酒精液保存自体颅骨行颅骨修补术4例

24～64岁4例男性,因闭合性颅脑损伤行开颅术,颅骨缺损部位为:右顶枕、右颞枕、左额顶及左额颞各1例,大小为32～80cm~2。取下的颅骨瓣经生理盐水水清洗后,     

医用高分子纤维增强材料颅骨成形术

我院1987年3月至今采用医用高分子纤维增强材料(简称纤维增强材料)行颅骨成形术24例,效果良好,介绍如下:临床资料男16例,女8例。年龄6～56岁,以20岁左右居多。病程:半年以内4例,1年以内11例,2年以内8例,12年1例。颅骨缺损原因:外伤22例,脑膜瘤术后1例,脑内血肿清除去骨瓣减压术1例。部位:左、右额颞顶各5例,左额顶4例,左颞顶、左额顶、右颞顶各2例,左顶、左顶枕、右额顶、     

Hand-Schuller-Christian病1例报道

病例资料病例:住院号:432485,患者男性,19岁。因“右枕部肿块术后2年,发现左额顶部肿块1个月”于2006年5月收治入院。患者曾于2004年2月因右枕部肿块在外院行手术切除+颅骨修补术,术后病理示“颅骨嗜酸性肉芽肿”。1年后出现尿量增多,每天达6000mL左右,     

小儿脑积水术后颅骨变形2例报告

例1 患儿,女,3岁。出生时难产,疑有颅内出血。近半年来,头围渐大,查头部CT示三脑室及双侧侧脑室扩大,梗阻性脑积水。术前检查颅骨形态尚正常。1995年4月7日在全麻下行脑空腹腔分流术,手术经过顺利,术后恢复良好。术后2周复查头部CT示脑室形态及大小恢复正常,但颅骨形态发生变形,左侧顶结节变平,左颞枕部骨质自然弯曲消失。肉眼观见头颅前后经变长,左侧颞、枕、顶部外观较平坦。家属自诉患儿术后一直左侧卧位。     

硬膜外血肿骨化合并颅骨缺损修补一例报告

患者男,26岁.因"脑外伤去骨瓣减压术后6年"收住我院.患者自述于6年前因颅脑外伤在当地医院行颅内血肿清除术和去骨瓣减压术(伤时资料均已遗失),术后恢复良好,入院诊断为颅骨缺损并脑穿通畸形.头颅CT提示左侧额颞部颅骨缺损合并左枕硬膜外血肿骨化,脑室穿通畸形(图1).全麻下行右额颞顶枕部开颅手术,术中取带蒂的硬膜外血肿骨化骨组织,见血肿与该处硬脑膜已共同完全骨化,呈凸透镜形(图2),切开后见其内为淡黄色液体.两块骨瓣均留用,将带蒂骨瓣还纳原处,以硬膜外血肿形成的骨瓣作为自体修补材料,修补额颞部颅骨缺损处,大小合适无需塑形(图3).术后服用丙戊酸钠预防癫痫.术后随访3年,患者两年后停止抗癫痫治疗,无癫痫发作,无其他合并症状,头颅外形良好.     

成功切除颅骨复发性巨大错构瘤一例

成功切除颅骨复发性巨大错构瘤一例袁俊，翟卫东，王春明患者男，９岁。因左后枕部肿物术后６年复发而于１９９１年３月１７日入院。患者自幼后枕部有“蚕豆”大肿物，逐渐增大，３岁时在当地医院诊为“骨瘤”给予手术切除，并作一期颅骨修补。术后１个月该部位又出现肿物...     

肾透明细胞癌伴颅骨转移1例

目的报道肾透明细胞癌颅骨转移1例。方法对1例影像学上诊断小明确的左枕部病灶行于术切除,明确病理为肾透明细胞癌颅骨转移,并复习相关文献。结果患者行左枕部病灶切除后送病理检查明确诊断该颅骨病灶为肾透明细胞癌。结论本病例为单发转移癌,手术切除为有效的治疗方法,确诊需舷病理检查．术后积极探明井治疗原发灶。     

自体颅骨帽状腱膜下保存及回植

我院自 2 0 0 0年以来对颅内压增高需去骨瓣减压患者采用自体颅骨带蒂转移至帽状腱膜下保存 ,待颅高压消退后再将保存颅骨回植于原骨窗 ,达到颅骨成型满意效果。现报告如下 :资料与方法　　 1 .临床资料 :本组 3 0例 ,男 1 9例 ,女 1 1例。年龄在 1 9～ 71岁。颅脑损伤 2 3例 ,自发性脑内血肿 5例 ,高血压脑出血 2例 ;去骨瓣左额颞 1 0例 ,右额颞 8例 ,左颞顶 5例 ,右颞顶 5例 ,左颞顶枕 2例。颅骨瓣面积 4cm× 5cm～ 7cm× 8cm ,骨瓣回植时间 3 0～ 95d。2.手术方法 :在开颅去骨瓣减压术中 ,选择适合埋藏颅骨的帽状腱膜下间隙 ,用锐性分离…     

颅骨的自体保存

我科对3例急重型颅脑损伤患者施行手术治疗,并作了大骨片减压术。将颅骨瓣包埋于患者的腹壁下,自体保存2～3个月后取出复位于颅骨缺损处,术后8～12个月拍颅片观察,未见有骨质吸收,与其它开颅术后颅片相比未见差别。 例1 男,26岁。枕部摔伤后昏迷7小时,呕吐伴抽搐,病情进行性加重。检查:深昏迷,右瞳5mm,光反应消失,左肢体无自主活动,巴氏征(+)。入院后急行右额颞开颅,清除硬膜下血肿95ml和右额极挫伤之脑组织,脑压仍高,作大骨片减压(骨     

颅脑盲管火器伤手术治愈1例

1病历资料男,23岁,右颞部被近距离6.4警用手枪子弹击中,伤后半小时被急送我院抢救。体格检查:嗜睡,双侧瞳孔等大等圆,右瞳孔对光反射迟钝;右颞部可见一约0.5cm×0.5cm创口,创口处可见活动性出血及碎裂脑组织溢出;左侧肢体肌力Ⅲ～Ⅳ级,左下肢病理征(±)。头部CT三维重建、X-光片均显示伤者右顶部大脑镰旁一花生米大小金属影(图1),右颞部颅骨子弹入口处颅骨粉碎凹陷骨折,多个游离碎骨片进入右颞部脑内近5cm,右颞顶部大脑挫裂伤并出血严重,脑水肿明显,脑中线轻度左移。伤后病人意识障碍进行性加重,生命垂危。遂立即在全麻下行右颞部开颅手术…     

Infantile myofibromatosis presenting with scalp dermoid cyst

Infantile myofibromatosis is a disorder of infancy and early childhood, typically presenting as a solitary lesion or multiple widespread nodular tumors localized to skin, subcutaneous tissue, muscle, bone, viscera, or central nervous system. We present a case of infantile myofibromatosis, multicentric type, in a 4-month-old male infant who initially presented with an occipital scalp mass and other skin-colored nodular mass lesions over his face, trunk, and four limbs. He received tissue biopsy to establish a definite diagnosis. Craniotomy was also arranged for tumor removal due to dural involvement with internal extension and compression of adjacent sigmoid sinus. The patient eventually died of cardiopulmonary failure secondary to primary pulmonary hypertension at age 11 months. Before his death, he had suffered from abdominal distention and frequent vomiting, followed by aggravated respiratory distress and cyanosis. Aggressive surveillance for cardiopulmonary or gastrointestinal involvement is recommended in such cases because prognosis varies according to the involvement of vital organs.     

Solitary myofibromatosis of the skull: a case report and review of literature

Case report We present a case of solitary myofibromatosis of the skull in a 4-year-old girl. Surgery was performed and the final diagnosis of myofibromatosis was made histopathologically.Discussion Solitary myofibromatosis of the skull is rare and we found approximately 20 reported cases in the English-language literature. We reviewed eight well-described cases.Conclusion Neuroradiologically, common features such as a lytic lesion with a sclerotic rim on roentgenogram and intra-diploic lesion with periosteal new bone formation both in the outer and inner table of the skull on computed assisted tomography are noticed.     

Serial brain imaging analysis of stroke-like episodes in MELAS

We report 2 patients of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and consider the pathophysiology of stroke-like lesions, using magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) on MRI, perfusion imaging on MRI, and 1H magnetic resonance spectroscopy (1H-MRS). In Patient 1, T2-weighted imaging (T2-WI) on MRI at onset and even at 44 days after onset of the stroke-like episode showed high intensity in left parietal, temporal, and occipital lobe lesions. In the temporal lobe lesion, the apparent diffusion coefficient (ADC) at 44 days after onset was higher (average: 1.219x10(-3)mm2/s) than that in a normal region (average: 0.796x10(-3)mm2/s). (1)H-MRS of the left parietal lobe lesion at the same day showed a decrease in N-acetylaspartate/(creatine+phosphocreatine) (NAA/Cr) (0.43) and a peak in lactate. 1H-MRS of the contralateral side at the same day showed NAA/Cr (1.57) and no peak in lactate. Thereafter, ADC gradually decreased and NAA/Cr gradually increased, and the peak in lactate disappeared in the lesion. In Patient 2, T2-WI at onset showed high intensity in bilateral occipital lobe lesions. In the left occipital lobe lesion, ADC at the same day was higher (1.082x10(-3)mm2/s) than that in a normal region (average: 0.841x10(-3)mm2/s). (1)H-MRS of the left occipital lobe lesion at the same day showed a decrease of NAA (3.0mM) and a peak in lactate (13.1mM) (measured by LCModel). In 1H-MRS of the normal left parietooccipital lobe at 4 months before onset, NAA was 7.6mM and there was no peak in lactate (0mM). Perfusion imaging at onset showed high intensity in bilateral occipital lobes, which indicated hyperperfusion in stroke-like lesions. Thereafter, ADC gradually decreased and the peak in lactate partially decreased, and the low concentration of NAA persisted (regardless of the partial recovery) in the lesion. These results suggest that the stroke-like episodes is related to vasogenic edema, hyperperfusion, and neuronal damage. Acute oxidative phosphorylation defect may have a crucial role in the pathophysiology of stroke-like episodes.     

Infantile myofibromatosis of the central nervous system

BACKGROUND: Infantile myofibromatosis is the most common fibrous disorder of infancy and childhood. It may occur in two distinct forms: multicentric and solitary. In both cases involvement of the central nervous system (CNS) is unusual: brain myofibromas are usually intracranial in proximity of the dura mater, with infiltration of the calvarial bones and secondary brain compression. Spine myofibromas are exceptional and most of the cases reported in the literature represent secondary locations of visceral lesions. The natural history of myofibromas of the CNS in infantile myofibromatosis is characterized by a period of rapid growth, subsequent stabilization, and spontaneous regression in many cases. On these grounds surgical treatment is reserved for lesions that compress the brain or spinal cord and show an obvious progression. Small lesions or tumor residuals in asymptomatic children without visceral involvement should be closely observed as first choice. CASE REPORT: We report the case of a 10-month-old child with a solitary intramedullary myofibroma, extended from C7 to the conus. The patient underwent partial surgical removal of this lesion. Control MRI has shown the spontaneous slow reduction of the tumor residual and a progressive improvement of preoperative neurological conditions has been observed. To our knowledge this is the first case in which a solitary myofibroma was localized within the spinal cord.     

Intraparenchymal myofibromatosis of the brain in an adult: report of an unusual case

An unusual case of intraparenchymal myofibromatosis of the brain occurring in a 29‐year‐old woman is described. Preoperative CT and MRI examinations revealed two well‐circumscribed nodular masses localized in the wall of the left lateral ventricle and right temporal lobe, respectively. Both masses were completely resected, and the patient remains disease‐free 2 years post‐surgery. Histopathologically, the lesions were characterized by stratification. From outer to inner, there was a reactive glial component, lamellated well‐differentiated muscle‐like cells, densely compact collagen fibers and cellular tumor with nodular and hemangiopericytoma‐like patterns, respectively. The myofibroblastic nature of this tumor was verified by immunohistochemical staining and ultrastructural analysis. Intraparenchymal myofibromatosis may be confused with, and should be distinguished from, meningioma, myopericytoma, solitary fibrous tumor, leiomyoma and inflammatory myofibroblastic tumor for accurate diagnosis and optimal treatment.     

An unusual case of epilepsy exhibiting gelastic seizure, simple visual hallucination, and transient swelling of the left parieto-occipital region]

We report a 74-year-old man with gelastic seizure, simple visual hallucination, and adversive seizure. The patient described his visual hallucinations as "rotating light like a firefly" and "mimicking a stream". Brain CT scan showed a transient swelling as well as low density of a left parieto-occipital region. Electroencephalographic study revealed spikes and fast waves beginning at left occipital region. Although temporal lobe and hypothalamic lesions (especially hypothalamic hamartomas) are well known as origins of gelastic seizures, we could not find any report that described a series of occurrence of gelastic seizure and simple visual hallucination. Usually, simple visual hallucination is thought to occur in occipital lesion. In our case, it is possible that gelastic seizure and simple visual hallucination are related to the epileptic discharge from occipital lesion directly or indirectly. The reversible brain swelling with low density seen in the present case might be caused by cytotoxic edema due to status epilepticus.     

缺血性脑卒中继发血管性痴呆患者与头颅CT所示病变部位的相关性研究

目的 探讨缺血性脑卒中患者继发血管性痴呆(VaD)与头颅CT所示病变部位的相关性。方法 纳入2014年5月1日～2015年5月1日收治的缺血性脑卒中患者为研究对象。收集患者入院后的CT检查表现,采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、Addenbrooke改良认知评估量表(ACE-R)评估患者脑卒中后3个月的认知功能; 以患者是否继发VaD为因变量,脑组织病变部位为自变量,采用单因素和多因素logistic回归分析研究不同病变部位对于缺血性脑卒中患者继发认知功能障碍的相关性。结果 经随访,最终纳入66例缺血性脑卒中患者,其中36例继发VaD,30例认知功能正常,2组基线资料无显著差异性(P>0.05)。单因素logistic回归分析显示,下丘脑、丘脑后部、左额/颞/枕以及多发病灶、脑白质病变、脑萎缩对缺血性脑卒中患者继发认知功能障碍产生影响(P<0.05); 多因素logistic回归分析显示,5项自变量进入回归模型,包括下丘脑、左额、左枕、多发病灶、脑白质病变(P<0.05)。结论 下丘脑、左额、枕以及多发病灶和脑白质病变是缺血性脑卒中患者继发VaD的危险因素,临床上应及时予以干预。     

Skull asymmetries bear no relation to the occurrence of apraxia. A clinical and CT-scan study in patients with unilateral brain damage

This study aimed at assessing whether there was a relation between presence or absence of apraxia following a parietal and/or frontal left hemisphere lesion and "typical" skull asymmetries, evidenced by CT scan (prevalence of the left over the right occipital length and width and of the right over the left frontal length and width). Skull asymmetries were measured in a sample of 160 brain-damaged patients and their prevalence was found to agree with those reported by the literature in normal subjects. A subgroup of 72 patients with lesions restricted to the parietal and/or frontal lobe were given a movement imitation test and diagnosed as apraxic, borderline or normal making reference to the performance of 150 control subjects. The incidence in these three groups of typical or atypical occipital and frontal asymmetries was assessed and found not to differ significantly. It is concluded that no consistent relation between hemisphere dominance for praxis and skull asymmetry can be asserted. The study also investigated the relation of idemotor apraxia to the locus of left hemisphere damage and confirmed that both the incidence and the severity of the disorder are much greater following parietal than frontal lesions.     

Tactile agnosia and tactile aphasia: symptomatological and anatomical differences.

Two patients with tactile naming disorders are reported. Case 1 (right hand tactile agnosia due to bilateral cerebral infarction) differentiated tactile qualities of objects normally, but could neither name nor categorize the objects. Case 2 (bilateral tactile aphasia after operation of an epidural left parietal haematoma) had as severe a tactile naming disturbance as Case 1, but could categorize objects normally, demonstrating that tactile recognition was preserved. Case 1 may be the first case of tactile agnosia clearly differentiated from tactile aphasia. CT scans of Case 1 revealed lesions in the left angular gyrus, and in the right parietal, temporal, and occipital lobes. Case 2 had lesions in the left angular gyrus and of posterior callosal radiations. Our findings suggest that tactile agnosia appears when the somatosensory association cortex is disconnected by a subcortical lesion of the angular gyrus from the semantic memory store located in the inferior temporal lobe, while tactile aphasia represents a tactual-verbal disconnection.     

Eosinophilic granuloma of the skull associated with epidural haematoma: a case report and review of the literature

Introduction Eosinophilic granuloma (EG), a benign bone lesion, represents a focal form of histiocytosis X. Here, the authors report a case of an extremely rare presentation of a solitary EG of the skull.Case report A 9-year-old boy presented with headache and vomiting for 3 days. His examination was unremarkable except for a tender mass in his left occipital region. Radiological studies revealed a huge bilateral epidural haematoma under the occipital bone, extending supratentorially and infratentorially, and a nonenhanced, epidural, soft tissue mass overlying the left transverse sinus. Evacuation of the epidural haematoma was performed and it was noted that the left transverse sinus wall was eroded by the EG at one point with venous oozing. Review of the literature The acute presentation of a solitary EG of the skull with an epidural haematoma was described in only four cases in the literature. This is the first documented case in terms of the origin of an epidural haematoma.