblastoma. The aim of this study is to evaluate the role of miR-125a-5p in glioblastoma and in the tumorigenesis of chemotherapeutic drug-resistant cancer stem-like cells in brain glioma.METHODS:The role of miR-125a-5p in the regulation of CSCs, EMT, migration, and invasion in glioblastoma was measured in this study.RESULTS:We showed the roles of miR-125a-5p in the regulation of CSCs, EMT, migration, and invasion in glioblastoma. miR-125a-5p can inhibit the CSCs phenotype and EMT in glioblastoma cells. In addition, its over-expression can significantly regulate CSCs-associated genes and EMT-associated gene expression in glioblastoma cells.CONCLUSIONS:We concluded that miR-125a-5p is one of the key microRNAs regulating CSCs and EMT programs in glioblastoma. The results suggested that miR-125a-5p might be a novel therapy target for glioblastoma.

Objective:To investigate the postoperative complications of cranioplasty using autologous bone for traumatic skull defect.Methods:Between January 2011 and December 2018, a total of 758 consecutive patients with traumatic skull defect underwent cranioplasty using autologous bone at Department of Neurosurgery, Linyi People′s Hospital. Their clinical data were retrospectively analyzed in this study. The outcomes of cranioplasty, postoperative complications and their occurrence time were documented.Results:All 758 patients underwent cranioplasty successfully. One patient (0.13%) died of massive cerebral infarction. One patient (0.13%) developed delayed epidural hematoma on the second day post operation. The follow-up duration of 757 patients were 12-36 months with a median of 14 months. During the follow-up period, 16 cases (2.11%) reported infection in the surgical site resulting in removal of bone flap, among which infection occurred at 8-72 days post operation (median: 21 days) in 13 cases, and the remaining 3 cases reported infection at 4, 11 and 30 months post operation respectively. Seven cases (0.92%) had severe bone resorption. Bone resorption began to appear at 4-6 months after operation, and severe bone resorption occurred about 1 year after operation.Conclusions:The rates of severe complications and surgical failures can be controlled at relatively low levels in cranioplasty using autologous bone for traumatic skull defect, so autologous skull bone is still a suitable choice for cranioplasty. It is necessary to pay attention to the prevention and control of postoperative infection, especially early infection, and bone resorption needs to be followed up.

目的 了解临沂市颅骨修补材料使用现状.方法 选择临沂市27家医院,通过电话联系、发放调查问卷等方式获得其基本资料,统计分析2011-2015年各单位行去骨瓣减压术例数、颅骨缺损成形术例数及应用材料,自体颅骨保存条件及使用方法.结果 近5年中,16家医院共行开颅去骨瓣减压手术3 613例次,行颅骨缺损成形术1 984例次,其中应用自体颅骨1 136例次(占57.26％),应用钛网795例次(占40.07％),应用骨水泥复合材料53例次(占2.67％).自体颅骨使用率呈下降趋势,钛网的使用率呈上升趋势.结论 保存自体颅骨的医院逐渐减少,其使用率呈下降趋势,钛网使用率呈上升趋势.

目的 探讨采用细孔钻颅血肿清除术微创治疗老年人创伤性脑内血肿(ICH)的临床疗效.方法 采用回顾性病例系列研究,分析采用细孔钻颅血肿清除术治疗老年ICH患者的临床资料.本组共纳入35例,均在局麻下行细孔钻颅微创血肿清除术,对患者的血肿变化、意识状态、凝血指标、手术效果、并发症及早期预后进行评价,分析影响老年ICH预后的相关因素.结果 35例伤后24 h内复查头颅CT,均显示在首次CT脑挫裂伤的基础上有ICH形成,其中17例血肿进展性增大.入院时格拉斯哥昏迷评分(GCS)中位数为11(9,14)分,术前为10(7,12)分,差异有统计学意义(P<0.05).术后随访显示预后良好者24例,预后不良者11例,校正的χ2检验显示,入院及术前GCS低与预后不良相关(P<0.05).结论 部分老年人ICH病程表现为进展性,但其中大部分患者在血肿增大的过程中并无明显意识水平的降低.行细孔钻颅微创血肿清除术能有效地清除血肿,在意识水平好的患者可获得良好的临床疗效.

Objective To observe and the clinical characteristics in children with acute traumatic bi-lateral eip dural hematomas,analyze the formation mehc ansi ms and explore the early diagnso is strategies and effective surgical treatment methods.Methods From August 2004 to December 2013,21 cases(17 males,4 females) of pediatric patients with acute traumatic bilateral epidural hematomas were treated in our hospital, and the clinical materials,imaging data and prognosis were summarized and analyzed.Results The 21 pedi-atric patients were aged from 4 months to 16 years,the mean ga e was 6.88 years.Bilateral single epidural hematoma across the superior sagittal sinus was found in 5 cases,bilateral double or more hematomas in both sides of the midline were observed in 16 cases.Initial CT scan showed simultaneous bilateral hematomas in 12 cases;while in 9 cases of bilateral hematomas were found with a delayed onset by the reviewed CT.The admitting glasgow coma score was between 13-15 in 8 cases,9-12 in 11 cases and 3-8 in 2 cases.Surgi-cal treatment was performed in 8 cases,including 7 cases with bilateral operations and 1 case with unilateral operation.Thirteen cases were managed consevr atively.Exec pt one death case, all other children were well er covered to normal lives.Conclusion Delayed contra-lateral epidural hematomas following evacuation of a prior EDH can lead to poor outcome because of usually delayed discovery.Early dynamic CT scans can detect bilateral epidural hematomas and observe their changes in time.Early detectiona nd prompt individual treat-ment should be applied in children with bilateral epidural hematomas to get good prognosis.

胼胝体在颅内作为连接两侧大脑半球的主要神经纤维，具有众多重要的功能，各种原因导致的胼胝体部位损伤可能是颅脑创伤或脑血管疾病导致患者长时间昏迷、致残、致死以及神经内分泌功能紊乱的重要原因［1］，故认识胼胝体损伤有重要临床意义。但胼胝体损伤临床表现复杂多样且缺乏特异性，临床诊断较为困难，需要现代神经影像技术为临床提供有价值的诊断信息，以达到早期确诊并判断损伤严重程度。近年来随着胼胝体损伤的报道逐渐增加，对胼胝体损伤有了更深入的认识，使得更多的患者可获得及时准确的诊断。

Objective To investigate the alterations of serum cortisol (COR), corticosteroid-binding-globulin (CBG) and free cortisol (FC) after acute traumatic brain injury (TBI) emergency operation, and to find out the influence of emergency craniotomy to COR.Methods All patients were randomly selected, 29 of which were treated conservative-ly (conservative group) and 26 were treated surgically (surgical group).COR and CBG were measured; FC was calculated from COR and CBG.COR levels were compared between conservative and surgical groups, and between pre-operation and postoperation in surgical group.Results After acute TBI, the preoperation COR level in surgical group was higher than that in conservative group (P<0.05); in surgical group, COR level decreased after operation (P<0.05);COR was of the same level between two groups after treatment (P>0.05).FC levels were relatively stable in different conditions (P>0.05).Conclusion Following acute TBI, emergency operation can alleviate stress reaction to keep the stability of neuroendocrine.Bio-active FC preserves relatively stable in perioperative period to maintain nor-mal physiological function.

Objective To investigate the clinical effect of performing external ventricular drainage using the rapid pore drilling method in acute severe primary brain injury patients.Method A retrospective study of the clinical data of 42 acute severe primary brain injury patients that underwent the rapid pore drilling method.Results There were 29 cases (69％) where ADL level achieved improvement (level Ⅰ ～ Ⅲ),6 (14％) cases of severe disability (levelⅣ ～ Ⅴ),and 7 (17％) cases of death.The mortality of patients with a GCS score of 3 ～5 was 25％.Conclusions The process of Dandy's drilling skull must be operated in the operating room.It may take around 60 minutes to finish the entire procedure.However,the rapid pore drilling method only takes about 3-5 minutes.It is an effective method that could decrease the ICP rapidly in acute severe primary brain injury patients.It could also reduce the disability rate and death rate.Therefore,the rapid pore drilling method could be an effective therapeutic method in acute severe primary brain injury.

Objective To investigate the changes in cortisol (COR) secretion in the acute phase of traumatic brain injury (TBI) .Method Seventy-five patients admitted to the hospital at 2-24 h after TBI were divided into 3 groups based on the Glasgow Coma Scale score: mild TBI group (group TBI1, n = 30), moderate TBI group (group TBI2, n = 12) and severe TBI group (TBI3, n = 33). Thirteen patients with cervical spondylosis or osteoma of the skull (admitted to the hospital at the same period) were regarded as control group (group C). Venous blood samples were taken on the first day after admission to measure the serum concentrations of total COR, adrenocorticotropin (ACTH) and corticosteroid-binding globulin (CBG). Free COR concentrations and free COR index were calculated. High blood COR was recorded. Result Compared with group C, the serum concentrations of total COR and ACTH, free COR levels and free COR index were significantly increased in TBI1, TBI2 and TBI3groups (P ＜ 0.05). The parameters mentioned above were significantly higher in TBI2 and TBI3 groups than in TBI1 group ( P ＜0.05). There was no significant difference in serum CBG concentrations among the four groups.The incidence of high blood COR was significantly higher in TBI1, TBI2 and TBI3 groups than in C group, and in TBI3 group thanin TBI1 and TBI2 groups (P ＜0.05). Conclusion COR secretion is increased in the acute phase of TBI and the level of COR secretion is related to the severity of brain damage.

恶性大脑中动脉梗死(malignant middle cerebral artery infarction,mMCAI)是由大脑中动脉主干阻塞所致的大面积脑梗死,梗死的范围为大脑半球中3/5,由于脑组织损害范围较大,临床上除表现脑梗死的症状外,还伴有严重的意识障碍和急骤的颅内压增高.对于部分mMCAI的患者,经积极内科治疗后病情仍进行性加重发生脑疝而死亡,去骨瓣减压术可明显降低经内科治疗无效的mMCAI患者的死亡率和致残率,是常规内科治疗的必要补充[1].我科采用改良标准外伤大骨瓣减压术治疗mMCAI26例,效果良好,报告如下。

患者 男,20岁,工人,因骑摩托车跌伤后头痛、恶心12 h入院.查体:神志清,精神差,瞳孔无异常,左额颞顶肿胀,头皮裂伤,皮下有波动感,可触及颅骨凹陷;左耳听力差,外耳道未见流血;颈部活动稍受限,上颈部压痛.头部CT示左额颞顶硬膜外血肿伴颅内积气,左额颞顶多发颅骨骨折:左额颞蛛网膜囊肿。

Objective To observe the MRI features of traumatic brainin jury to corpus callosum and provide valuable diagnostic information for clinical application. Methods Clinical and radiological data were retrospectively analyzed in 20 MRI-diagnosed patients as having traunmtic brain mjury to corpus callosum. Results Traumatic injury to corpus callosum was rather rare in brain trauma.Most traumatic injury to corpus callosum was non-hemorrhagic and its lesion mainly laid at its body or splenium,sometimes at genu,but rarely at rostrum.Traumatic injury to corpus callosum,being one of the common manifestations in diffuse axonal injury(DAI), could be demonstrated slight hyperintense signal on TI WI and T2WI in early phase.The injury site shrank and liquefaction necrosis appeared in the lesion at the late-mid-injured period with softened focus or gliai scar.MRI showed hyperintense T1 and T2 signal, similar to the signal of the cerebrospinal fluid and demonstrated ventriculomegaly in the corresponding parts.DWI showed hyperintense signal in the lesion in acute and subacutc stages:with time prolonged,isointense signal of the normal brain tissue was found and signal of the cerebrospinal fluid appeared in the present of softened focus.Conclusion Attention should be paid to the traumatic injury to corpus callosum,an indicator for severe trauma or disease.MRI,a sensitive and multi-directional imaging,is superior in detecting non-hemorrhagic injury to the corpus callosum.

目的总结中枢神经细胞瘤的诊治经验。方法对12例中枢神经细胞瘤患者的临床资料作回顾性分析。结果患者多以不同程度高颅压起病,CT、MRI检查可见患者Monro孔区存在可强化的占位性肿块,光镜结合免疫组化检查证实为中枢神经细胞瘤。手术全切8例,次全切除3例,大部切除1例,无手术死亡;术后行颅脑局部放疗。结论中枢神经细胞瘤有较特异的临床、影像及病理特征,据此术前多可作出诊断。手术联合放疗治疗效果较好。

Objective To discuss the emergency treatment of acute bilateral epidural hematomas(BEHs) striding over superior sagittal sinus(SSS).MethodsA retrospective analysis was done in 10 cases of EDHs striding over SSS hospitalized between January 2005 and December 2006.ResultsNine patients were operated and one was treated nonsurgically.Their hospital stay was seven days to three months.The follow-up was three to 12 months.Eight patients recovered well,one became a plant man and one died.ConclusionBilateral epidural hematomas striding over SSS are rare emergency,the patients' conditions may deteriorate rapidly which need early detection and in-time management.

Objective To investigate serum ACTH,total cortisol,corticosteroid-binding-globulin(CBG) and free cortisol and their circadian changes in craniocerebral trauma. Methods Serum ACTH,total cortisol,and CBG in 32 patients were measured by chemical illuminate and radioimmunoassay,free cortisol was calculated by Coolens equation and analyzed by cross-sectional study. Results The ACTH,total cortisol,CBG and free cortisol in the patients were mostly within normal range;circadian changes of ACTH and total cortisol existed,but CBG and free cortisol were not involved. Conclusion Following craniocerebral trauma,the levels of ACTH,total cortisol,CBG and free cortisol in most patients remain within normal scope;pituitary-adrenal function remains complete;ACTH and total cortisol show day-night rhythm changes,while about 50% of patients may present different-type abnormal cortisol secretion.

Objective To explore the changing rule and clinical significance of the abnormal cortical secretion resulted from traumatic brain injury (TBI). Methods The serums from 55 TBI patients and 13 normal persons were collected to measure the level of secreting total cortisol (Cor) , adrenocorticotropin (ACTH) and corticosteroid-binding-globulin (CBG) by using radioimmunoactive assay and chemiluminescent immunometric assay. In the meantime, the free cortisol (FC) and free cortisol index (CI) were calculated by using Coolen formula. Results CBG maintained stable, while Cor and other hormones were increased significantly with the severity of TBI. Surgical operation could release the stress partially without disturbing the secretion of hormone. The more quickly the serum hormone decreased, the better prognosis the patients would have. The lower level of Cot could result in poorer prognosis. Conclusions TBI can result in a higher level of Cor as well as other hormones in the serum. The prognosis is poor in patients with a persistent high or low level of Cor. It should be cautious to supply large volume of cortisol at the early phase of TBI.

患者 女性,22岁,宫内妊娠22周,因入院前2d夜间睡眠时癫痫全面强直一阵挛发作于2005年6月1日入院.

皮质醇(cortisol,COR)作为内源性糖皮质激素(Glucoconicoids,GCs)的主要激素,是维持内环境稳态所必需的应激因子.