目的 探讨脑室镜下脑室-囊肿-脑池造瘘术(VCC)治疗儿童鞍上蛛网膜囊肿(SACs)的临床治疗及疗效评估方法.方法 回顾性分析2017年5月—2021年11月首都儿科研究所附属儿童医院神经外科收治的SACs患儿的临床资料,患儿术前均行头CT平扫、头MRI平扫及矢状位磁共振三维稳态进动快速成像序列(3D-FIESTA)评估,根据术前影像及术中所见将SACs分为两种类型:Ⅰ型基底动脉位于囊肿内,Ⅱ型基底动脉位于囊肿下方.手术方式均采用脑室镜下VCC.患儿于术后1周、1个月、3个月、6个月及1年行头颅MRI平扫和矢状位3D-FIESTA序列,评估脑室大小变化情况、囊肿变化情况及脑脊液通路改善情况.结果 共纳入8例患儿(年龄1.5个月～3岁10个月).8例SACs中7例Ⅰ型,1例Ⅱ型.8例患者均顺利完成VCC.无手术死亡及术后感染患者.术后平均随访时间36个月.术后2例患者出现短期轻微硬膜下积液,均在1个月内自行消失.术后3D-FIESTA序列示囊肿均明显减小或消失,中脑导水管及双侧室间孔均通畅,造瘘口通畅.6例患者术后脑积水症状消失,脑室缩小,术前症状消失.2例患者术后脑积水未缓解,1例术后1个月行内镜探查术见造瘘口通畅即行脑室腹腔分流术,1例于术后3个月行脑室腹腔分流术.2例脑积水未缓解患者虽然经分流治疗,但均有不同程度的发育落后.结论 脑室镜下VCC治疗SACs微创且有效,磁共振3D-FIESTA序列可清晰评估囊肿术前及术后情况.

Objective:To describe the clinical outcomes of a cohort of consecutive pediatric moyamoya patients of ischemic type undergoing modified EDAS (encephaloduroarterio-synangiosis).Methods:A retrospective study was conducted on the clinical and radiographic data of 26 patients with moyamoya disease consecutively admitted to Department of Neurosurgery, Children′s Hospital Affiliated to the Capital Institute of Pediatrics in the period from June 2016 to June 2019. The 26 children underwent superficial temporal artery EDAS, superficial temporal artery (STA) EDAS with bilateral frontal encephalogaleoperiosteal synangiosis (EGS), or occipital artery EDAS combined with multiple burr-hole (MBH). During operation, the arachnoid membrane over the M4 segment of MCA was opened under the pathway of arterial band and dural inversion was performed. Neurological function outcomes after the operation were evaluated according to the modified Rankin Scale (mRS).Results:Among 26 patients with ischemic momyamoya disease, 12 underwent bilateral. A total of 39 surgical procedures were performed and included 37 procedures of superficial temporal artery EDAS, 1 procedure of superficial temporal artery EDAS combined wih bifrontal EGS, and 1 procedure of occipital artery EDAS combined with MBH. One patient developed subcutaneous and intracranial hematomas postoperatively which were resolved by pressure dressing. There was no perioperative death. The follow-up duration of the children was 17.1±1.3 months (3-39 months). Out of 39 procedures, 38 led to the results of TIA (transient ischemic attack)-free or improvement of ischemic stroke without new infarction during 2 months post operation. There was no symptomatic improvement in 1 procedure, and the effectiveness of the operation was 97.4% (38/39). The mRS scores of 26 patients in 3 months after surgery were all scored ≤ 2 points. A total of 29 cases of vascular imaging follow-up examination at 3 months post surgery showed that the branches of the external carotid artery provided blood supply to the brain tissues, consisting of STA (or occipital artery) plus middle meningeal artery (MMA) in 26 cases and merely MMA in 3 cases.Conclusion:Modified EDAS is a safe and effective procedure for ischemic pediatric moyamoya disease, which could increase blood supply region, enhance the effective rate of cerebral vascular reconstruction and thus improve the neurological functions of the patients.

Objective To investigate the clinical characteristics of intracranial tuberculoma and its diagnosis and outcomes of surgical treatment.Methods In this retrospective study,clinical data including manifestations,imaging,laboratory tests and surgical outcomes of 8 adults were analyzed who were consecutively identified with intracranial tuberculoma from August 2013 to April 2016 at Department of Neurosurgery,Beijing Ditan Hospital,Capital Medical University.Results Among the 8 patients with intracranial tuberculoma,the human immunodeficiency virus (HIV) infection was identified in 4 cases and tuberculosis (TB) involving other systems was found in 3 cases.Out of the 8 patients,lesions were supratentorial in 5 cases and located in posterior fossa of the remaining 3 cases.Seven cases underwent total resection and stereotactic biopsy was performed in 1 case.Pathological acid-fast stain demonstrated positive results and confirmed the diagnosis of tuberculoma.All the patients were regularly treated with antituberculosis drugs.One case died from HIV-related complications 1 year post operation and the rest recovered well.Conclusions The clinical characteristics of intracranial tuberculoma vary depending on its location.The supratentorial tuberculoma commonly caused epilepsy and headache and the subtentorial lesion often presented with symptoms related to high intracranial pressure due to hydrocephalus.The diagnosis should be based on a combination of clinical manifestations,imaging features,laboratory examination and antituberculosis efficacy.With strict following of its indications,surgical treatment might be effective.

Objective To study treatment strategy and efficacy of skull deformity resulted from ossified cephalhematoma for infant.Methods This retrospective study involved 4 infants with skull deformity resulted from ossified cephalhematoma who were underwent treatment in neurosurgery center of Children`s hospital affiliated to the capital institute of pediatrics from March 2016 to November 2016.Ossified cephalhematoma with thick wall was underwent skull plastic surgery.And ossified cephalhematoma with thin wall was underwent puncture aspiration.Result 3 cases with thick wall were underwent skull plastic surgery and 1 infant was underwent puncture aspiration.3 cases underwent skull plastic surgery achieved wonderful skull contour and all of them suffered from postoperative transient fluid collection under skin.Most of the hematoma was extracted and skull deformity was corrected in the aspiration case.No patient suffered from postoperative infection and neurologic impairment.Conclusion Infant ossified cephalhematoma with thick wall could be treated by skull plastic surgery and will obtain good effect.Postopetative fluid collection under skin should be prevented.For the thin wall cases puncture aspiration and pressure dressing could be selected and the result is satisfied.

Objective To discuss strategy of microsurgical treatment and efficacy of dumbbell neuroblastoma (NB) with intraspinal extension at cervical,retroperitoneal and pelvic locations.Methods This retrospective study involved 6 patients with dumbbell NB with intraspinal extension who underwent operation at Department of Neurosurgery,Children's Hospital Affiliated to Capital Institute of Pediatric,from June 2016 to January 2017.It included 3 cases located in pelvic cavity invading spinal canal via anterior sacral foramen,2 cases in retroperitoneal region invading spinal canal via lumbar intervertebral foramen and 1 case in anterior cervical region invading spinal canal via cervical intervertebral foramen.Resection through single posterior extensive approach was conducted for retroperitoneal dumbbell NB.Posterior and anterior approaches were taken for one-or two-stage resection of tumors in the cervical and pelvic region,respectively.All patients underwent laminotomy and restoration.For the cases with vertebral plate thickness of less than 5 mm and not suitable for fixation by titanium nail and plate,we cut cephalic supraspinous and interspinous ligaments and reserved caudal ligament.The cut ligaments were sutured post tumor resection.Results One-stage resection was performed in 2 cases in retroperitoneal region.Among the 3 pelvic cases,1 underwent one-stage excision and the other 2 cases received two-stage operation.The 1 case with cervical NB underwent two-stage resection of tumor.Postoperative MRI showed subtotal resection in 4 cases in which the residual tumor tissues were mainly located at anterior sacral foramen or intervertebral foramen and total resection in 2 other cases.The follow-up time was from 3 to 10 months.Recurred was reported in 1 case 3 months post operation and no recurrence occurred in the other 5 cases.Conclusions Different operative strategies are needed for dumbbell NB with intraspinal extension and varying locations.There tends to be slight amount of residual tumor tissues at bone foramens that dumbbell NB invade.

目的 探讨神经电生理监测下成熟型脊髓畸胎瘤的显微外科手术治疗效果.方法 回顾性分析在神经电生理监测下经显微外科治疗的7例脊髓畸胎瘤病人的临床资料,同时复习相关文献.结果 1例脊髓圆锥处肿瘤予以大部分切除,3例原发于终丝的肿瘤予以全切,余3例均予以近全切除.病理诊断均为成熟型脊髓畸胎瘤,术后随访3～38个月,症状明显改善6例,无改善1例.术后McCormick分级:Ⅰ级4例,Ⅱ级2例,Ⅲ级1例.结论 在神经电生理监测下最大程度切除成熟型脊髓畸胎瘤,有助于减少手术损伤,改善病人预后.

Objective To analyzes the lumboperitoneal shunt in the treatment of AIDS complicated with cryptococcus neoformans meningitis caused by non-hydrocephalus high intracranial pressure .Methods From October 2011 to December 2014 , 12 AIDS patients complicated with new cryptococcus neoformans meningitis caused by non -hydrocephalus and increased intracranial pressure were enrolled , with medical conservative treatment to reduce intracranial pressure invalid , used lumbo-peritoneal shunt for treatment and at the same time with regular anti fungal treatment , the curative effect were followed up .Re-sults 12 patients were 11males and 1 female, aged 18 to 45 years, median age was 26 years old, the course of disease was 3 d to 1 month.12 cases were found with increased intracranial pressure symptoms , among them,10 cases with headache , dizziness in 8 cases, 8 cases with anorexia and nausea , frequent vomiting in 1 cases, diplopia in 2 cases, hearing loss in 3 ca-ses, decreased visual acuity in 8 cases;8 cases with intermittent , median or low fever;psychiatric symptoms in 1 case.After lumbar peritoneal shunt treatment , high intracranial pressure symptoms disappeared in 9 cases, 3 cases were improved, and without causing cryptococcus neoformans infection spread .Conclusion Lumboperitoneal shunt can significantly improve clini-cal symptoms of AIDS patients complicated with cryptococcus neoformans meningitis caused by non -hydrocephalus high in-tracranial pressure .

多形性黄色瘤型星形细胞瘤(pleomorphic xanthoastrocytoma,PXA)是一种少见的中枢神经系统肿瘤,占颅脑肿瘤的1％,在1979年被首次命名[1],属于WHOⅡ级肿瘤[2-3].本病好发于年轻患者,无性别差异,多以癫痫起病,亦可以高颅压、局灶定位体征起病,主要发病于大脑半球,尤以颞、顶叶多见,其他部位发病者罕见,CT、MRI表现多为囊性肿瘤伴壁结节或实性肿瘤伴瘤内囊性变[4-7].2014年3月首都医科大学附属北京地坛医院神经外科确诊1例PXA患者,生长部位及CT、MRI表现少见,现报告如下。

Objective To explore the clinical features and treatments of spinal myxopapillary ependymoma( MPE).Method The clinical features,treatments and prognosis of 11patients with primary or recurrent spinal MPE treated with microneurosurgical technique at a single institution from 2010 to 2012 were analyzed retrospectively. Results In this serial,gross total removal was achieved in 3 cases,subtotal removal in 6 cases,gross removal in one case,and partial removal in one case.A total of 17 operations were performed on 11 MPE patients. Seven patients received radiotherapy and two patients received chemotherapy.The mean follow - up period was 38.1months.All patients survived during follow - up period. Two patients developed tumor local recurrence and two patients developed tumor disseminated recurrence requiring reoperations.Conclusions MPEs are likelihood for tumor local and disseminated recurrence.Gross total removal of the tumor is the most effective for the treatment of MPE. Postoperative radiotherapy to residual or unresectable tumors is recommended.