目的 研究临床早期小骨窗开颅治疗高血压基底节区脑出血的应用价值.方法 将2015年1月至2021年1月神经外科手术治疗的高血压基底节区脑出血患者116例随机分为2组,每组58例.对照组使用传统大骨瓣开颅手术,观察组使用早期小骨窗开颅手术,比较2组血肿清除率及再出血率、各项手术及恢复指标、临床疗效、并发症发生率、术后日常生活能力.结果 观察组消除血肿率高于对照组,复发出血率明显低于对照组,差异有统计学意义(P<0.05),2组住院期间死亡率比较差异无统计学意义(P>0.05);观察组手术指标包括住院时间、住院费用明显少于对照组,术后GCS评分、MMSE评分较对照组优良,差异有统计学意义(P<0.05);观察组治疗有效率为94.83％,明显高于对照组的79.31％,差异有统计学意义(P<0.05);观察组术后机体感染并发症发生率明显低于对照组(P<0.05);观察组术后4周ADL分级Ⅰ级、Ⅱ级比例、预后良好率明显高于对照组,Ⅲ～Ⅴ级比例明显低于对照组(P<0.05).结论 早期小骨窗开颅能够提高血肿清除率,再出血率低,并发症发生率低,恢复效果好,有助于神经功能的恢复和改善预后,是一种高效、安全的术式选择.

目的 对急性基底节出血患者血清铁蛋白(SF)、骨桥蛋白(OPN)及细胞纤维连接蛋白(cFN)水平分布特征进行分析,并讨论其对预后的影响.方法 选取2015年1月至2016年6月该院急性基底节出血患者50例作为急性基底节出血组,同期就诊的其他类型急性脑出血患者68例作为对照组.收集两组受试对象一般情况,采用酶联免疫吸附法(ELISA)检测血清中SF、OPN及cFN水平,并嘱患者在出院2年后进行入院随访;研究分析急性基底节出血患者SF、OPN及cFN水平分布特征,并讨论其对随访不良预后的影响作用.结果 急性基底节出血组SF水平为(44.28±2.47)μg/L、OPN水平为(12.03±3.66)ng/mL,cFN水平为(3.22±0.70)ng/mL,均高于对照组,差异有统计学意义(P<0.05).急性基底节出血组预后不良患者中SF、OPN及cFN水平异常的例数均显著多于正常的例数,差异均有统计学意义(P<0.05);生存分析曲线结果显示,SF、OPN及cFN高水平患者出现预后不良事件(死亡、神经功能中度缺损)的时间普遍提前.结论 急性基底节出血患者的SF、OPN及cFN水平与病情和预后存在关联,可在临床上指导患者诊疗.

Objective To evaluate the feasibility and safety of supratotal resection of frontal or temporal lobe glioblastoma by the postoperative cognitive function and overall survival. Methods The clinical data of patients with frontal or temporal lobe glioblastoma and treated from January 2010 to January 2015 were analyzed retrospectively.The patients underwent supratotal resection of glioblastoma after March 2012(trial group, 33 cases). Before March 2012, the patients underwent total resection of glioblastoma(control group,28 cases).The Montreal cognitive assessment(MoCA)scores before operation and the 7th day after operation were used to evaluate the security, while overall survival was used to evaluate the feasibility. Variance analysis of repeated measurement quantitative data was used for the statistical analysis of the results. Multivariate Cox model was used as a method to estimate the independent association of a variable set with overall survival. Survival time observation was plotted by the Kaplan-Meier analysis,starting from the data of surgery.Results The MoCA scores in control group at the 7th day after operation were significantly lower than those before operation:(25.39 ± 3.04)scores vs.(26.67 ± 2.19)scores, t = 4.446,P < 0.05. The MoCA scores in trial group at the 7th day after operation were significantly lower than those before operation:(21.93 ± 4.46)scores vs.(25.39 ± 3.04) scores,t = 3.485,P < 0.05. The survival analysis of Kaplan-Meier method showed that age, surgical method and preoperative KPS scores were statistically significant (P < 0.05). Cox regression analysis showed that the choice of surgical method and preoperative KPS was 0.286 and 0.965,respectively.The risk of death in control group was 0.286 times of that in trial group.The survival time of trial group was better than that of control group.Conclusions The cognitive function of patients with frontal or temporal glioblastoma may have a certain degree of decline after tumor resection or supratotal resection.Supratotal resection could represent a promising strategy that can impact on outcome in glioblastoma patients. Supratotal resection could be a factor influencing survival.

Objective To examine the clinical factors associated with postoperative outcome in dementia combined with cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-ICH). Methods The clinical data of 25 surgical patients of dementia combined with CAA-ICH were retrospectively analyzed. The postoperative short-term effects and long-term effects were evaluated at the 30 d and 6 months after operation according to the modified Rankin score (MRS), and the influencing factors were analyzed. Results Among the 25 patients, eusemia was in 6 cases. Age ≥ 75 years, Glasgow coma score (GCS) ≤ 8 scores on admission, hypertension, postoperative anemia, pulmonary diseases, midline shift were the influencing factors of postoperative short-term effects (P < 0.05 or <0.01). Twenty-two patients were followed up for 6 months, and ensemia was in 9 cases. Age≥75 years, GCS ≤ 8 scores on admission, hypertension, postoperative anemia, hypoproteinemia and pulmonary diseases were the influencing factors of postoperative long-term effects (P<0.01 or<0.05). Conclusions Preoperative assessment is important for the patients of dementia combined with CAA-ICH. Age ≥ 75 years, GCS ≤ 8 socres on admission, hypertension, postoperative anemia, pulmonary diseases, midline shift are associated with poor short-term effects; age ≥ 75 years, GCS ≤ 8 scores on admission,hypertension, postoperative anemia, hypoproteinemia and pulmonary diseases are associated with poor long-term effects.

鞍区病变的手术治疗,对于神经外科医生来说仍是个挑战.额底纵裂是鞍区病变常见手术入路之一[1-4].前交通动脉复合体(ACoAC)为该区域十分重要的结构,其中尤以前交通动脉(anterior communicating artery,ACoA)变异最多.因此掌握这一手术入路下前交通动脉的结构变异显得尤为重要.本研究模拟额底纵裂入路对于前交通动脉的解剖变异及穿支动脉进行研究,为临床应用提供形态学资料.

<正>显微神经外科和影像学技术的发展可提高颅内疾病的治愈率。对于第三脑室和鞍区疾病,如三脑室肿瘤、前交通动脉瘤、颅咽管瘤、鞍结节脑膜瘤等采用额底纵裂入路处理鞍区病变的优势日益受到神经外科医生的青睐[1]。关于额底纵裂的解剖学研究国外也有相关报道[2-3]。因此本入路的解剖学研究显得十分的重要,可以为临床手术提供相应的理论依据。

软骨瘤是起源于透明软骨的良性肿瘤.患者的发病年龄在20～60岁,高峰在20～30岁[1],平均年龄29岁.无性别差异[1,2],但也有文献报道女性患者稍多于男性[3].