美国《化学文摘》、《乌利希国际期刊指南》及波兰《哥白尼索引》正式收录本刊

美国《化学文摘》(Chemical Abstracts,CA)是世界最大的化学文摘库,也是目前世界上应用最广泛,最为重要的化学、化工及相关学科的检索工具。CA创刊于1907年,由美国化学协会化学文摘社(CAS)编辑出版,为国际六大著名检索期刊之一。     

神经内镜扩大经鼻-垂体移位切除三脑室-脚间池巨大皮样囊肿1例并文献复习

目的探讨神经内镜扩大经鼻-垂体移位切除三脑室-脚间池巨大皮样囊肿的疗效及并发症。方法回顾分析1例行神经内镜下扩大经鼻垂体移位切除三脑室-脚间池巨大皮样囊肿的女性患者的临床资料。并复习传统开颅手术及神经内镜下垂体移位切除中线区肿瘤的相关文献。结果应用神经内镜扩大经鼻垂体移位完整切除了患者的三脑室-脚间池巨大皮样囊肿。术后患者出现了短暂的尿崩,经对症处理,完全恢复健康,无永久性尿崩及永久性垂体功能减退。结论神经内镜扩大经鼻蝶垂体移位切除三脑室-脚间池皮样囊肿,无需牵拉重要脑组织及血管,手术创伤小、并发症少,是一种有效的手术方法。     

Ultrasonographic superb microvascular imaging for emergency surgery of intracerebral hemorrhage

Ultrasonography (US) has been used as a reliable imaging modality, providing real-time information during neurosurgical operations. One recent innovative US technique, superb microvascular imaging (SMI), visualizes small vessels and flow, which are not detected with standard US with doppler. We apply SMI to intraoperative US monitoring in emergency surgery for intracerebral hemorrhage (ICH).Eleven consecutive patients with ICH underwent endoscopic emergency surgery under US monitoring with SMI. After performing a small craniotomy, US images were obtained using SMI, a fusion technique, and a contrast agent technique, with the probe on the brain surface during surgery. Fusion images were obtained with the probe on the head before craniotomy in some patients.Animated US images with SMI could differentiate hematoma containing no vessels from brain tissue, and flow images using SMI and contrast agent techniques clarified the borderlines. Animated fusion images of intraoperative US and preoperative CT provided information on the extent of hematoma and residual hematoma during emergency surgery. We made various fusion CT images showing intracranial hematoma with US probes and decided on the skin incision line before beginning surgery, as if we were using a neuronavigation system.US with SMI, contrast agent, and fusion techniques provide information on the extent of intracranial hematoma and residual hematoma with no vessels and no flow. Monitoring by US and fusion CT images is useful for ICH surgery as a next-generation neuronavigator.     

虚拟内镜技术在内镜经鼻蝶入路垂体瘤切除术中的运用

目的 运用虚拟内镜(VE)技术观察内镜经鼻蝶入路的解剖结构,探讨其对内镜经鼻蝶入路垂体瘤切除术的指导价值. 方法 南方医科大学珠江医院神经外科自2007年12月至2010年3月行内镜经鼻蝶入路垂体瘤切除术患者21例,患者术前均采用64排CT扫描及VE图像重建.比较术前VE和术中内镜图像并分析经鼻蝶入路中解剖结构累加分值的相关性. 结果 术前VE图像与术中神经内镜图像非常相似;解剖结构的相符性良好,术前VE和术中内镜下8个解剖结构显示的累加分值具有正相关关系(r=0.923,P=0.001);调整VE的位置可以模拟神经内镜经鼻蝶入路垂体瘤切除术,观察内镜下经鼻蝶入路的解剖结构. 结论 VE能于术前准确直观地显示内镜经鼻蝶入路的重要解剖结构及变异,指导术前计划形成,提高手术效率,增加手术操作的安全性.

Abstract：

Objective To observe the anatomical structure via endonasal transsphenoidal approach with virtual endoscopy (VE) and explore the clinical applications of VE in endoscopic pituitary tumor resection through the endonasal transsphenoidal approach. Methods The VE was applied to the reconstruction of the pre-surgical 64-slice CT scanning of the 21 patients with pituitary adenoma received the endoscopic endonasal transsphenoidal surgery. A comparative study and a correlation analysis of cumulative scores of the anatomical structure were performed between the reconstructed VE images and the intraoperative endoscopic ones. Results Preoperative VE images and intraoperative endoscope images are very similar. The correlation of cumulative scores of the anatomical structure between the VE images of anatomical findings and the intraoperative images was positively noted (r=0.923, P=0.001),indicating that VE can be applied to simulately observe the anatomical structure before the endoscopic endonasal transsphenoidal pituitary surgery, and observe the anatomical structure through the endonasal transsphenoidal approach. Conclusion Being able to display the important anatomical structure and its varieties before the endoscopic endonasal transsphenoidal pituitary surgery, VE proves to be a valuable approach to the preoperative planning, increases the surgical efficiency and improves the safety of the surgery.     

内镜下扩大经鼻入路切除侵犯斜坡的垂体瘤

目的探讨内镜下扩大经鼻入路切除侵犯斜坡的侵袭性垂体瘤的可行性。方法回顾性分析17例侵犯斜坡的侵袭性垂体瘤的临床资料,其中侵犯双侧斜坡旁颈内动脉10例,侵犯右侧斜坡旁颈内动脉4例,侵犯左侧斜坡旁颈内动脉3例;均采用内镜下扩大经鼻入路手术切除。结果全切除13例,次全切除1例,部分切除3例。疗效经综合评价:治愈13例,控制1例,改善3例。术前6例视力障碍的病人,术后恢复正常3例,明显改善2例,无改善1例。术后并发甲状腺危象1例,脑脊液鼻漏2例,一过性尿崩症1例,脑梗死1例。17例病人获随访3～88个月,平均34个月。肿瘤复发3例,无死亡病例。结论内镜下扩大经鼻入路适用于切除侵犯斜坡的侵袭性垂体瘤。     

老年垂体腺瘤的诊断和治疗(附38例报告)

目的探讨老年垂体腺瘤的诊断和治疗特点。方法收集作者医院2003-06-2010-06间收治的老年垂体腺瘤患者38例,对其临床资料进行回顾性分析。结果临床表现为视力障碍23例(60.5%),头痛15例(39.5%),垂体功能低下12例(31.6%),伴有合并症30例(78.9%);MRI显示为直径≥2cm的大腺瘤和巨大腺瘤者30例(78.9%)。36例患者接受内镜经鼻蝶入路肿瘤切除术,其中肿瘤全切除23例(63.9%),近全切除5例(13.9%),部分切除8例(22.2%),术中无死亡。术后对27例患者随访6～36个月(中位随访时间24个月),视力、视野障碍均有所改善。需长期激素替代治疗的11例患者无垂体功能低下表现。有残余肿瘤者10例,其中4例行伽马刀治疗,治疗后残余肿瘤均缩小。结论老年垂体腺瘤主要表现为视力障碍和垂体功能低下,内镜经鼻蝶入路手术是安全、有效的治疗方法。     

经蝶窦鞍内手术的颅内血管损伤性并发症

目的 通过回顾性总结分析经蝶窦鞍内手术中发生的8例血管损伤性并发症病例的临床资料,从而提高对这种少见并发症的认识.方法 1964年～2000年间经蝶窦鞍内手术中发生颅内血管损伤性并发症共8例,包括6例蛛网膜下腔出血、1例前海绵间窦出血、1例颈内动脉血栓形成;分析了病人的临床表现、诊断、出血原因,探讨了预防和治疗方法.结果 出血原因为肿瘤残体出血2例,损伤鞍膈或蛛网膜出血4例,前海绵间窦过渡发育1例;手术操作刺激引起颈内动脉血栓形成1例;死亡2例,治愈5例,1例术后肢体偏瘫.结论 经蝶窦鞍内手术并发颅内血管损伤是-种少见的手术并发症,其发生原因复杂,熟悉鞍区解剖结构和熟练操作技术可明显减少该并发症,一旦发生出血应给予综合性治疗.     

内镜下扩大经鼻蝶入路术中多层技术颅底重建

目的总结内镜下扩大经鼻蝶入路鞍区及鞍旁区多层技术重建颅底的经验。方法回顾性分析12例鞍区及鞍旁区肿瘤的临床资料,其中颅咽管瘤4例,鞍区脑膜瘤3例,巨大垂体腺瘤5例;均行内镜下扩大经鼻蝶入路肿瘤切除术,并采用多层技术进行颅底重建。结果所有病例肿瘤均达全切除,颅底重建均1次修补成功。术后部分临床症状明显改善。随访3～6个月,均未出现脑脊液漏、细菌性脑膜炎和张力性气颅等并发症。结论内镜下扩大经鼻蝶入路术中多层技术重建颅底是一种简单、安全、有效的方法。     

Approach by neuroimaging with power flow Doppler imaging

Doppler sonography is convenient and useful for evaluating intracranial lesions and hemodynamics, especially in the neonate. Recently we used power flow Doppler imaging (PF) to show vessels with a low flow velocity and a small caliber. The pulsed Doppler system (PD) in combination with PF can selectively visualize small vessels and slow blood flow, such as the steady flow conditions of the lenticulostriate artery (LSA). As PF can reveal the vessel crossing at a right angle to the ultrasonic beam, the bilateral middle cerebral arteries can be observed through the anterior fontanel under the same conditions. We can also evaluate the laterality of intracranial hemodynamics using PF. Four-dimensional PF images, which are reconstructed from the several three-dimensional reconstruction images during one cardiac beat, can show the pulsation of intracranial arteries. This technique may provide a new quantitative and qualitative method for intracranial circulation.     

Visualization of the Cerebral Circulation Using Three–dimensional Transcranial Power Doppler Ultrasound Imaging

The purpose of this study was to evaluate the anatomy of the cerebral circulation, particularly the circle of Willis, using three–dimensional ultrasound (3DUS) imaging. Image data were obtained through the right transtemporal window from 8 young, healthy volunteers by acquiring gray–scale and color Doppler spectral (CDI) and energy (CDE) images using two–dimensional ultrasound equipment with a 2–MHz probe. Images and transducer position coordinates were fed into a graphics workstation, reprojected, analyzed to extract the blood flow signal, volume rendered, and displayed interactively. The architecture of the cerebral circulation was evaluated from multiple orientations using stereo viewing glasses and rotation to enhance the understanding of vessel position. The primary vessels of the cerebral circulation including the circle of Willis and bilateral views of the branching arteries (middle, anterior, and posterior cerebral arteries and internal carotid artery) could be imaged readily with 3DUS through one transtemporal window. Acquisition time was typically less than 30 seconds. Volume–rendering methods greatly assisted in showing the overall spatial relationships and continuity of cranial vessels. Secondary branches of the cerebral arteries were seen in 2 patients. Color data from two–dimensional ultrasound imaging that otherwise might be identified as artifact was found to represent continuous small vessels on three–dimensional viewing. 3DUS facilitates imaging of cranial vascular anatomy by clarifying overall spatial relationships and enhancing comprehension, compared to two–dimensional ultrasound methods. The method is rapid and the circle of Willis can be visualized from one side of the head.     

内镜经鼻翼腭窝肿瘤切除术

目的探讨内镜经鼻入路在切除翼腭窝肿瘤中的作用，以减少处理翼腭窝病变时的外科侵袭。方法2004年5月～2006年5月，对5例翼腭窝的良性肿瘤实施了单纯内镜经鼻的外科治疗。其中神经鞘瘤2例，血管纤维瘤2例，神经纤维瘤1例。结果本组5例肿瘤均获得一次性完全切除，无任何并发症。均于术后5～12d痊愈出院，随访6个月～2年无复发。结论内镜经鼻入路可以安全而完整地切除翼腭窝的良性肿瘤。     

内镜单鼻腔蝶窦入路切除垂体腺瘤

目的探讨内镜单鼻腔蝶窦入路在切除垂体腺瘤中的临床应用。方法对256例垂体腺瘤患者进行手术切除,其中微腺瘤54例,大及巨大腺瘤202例。应用观察内镜直接自单侧鼻腔进入,于鼻中隔后1/3处作1.0cm的鼻黏膜剥离,离断骨性鼻中隔根部,暴露双侧蝶窦开口,咬开蝶窦前壁进入蝶窦腔。术中内镜伸入鞍内观察。术毕鼻黏膜复位,表面填一小条碘仿纱条,不填塞鼻腔。结果165(64.5%)例肿瘤全切,83(32.4%)例部分切除,8(3.1%)例活检。无严重并发症。结论内镜单鼻腔蝶窦入路切除垂体腺瘤是一种更微创、暴露更好、并发症更少的手术方式。     

内镜下经单鼻孔蝶窦入路垂体瘤切除术的改良手术配合

目的 通过手术器械的改进与应用,提高神经内镜下经鼻蝶入路垂体瘤切除术的手术效率,总结手术配合的经验.方法 南方医科大学南方医院神经外科自2004年3月至2009年4月采用经单鼻孔鼻中隔蝶窦入路切除垂体瘤288例,术前改进各种手术器械(单极电凝器、吸引器的形状和功用)并应用,总结分析手术的疗效.结果 本组垂体瘤全切除204例,次全切54例,大部分切除30例.手术时间最短30 min,术中无脑脊液漏患者手术时间平均70 min;术后并发脑脊液漏3例,鼻黏膜迟发性出血3例,经治疗后控制.结论 手术器械的改进与正确应用,加上默契的手术配合,可以提高神经内镜下经单鼻孔鼻中隔蝶窦入路垂体瘤切除术的效率.     

Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.

OBJECTIVE: Microsurgical transsphenoidal surgery for pituitary tumors has been standard therapy for decades and was established by Harvey Cushing in the early twentieth century. Today, endoscopy is increasingly accepted in the therapy of pituitary lesions. In this retrospective study, we analysed the surgical technique and outcome of 50 patients with pituitary lesions treated with an endoscopic endonasal trans-sphenoidal approach. METHODS: Between January 2004 and July 2005, 50 patients (30 female and 20 male) with pituitary tumors were operated upon using an endoscopic endonasal trans-sphenoidal procedure without nasal speculum or postoperative nasal packing. The follow-up period ranged from 3 to 18 months. RESULTS: All patients had normal airways through both nostrils immediately after extubation. Postoperative discomfort was minimal and hospitalization was 4-5 days. Three patients developed postoperative transient diabetes insipidus, persisting in one for a further 2 months. Among the 50 patients, total tumor removal was achieved in 47 patients (94%), subtotal in two patients (4%). One patient died intraoperatively due to subarachnoid haemorrhage. CONCLUSION: The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is a form of minimally invasive surgery offering excellent postoperative results.     

Endoscopic endonasal transsphenoidal surgery for invasive pituitary adenoma.

Invasive pituitary adenomas (IPA) involving the skull base extend from the sella region, and invade surrounding structures. In the present study, we reviewed the therapeutic efficacy in a group of patients with IPA treated with endoscopic endonasal transsphenoidal surgery. Data from 78 IPA patients at our hospital were retrospectively reviewed. The diagnostic modalities, surgical techniques, and outcomes were reviewed. Diagnosis was confirmed by endocrinological profile and CT or MRI in all patients. Surgery was performed via an endoscopic endonasal transsphenoidal approach. Thirty-five patients (44.9%) had hormonally active tumors, and 43 (55.1%) had nonfunctioning tumors. Complete removal of the tumor was achieved in 62 patients (79.5%) and subtotal removal in 12 (15.4%); partial removal was achieved in the remaining four patients (5.1%) who had fibrous or dumbbell-shaped adenomas. The mean follow-up was 43.2 months in 65 patients and the clinical symptoms in all patients improved to varying degrees. In 52 patients, the tumors completely disappeared on follow-up imaging. Visual symptoms improved in 96.4% of the patients who had presented with visual impairment. These surgical results show that endoscopic endonasal transsphenoidal surgery for resection of IPA has advantages. We suggest that the endoscopic endonasal transsphenoidal surgery method is a safe, minimally invasive and efficient surgical technique for removal of IPA, providing good visualization of the operative field, generally complete tumor removal, short procedure duration, and minimal postoperative complications.     

内窥镜经蝶窦垂体腺瘤切除术

目的 探讨应用内窥镜经蝶窦入路切除垂体腺瘤的方法及优缺点。方法 自2000年6月～2001年2月对12例垂体腺瘤患者施行内窥镜辅助经蝶窦腺瘤切除手术。经单侧鼻腔鼻中隔入路,在0°角内窥镜下分离鼻粘膜,暴露蝶窦前壁,以中鼻甲下缘和蝶窦开口为界切开蝶窦前壁,打开鞍底,切开硬膜,在内窥镜下探查肿瘤和正常腺体的分界,在手术显微镜下切除垂体腺瘤。结果 术后所肩异常升高的激素水平明显下降,无一例发生严重并发症。结论 内窥镜辅助经蝶窦垂体腺瘤切除术能提供良好的照明和手术视野,是一种安全、可行的手术方法。     

Methods of the endoscopic endonasal transsphenoidal adenomectomy

This paper provides the practical part of a procedure for endoscopic endonasal transsphenoidal resection of pituitary tumors. The authors have presently gained experience with about 400 endoscopic endonasal transsphenoidal operations. The advantages of endoscopic surgery include the wide vision field of an operative site under good illumination. The endoscopic intervention provides a possibility of extracting not only endo-, but also paracellular portions of a tumor under direct visual control, which can be rarely done during a standard microscopic transnasal operation. The paper gives recommendations on the equipment of an operating suite and anesthetic maintenance. It also describes surgical stages and postoperative management of patients.     

螺旋CT 血管生长技术及脑血管造影在烟雾病诊断中的价值

目的 探讨使用多排螺旋CT 血管生成技术(MSCTA)及脑数字减影(DSA)血管造影在烟雾病(MMD)中的诊断价值.方法 采用8 排螺旋CT 进行头部螺旋容积扫描,分析23 例烟雾病的CT 平扫及增强的影像表现,利用"血管生长(add vessel)"法对图像进行后处理,采用多平面体积重组及容积重建图像对脑血管进行三维重建并和DSA 结果进行比较分析.结果 CT 平扫13 例患者显示不同部位的脑出血,5 例患者表现为多发性的脑梗死,3 例患者仅见局限性的脑萎缩,2 例患者CT 平扫未发现明显异常.MSCTA 均清晰显示不同程度的颈内动脉颅内段和(或)大脑前动脉、大脑中动脉狭窄或闭塞,23 例均显示纤细迂曲的"烟雾"状异常血管网.其中15 例经股动脉插管行全脑数字血管减影(DSA)证实.结论 采用血管生成、容积重建技术,MSCTA 是明确诊断烟雾病的有效非创伤性首选检查方法,可替代DSA 进行烟雾病的筛选、诊断和随访观察.     

内镜经鼻岩尖病变的外科治疗

目的探讨单独使用内镜经鼻入路切除岩尖区病变的可行性。方法2003年1月～2006年4月间对11例岩区病变实施了单纯内镜经鼻的外科治疗。其中脑膜瘤2例、脊索瘤1例、神经鞘瘤1例，胆固醇肉芽肿1例、曲毒菌病1例、恶性淋巴瘤1例、低分化鳞癌4例。结果9例病变获得镜下及影像学全切，1例大部切除，1例以活检为目的：术中颈内动脉破裂1例，术后行颈内动脉球囊栓塞术无硕内出血、脑脊液漏、脑神经损伤及脑膜炎等行发症发生。结论应用内镜经鼻外科技术处理岩尖病变是一种安全的、可供选择的新方法，能够简单和迅速地到达岩尖：既能够达到微侵袋目的，又能够满足全切某些肿瘤的要求。     

内镜经鼻前颅底肿瘤的外科治疗

目的总结内镜经鼻入路切除前颅底肿瘤的经验。方法回顾性分析2003年11月～2006年5月18例肿瘤侵犯前颅底的临床资料．其中14例单独采用内镜经鼻手术入路．4例采用颅鼻联合入路进行了治疗。病理类型包括：脑膜瘤2例，脊索瘤1例，视神经鞘瘤1例．骨纤维异常增殖症1例．鳞状细胞癌3例，嗅神经母细胞瘤3例，腺样囊性癌1例，恶性骨巨细胞瘤1例，脊索肉瘤1例．神经内分泌小细胞癌1例，透明细胞癌1例，甲状腺癌颅底转移1例，腮腺癌颅底转移1例。结果经术中镜下及术后影像学检查证实17例肿瘤被全部切除．1例大部分切除。2例术后出现脑脊液鼻漏，经保守治疗后痊愈。无颅内出血、感染及死亡病例。结论内镜经鼻入路能够充分显露和切除前颅底肿瘤．且大多数病例无需处理硬脑膜及进行颅底重建。