1 病例资料 65岁男性,因鞍区脊索瘤术后10年伴头痛及视物模糊1年余入院.10年前,因头痛伴左眼疼痛、视物模糊行头颅MRI示鞍区占位,行经鼻蝶入路鞍区占位切除术,术后头痛及眼部疼痛症状消失,术后病理示脊索瘤,术后行放疗(具体不详),但未定期复查头颅MRI.

Ethanol metabolism can induce modifications in liver metabolic pathways that are tightly regulated through the availability of cellular energy and through the redox state. Since partial hepatectomy (PH)-induced liver proliferation requires an oversupply of energy for enhanced syntheses of DNA and proteins, the present study was aimed at evaluating the effect of acute ethanol administration on the PH-induced changes in cellular redox and energy potentials. Ethanol (5 g/kg body weight) was administered to control rats and to two-thirds hepatectomized rats. Quantitation of the liver content of lactate, pyruvate, β-hydroxybutyrate, acetoacetate, and adenine nucleotides led us to estimate the cytosolic and mitochondrial redox potentials and energy parameters. Specific activities in the liver of alcohol-metabolizing enzymes also were measured in these animals. Liver regeneration had no effect on cellular energy availability, but induced a more reduced cytosolic redox state accompanied by an oxidized mitochondrial redox state during the first 48 hr of treatment; the redox state normalized thereafter. Administration of ethanol did not modify energy parameters in PH rats, but this hepatotoxin readily blocked the PH-induced changes in the cellular redox state. In addition, proliferating liver promoted decreases in the activity of alcohol dehydrogenase (ADH) and of cytochrome P4502E1 (CYP2E1); ethanol treatment prevented the PH-induced diminution of ADH activity. In summary, our data suggest that ethanol could minimize the PH-promoted metabolic adjustments mediated by redox reactions, probably leading to an ineffective preparatory event that culminates in compensatory liver growth after PH in the rat.

1病例资料 17岁女性,因背部肿物渐进性增大半年余入院.半年前发现背部正中隆起肿物,质韧,约"花生米"大小,肿物渐进性增大.入院体格检查:背部胸6～7椎体水平可触及肿物,大小约6 cm×4 cm,质韧,边界尚清楚,与后方胸椎黏连,活动度差,触之无压痛,无皮肤红肿;四肢肌力5级,肌张力正常.

Objective To explore the value of hybrid surgery in children with cerebral arteriovenous malformation (CAVM). Methods Nineteen cases of pediatric CAVM from December 2015 to December 2019 were included. After the preoperative enhanced MRI and CTA, MRA or DSA examination confirmed the diagnosis, the hybrid surgery (craniotomy combined with endovascular embolization and intraoperative real⁃time DSA) were performed. Operative time, intraoperative blood loss, hospital stays and perioperative complications were recorded. The modified Rankin Scale (mRS) was used to evaluate prognosis 6 months later after surgery. Results In 19 CAVM cases, 2 cases were Spetzler ⁃ Martin grade Ⅰ, 5 cases were grade Ⅱ, 7 cases were grade Ⅲ and 5 cases were grade Ⅳ, and 4 cases dense type, 4 cases intermediate type and 11 cases diffuse type. The average operative time was (307.21 ± 115.64) min and intraoperative blood loss was 150 (100, 260) ml. Intraoperative endovascular embolization was performed in one case, the DSA after CAVM resection revealed 3 cases with residual malformations, and the final DSA cure rate was 100% (19/19). One patient presented with transient nominal aphasia, one with left limb hemiplegia, one with pulmonary infection, and one with epileptic seizure. Average hospital stays was (15.74 ± 5.04) d, followed ⁃ up time was 32 (20, 40) months. Sixteen patients had good prognosis (mRS score < 2), and 3 patients had poor prognosis (mRS score ≥ 2). There were no cases of rebleeding or recurrence. Conclusions Hybrid surgery can safely and effectively improve the cure rate of CAVM in children, especially for children with complex structure and diffuse type or with previous treatment. DOI：10.3969/j.issn.1672⁃6731.2020.04.009

三叉-心脏反射是一种脑干反射,由Schaller等于1 999年首次报道,典型的临床表现为:三叉神经的任一感觉支受刺激,出现心率变慢,血压下降,有时伴有呼吸暂停或胃肠蠕动增强等.本文报道1例蝶骨嵴内侧型脑膜瘤术中出现三叉-心脏反射. 1病例资料 46岁女性,因头痛头晕伴恶心呕吐、视物模糊半个月入院.既往无高血压、心脏病、脑血管病等病史.入院体格检查:心律84次/min,血压125/65 mmHg,未见明确神经系统阳性体征.心电图示:窦性心律,正常心电图.头颅增强MRI示:左侧蝶骨嵴内侧型脑膜瘤,与左侧海绵窦外侧壁关系紧密.全麻下行左侧翼点入路脑膜瘤切除术,用瑞芬太尼及丙泊酚进行麻醉诱导.麻醉状态下,病人心率60次/min,有创动脉压135/80 mmHg.术中牵拉海绵窦外侧壁肿瘤时,病人心率下降至40次/min,下降比例33％;血压下降至95/55mmHg,下降比例30％.暂停手术20 s后,心率及血压恢复至正常.同样力度再次牵拉外侧壁肿瘤后,病人再次出现心率及血压急剧下降,暂停手术刺激后,心率及血压恢复正常.

患者男,65岁,主因"突发左侧肢体无力2 d",于2018年2月22日收入首都医科大学附属北京友谊医院神经外科。入院体格检查:左侧肢体肌力Ⅴ - 级,肌张力偏高,神经系统其他检查未见异常。既往史:高血压病史10余年,平时血压控制在125/70 mmHg左右。既往多次发生短暂性肢体麻木。患者口服阿司匹林后有呕血症状。头部CT平扫示,右侧颞叶占位（图1）,肿瘤卒中可能。头部增强MRI示,右侧颞叶占位,血肿可能,右侧基底节区近期脑梗死（图2）。

Object Congenital arteriovenous fistula involving the external carotid system is rare.Methods This paper reports a case of congenital external carotid artery-external jugular vein arteriovenous fistula admitted to Xuanwu Hospital, and reviews the literature.Results The patient was a boy, 9 years old, with a history of pulsatile mass and thrill in the right neck since his birth. External carotid artery-external jugular vein fistula was confirmed by the digital subtraction angiography. And coil embolization was done later. Postoperative immediate angiography confirmed the complete occlusion of the fistula, and partial branch of the external carotid artery can be seen. The abnormal clinical manifestation disappeared after the procedure without any complications.Conclusion This case and relevant literatures remind us that congenital external carotid artery-external jugular vein arteriovenous fistula has its unique features, and it can be treated by coil embolization safely and effectively.

Objective To investigate the safety and effectiveness of digital subtraction angiography (DSA) in the surgical treatment of intracranial arteriovenous malformations (AVMs) in children.Methods Between December 2015 and February 2017,the clinical and imaging data of 9 children with AVM (2-14 years) underwent hybrid surgery at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.According to the Spetzler-Martin grade,there were 2 patients with grade Ⅰ,3 with grade Ⅱ,2 with grade Ⅲ,and 2 with grade Ⅳ.All the children were treated with microsurgery,and their AVMs were removed by real-time assistance using DSA technique during the operation.The imaging cure rate of surgical treatment and the complications of intraoperative angiography of the children were analyzed.The children were followed up clinically after procedure.According to the modified Rankin scale (mRS) score,their prognoses were evaluated.Results Intraoperative angiography revealed that the AVMs in 8 of 9 children were resected completely,and 1 had a residual lesion,then it was resected completely.Immediately after the resection of the nidi,the angiography confirmed that the nidi of 9 children were resected completely.No related complications caused by intraoperative angiography were observed.Nominal aphasia occurred in 1 child after procedure,and he recovered gradually after 6 months.Pulmonary infection occurred in 2 children,and they were cured after anti-infection treatments.Postoperative follow-up mRS scores were 0-1 in 8 children,2 in 1 child,and no rebleeding was observed.Conclusions In children undergoing AVM surgery,initial observation of DSA is safe and effective.Intraoperative angiography can guide the complete resection of the lesions in real time,improve the surgical cure rate of AVMs,and improve the prognosis of children.

颅内动静脉畸形( cerebral arteriovenous malfor-mation,cAVM)是儿童颅内自发性出血的最常见原因[1] ,年出血率高达2% ~4% [2] ,进而导致20% ~25%的并发症及病死率[3-5]. 因此对于儿童cAVM,国内外学者普遍建议应该采取积极的治疗策略. 目前,关于cAVM的主要治疗方式有外科治疗[6-7]、放射治疗[8-9]、栓塞治疗[10-11]或以上治疗方式的联合治疗[12-13]. 总体而言,经过积极治疗后,多数患儿可获得影像学治愈,并能得到较好的功能恢复[7,12]. 笔者现就儿童cAVM的外科治疗综述如下.