患者女，49岁，以"双手掌指关节间断疼痛伴脚后跟疼痛并行走受限"为主诉入院。无胸闷、胸痛、腹痛、腹胀等其他不适。体格检查见双下肢水肿，无压痛、肌肉萎缩或肢体畸形表现。既往曾行"阑尾切除术"，余病史无特殊。入院后血常规、血沉、尿常规、粪常规、甲状腺功能三项、血脂六项、肝功能、心肌酶谱、肾功能、电解质、凝血四项、D-二聚体、CCP、ANA、ENA、免疫全套等检验结果均无明显异常。行下肢动脉血管超声检查示双下肢动脉频谱呈低流速、低搏动改变(图1，2)，为进一步明确原因，遂继续行双侧髂动脉、腹主动脉扫查，超声提示：腹主动脉下段、右侧髂总动脉未测及(考虑：先天缺如，图3，4)；左侧髂总、双侧髂外动脉近心端管样狭窄(考虑：先天发育异常，双侧髂内动脉向髂外动脉逆向供血，图3~7)；腹主动脉残端、腹腔干、肠系膜上动脉与盆腔动脉间侧支循环形成；腹主动脉残端－左侧髂总动脉－右侧髂总动脉残端间侧支循环形成。后行腹主动脉CTA提示：腹主动脉下段(平肾动脉以下层面)、肠系膜下动脉、右侧髂总动脉未见明确显影，左侧髂总动脉仅见一纤细残端，腹盆腔内可见多支侧支血管；脾动脉走形迂曲；肠系膜上动脉中段管腔局限性增宽(图8，9)。回顾病史，患者自诉10余岁时便出现双腿乏力、运动耐受性下降，结合CTA及血管超声，考虑为先天发育异常，经外科医生会诊后，建议患者行股动脉－髂动脉支架植入术+股－股转流术，恢复下肢血供，但患者及家属选择保守治疗。

Objective To explore the influence of the type of anterior clinoidal meningioma on surgical strategy planning, surgical approach selection, and postoperative efficacy. Patients and methods We conducted a retrospective analysis of the clinical data of 63 cases, including data on visual function, extent of tumor resection, and postoperative follow-up. Grade I and II approaches were selected according to the type of tumor. A univariate analysis of the factors influencing the extent of tumor resection, postoperative visual function, and postoperative relapse and complications was conducted. Results Simpson Grade I–II total resection was seen in 48 cases (76.2%), with an overall relapse/progression rate of 12.7%. The tumor type and texture and the relationship between the tumors and adjacent structures were the main factors influencing total tumor resection (P < 0.01). The overall postoperative visual acuity improvement, stabilization rate, and deterioration rate were 76.2, 15.9, and 7.9%, respectively. Postoperative visual acuity level was significantly correlated with preoperative visual acuity level and tumor type (P < 0.01). Conclusions Determining the type of tumor at a preoperative level and whether the optic canal and cavernous sinus are invaded can aid in the planning of detailed individualized surgical strategies.

目的 观察儿童疣状血管瘤(VH)特征性超声、MRI及临床表现.方法 回顾性分析25例经术后病理证实的VH患儿,观察VH影像学及临床特征性表现.结果 25例VH患儿皮肤见不规则红色、青紫色斑块,斑块边缘皮肤呈暗红色,范围较广时呈"铠甲样"外观,周边见"卫星状"病灶.15例仅接受超声检查,体表疣状物多呈低回声、后方伴声影,深部皮下组织以高回声为主;其中10例病灶呈均匀高回声、4例高低混杂回声、1例均匀低回声;13例病灶边界不清,2例边界清晰;12例病灶内未见明显血流信号,3例见少量血流信号.10例仅接受MR检查;其中9例病灶T1WI呈低信号、脂肪抑制(FS)-T2WI呈不均匀稍高信号,1例病灶呈等TIWI信号、FS-T2WI高信号.结论 儿童VH皮肤病变多呈不规则红色、青紫色斑块,斑块边缘皮肤呈暗红色,可形成"铠甲样"外观,伴周边"卫星状"病灶;超声多表现为均匀高回声且边界不清;MRI多呈T1WI低信号、FS-T2WI不均匀稍高信号.

Objective:To investigate the differential performance of ultrasound between fibro-adipose vascular anomaly (FAVA) and venous malformations(VMs).Methods:From January 2015 to December 2020, the patients diagnosed with lower extremity FAVA by pathology in Henan Provincial People’s Hospital were enrolled as FAVA group. The patients diagnosed with lower extremity VMs by pathology were enrolled as the control group. The clinical and ultrasound imaging data were retrospectively analyzed. Through the single factor analysis of the two groups’data, the ultrasonic imaging indicators which may be valuable for distinguishing FAVA from VMs were screened. Further, the indicators valuable for differential diagnosis were determined by multi-factor Logistic regression analysis, and a multi-factor joint diagnosis model was constructed. The diagnostic efficiency of the joint diagnosis model was evaluated by the receiver operator characteristic curve (ROC curve), sensitivity, and specificity of the subjects.Results:A total of 20 patients with FAVA were involved, including 11 males and 9 females. The mean age was (18.1±12.2) years. Forty-six patients with VMs were involved, including 20 males and 26 females. The mean age was (19.9±13.6) years. Results of the single-factor analysis were differences in the lesion echo, fascial tail, blood flow, extrusion test, and posterior echo enhance characteristics between groups ( P<0.05). Multivariate analysis showed significant differences between groups in three aspects: fascial tail, extrusion test, and posterior echo enhancement ( P=0.001, 0.008, 0.007). The sensitivity and specificity of the multi-factor combined diagnosis model were 90.0% (95% CI: 68.3%-98.8%) and 93.5%(95% CI: 82.1%-98.6%), indicating high diagnostic efficiency. The ROC(AUC) area was 0.964(95% CI: 0.886-0.994), indicating high diagnostic efficiency. Conclusions:The ultrasonic imaging features of FAVA and VMs were different. The combined diagnosis of the fascial tail, compression test, and posterior echo enhancement has a higher auxiliary diagnostic value.

Objective:To explore the impact of risk grading and stratified treatment of children with medulloblastoma (MDB) on the prognosis.Methods:A retrospective analysis of the clinical data of 32 children with MDB treated by microsurgery through the cerebellar medulla oblongata approach admitted by the author from January 2011 to December 2019 was retrospectively analyzed. According to risk stratification criteria, MDB was divided into low-risk, intermediate-risk and high-risk groups, and the relationship between treatment mode, risk classification and prognosis was analyzed.Results:There were 29 cases of total resection and near total resection, and the rate of total resection and near total resection was 90.6%; 3 cases were subtotal resection. There were no deaths related to surgery and no permanent cerebrospinal fluid leakage. The follow-up time was 6-84 months, the 3-year overall survival (OS) rate was 96.9%, and the 5-year OS rate was 84.4%. The 3-year and 5-year OS rate of the low-risk group was significantly better than that of the high-risk group. The 5-year OS rate of the intermediate-risk group was 91.7%, and the 5-year OS rate of the high-risk group was only 63.6%. The combined 5-year OS rate of combined chemotherapy (ChT) and radiotherapy RT after surgery was 95.5%, and surgery alone had the worst effect, with a 3-year OS rate of only 66.7%.Conclusion:According to the risk classification of MDB, an individualized treatment plan is helpful to increase the survival rate of MDB treatment and improve the quality of life. Combining RT and ChT after surgery is of great significance to improve the prognosis.

Objective:To explore the prevention and treatment of surgical complications of anterior clinoid meningioma (ACM).Methods:The clinical data of 63 patients with ACM treated by Chen Lihua from July 1999 to June 2021 were analyzed retrospectively. On the basis of Al-Mefty classification standard, ACM was divided into 4 types. According to the preoperative imaging examination, there were 7 cases (11.1%) of type Ⅰ tumors, 39 cases (61.9%) of type Ⅱ tumors, 5 cases (7.9%) of type Ⅲ tumors and 12 cases (19.0%) of type Ⅳ tumors. According to the preoperative tumor classification, corresponding measures were taken to prevent and treat complications, and the main factors affecting postoperative complications were analyzed.Results:Twenty-five patients had different degrees of complications after surgery, iof which 13 were more serious. The main complications were vision deterioration in 5 cases (7.94%), early oculomotor paralysis in 3 cases (4.76%), light hemiparesis in 4 cases (6.35%) and intracranial infection in 1 case (1.59%). The total incidence of major complications after surgery was 20.6% (13/63), and 6.35% (4/63) for permanent complications. There were no deaths. The univariate analysis showed that the type of tumor, the size of the tumor, the grade of the relationship between tumor and vessels, and the involvement of the cavernous sinus were the main factors affecting postoperative complications.Conclusion:The total resection of ACM should take a positive and cautious attitude. According to the characteristics of different types of ACM, making a detailed surgical plan and using appropriate surgical techniques during the operation are the guarantee of reducing surgical complications and improving the overall prognosis.

目的 研究前床突脑膜瘤(ACMs)的临床和影像学特征,以及手术效果与影像学分型的关系.方法 回顾性分析63例ACMs患者的临床资料,对其临床和影像学表现、肿瘤分型进行分析.患者术前均接受眼科检查评估.结果 本组患者的症状以视觉功能障碍最多(49例,77.8％),其中单侧视力下降者占71.4％;以视觉功能障碍为首发症状者占61.9％;视野缺损者占33.3％,其中单侧视野缺损占30.2％,双侧视野缺损仅有3.2％.视神经管受侵袭与术前视力缺损有明显关系.ACMs影像学分型:Ⅰ型7例(11.1％),Ⅱ型39例(61.9％),Ⅲ型5例(7.9％),Ⅳ型12例(19.1％).肿瘤累及海绵窦者9例(14.3),侵袭视神经管22例(34.9％);包绕前循环动脉39例(61.9％),侵袭前循环血管外膜7例(11.1％).Ⅰ型患者的肿瘤全切除率仅为14.3％,Ⅱ型患者高达92.3％,Ⅲ型患者为80％,Ⅳ型患者的肿瘤切除程度(全切除率50％)取决于肿瘤与前循环血管的关系.结论 单侧视觉功能障碍是ACM最常见的症状和首发症状.术前明确肿瘤是否侵入视神经管和海绵窦,有助于制定个体化手术方式、预测手术疗效、降低手术风险;而ACMs切除程度与肿瘤分型有密切的关系.