目的 探讨神经内镜辅助手术治疗高血压性基底核区脑出血破入脑室的技术特点及治疗效果.方法 回顾性分析18例行神经内镜手术治疗高血压性基底核[脑出血破入脑室病人的临床资料,统计病人平均手术时间、术后血肿清除率、术后意识状态及并发症情况.结果 神经内镜操作时间为46～120 min,平均(58.0 ±8.2)min;血肿清除率为65.6％～100％,平均(92.5 ±6.2)％;术后GCS评分平均(9.5 ±4.6)分.术后行气管切开术9例,再出血3例,脑积水2例,肺部感染10例;均经治疗后好转;术后颅内感染1例,最终病人呈植物状态;脑干功能衰竭死亡2例.结论 神经内镜辅助高血压性基底核区脑出血破入脑室的手术治疗,具有操作时间短、血肿清除率高、术后意识恢复良好的特点,值得临床推广.

2019年1月至2020年6月首都医科大学附属北京地坛医院神经外科收治20例患者，其中脑出血或蛛网膜下腔出血后脑积水6例，脑室炎合并脑积水7例，脑室出血2例，艾滋病合并隐球菌脑膜炎4例，艾滋病合并结核性脑膜炎1例。所有患者均行脑室-腹壁长程外引流术，其中位引流时间为46.2 d(范围为28～180 d)。20例患者无一例发生引流口感染、逆行皮下隧道感染、头皮或腹壁切口感染。其中18例患者行二期脑室-腹腔分流术，术后无一例发生颅内或腹腔感染。术后5例颅内感染患者的感染均得到有效控制，13例患者的脑积水症状缓解。

目的 探讨鞍区占位性病变的手术治疗方法及疗效.方法 回顾性分析2017年10月至2019年10月手术治疗的23例鞍区占位性病变的临床资料.结果 采用额底外侧入路12例,额底纵裂入路7例,眉弓入路4例.病灶全切除19例(82.6％),次全切除4例.术后病理结果示垂体腺瘤7例、鞍结节脑膜瘤5例、颅咽管瘤6例、嗅沟脑膜瘤1例、嗅神经鞘瘤1例、Rathke囊肿3例.21例术后恢复良好.术后出现发热10例、电解质紊乱15例、尿崩8例,无死亡病例.23例术后3个月至1年;肿瘤复发4例,其中2例垂体腺瘤、1例颅咽管瘤,再次手术效果良好.结论 对于鞍区占位性病变,良好的手术入路及解剖暴露可提高手术全切除率,减少术后并发症.

目的 总结两种外科分流手术方法治疗HIV相关性新型隐球菌性脑膜炎所致颅内高压的疗效.方法 采用回顾性研究方法,选取2015年1月至2018年8月首都医科大学附属北京地坛医院收治的HIV相关新型隐球菌性脑膜炎所致颅内高压患者34例,总结分析患者症状、体征及实验室检查,比较导航下脑室-腹腔分流术、腰大池-腹腔分流术的疗效.结果 34例患者表现为头痛,20例患者有呕吐症状,3例出现视力下降、2例癫痫发作.所有患者经内科治疗效果不佳,14例行导航下脑室-腹腔分流术,术后头痛及恶心、呕吐症状全部明显缓解.20例行腰大池-腹腔分流术,1例术后第2天头痛症状再次加重,6例患者出现体位性不适,与脑室-腹腔分流术比较有统计学差异(P<0.05).所有患者均无围手术期颅内出血、感染及脑疝发生.两种手术方式治疗效果无统计学差异(P=0.501).结论 导航下脑室-腹腔分流术与腰大池-腹腔分流术均可明显改善HIV相关新型隐球菌性脑膜炎所致颅内高压,导航下脑室腹腔分流术术后并发症相对更少,潜在脑疝风险较小.

Objective To explore the clinical characteristics, diagnostic method of epilepsy caused by acquired immunodeficiency syndrome( AIDS)-related encephalopathy and the value of surgical treatment. Methods A retrospective analysis was conducted on 12 patients with epilepsy caused by AIDS-related encephalopathy admitted to Department of Neurosurgery, Beijing Ditan Hospital,Capital Medical University from June 2012 to January 2018. Of the 12 patients, 4 had intracranial lymphoma, 4 had intracranial tuberculoma, 2 had cryptococcal meningitis with intracranial hypertension and 2 had Toxoplasma encephalopathy. Three of them had intracranial multiple occupancies. Ten patients underwent pathological excision and 2 of them with hydrocephalus underwent ventriculo-peritoneal shunt simultaneously. Twelve patients received regular drug therapy and highly active antiretroviral therapy treatment before and after operation. Results The symptoms of epilepsy were significantly improved after 6 months to 2 years of follow-up except for 1 case who died of brain edema on the 6th day after operation. Among them, Engel gradeⅠ was achieved in 7 cases, Engel grade Ⅱ in 3, Engel grade Ⅲ in 1. Conclusions The seizure types and pathogenic factors of AIDS-related epilepsy patients are complex and diverse. Comprehensive treatment should be carried out according to clinical manifestations, laboratory examinations, imaging characteristics, electroencephalogram and medical treatment. Under the condition of full preoperative evaluation and mastery of indications, surgery could effectively control AIDS-related epilepsy.

目的 探索获得性免疫缺陷综合征(AIDS)患者合并神经外科疾病时进行手术治疗的可行性、时效性、安全性、并发症及是否影响预后的治疗经验.方法 对2012年4月至2017年6月首都医科大学附属北京地坛医院收治的52例AIDS合并神经外科疾病患者的入院情况、神经外科疾病种类、手术治疗方法、术后并发症、检验结果及术后临床症状改善情况进行分析总结.结果 52例AIDS患者均接受了神经外科手术治疗,术前住院时间(5.6±1.2)d,术后住院时间(12.0±1.5)d;血CD4+细胞计数及病毒载量数值对术后并发症未见明显影响,术后并发症无明显增加;不同部位、病理类型及手术方式对AIDS患者预后不同,手术可改善AIDS合并神经外科疾病患者预后.52例患者术后无中枢神经系统感染或手术切口感染,同时未见患者其他机会性感染情况增加.术后随访12个月,52例患者中临床症状缓解(减轻或消失)38例(73.0％),症状持续11例(21.1％),临床症状进展3例(5.7％).结论 AIDS不是神经外科疾病手术的禁忌证,及时、有效、安全、适当的手术治疗对AIDS合并神经外科疾病患者有益.

Objective To investigate the clinical features,diagnosis and surgical treatment of fungal infection of the central nervous system.Methods In this retrospective study,clinical data including manifestations,imaging,surgical procedure and therapeutic effect of 40 patients who were consecutively diagnosed as intracranial fungal infection from February 2011 to October 2016 at Department of Neurosurgery,Beijing Ditan hospital,Capital Medical University were analyzed.All 40 patients were treated with antifungal treatment.Among them,there were 23 cases with high intracranial pressure caused by Cryptococcus neoformans infection,and shunt operation was performed after failure of lowering intracranial pressure by treatment.There were 17 cases with intracranial occupying lesions,2 of which underwent stereotactic biopsy and 15 underwent craniotomy.Results Among the 23 patients with high intracranial pressure caused by Cryptococcus neoformans,21 cases had AIDS (acquired immunodeficiency syndrome)and the other 2 had immunodeficiency due to other diseases.After operation,symptoms related to high intracranial pressure disappeared in 18 cases and were relieved in 5 without spreading of Cryptococcus neoformans infection.At the 6-month follow-up,the patients' original symptoms completely disappeared in 19 cases and were improved in 3.In addition,1 case died of severe pulmonary infection.Among the 17 cases with intracranial lesions,16 cases had AIDS and 1 case had secondary fungal infection post operation.Two of them underwent stereotactic biopsy and 15 reported good outcomes after craniotomy.None of them developed significant neurological deficits.One patient died from Pseudomonas aeruginosa infection combined with hydrocephalus.Conclusions Fungal infection of the central nervous system fungal mostly occurs in patients with immunodeficiency and is mainly characterized by hydrocephalus or intracranial space occupying lesion.The lesions could be located at the brain parenchyma,skull base and the ventricle system with no specific imaging manifestations.Treatment could be administered by shunting or excision operation and antifungal therapy.