桥脑海绵状血管瘤的显微手术治疗:附12例报告

目的 分析桥脑海绵状血管瘤的显微外科手术治疗方法 和预后.方法 显微手术切除桥脑海绵状血管瘤12例.11例位于桥脑背侧的海绵状血管瘤,采用枕下正中经菱形窝入路切除;1例位于桥脑腹外侧的海绵状血管瘤,采用颞下经小脑幕入路切除.结果 均镜下全切除病灶,术后病理证实为脑海绵状血管瘤.术后临床表现改善6例,无变化3例,面瘫加重1例,出现外展神经瘫痪1例,死亡1例.术后平均随访时间3个月,复查MRI均未见病灶复发,脑干组织影像学修复良好,术后遗留的临床症状均有不同程度的恢复.结论 在正确选择手术适应症及手术方法 的前提下,桥脑海绵状血管瘤的手术治疗是安全和有效的.     

神经导航辅助显微外科切除颅内海绵状血管瘤

目的探讨神经导航辅助显微外科切除颅内海绵状血管瘤(CA)的效果。方法应用枢法模StealthStation影像导航系统,神经导航辅助显微外科切除颅内海绵状血管瘤45例,其中13例CA采用直切口锁孔入路手术。结果45例患者在神经影像导航辅助下均精确定位,导航注册平均误差为(2.3±1.1)mm。病灶均全切除,无手术死亡,术后复查MRI病灶无残留。术后原有症状改善,无偏瘫加重及其他术后并发症。结论神经影像导航辅助下的颅内海绵状血管瘤显微外科切除,可以精确定位,设计最佳手术入路,避开功能区,减少神经损伤和术后并发症。     

神经导航显微手术切除脑深部小型海绵状血管瘤

目的:探讨神经导航在切除脑深部小型海绵状血管瘤手术中的临床价值.方法:对44例脑深部小型海绵状血管瘤在神经导航辅助下进行显微手术.结果:所有病例均全切除病灶,术后无严重的并发症,无死亡病例.结论:在切除脑深部小型海绵状血管瘤的手术中应用神经导航技术,不仅定位准确,通过动态示踪全切除病灶,而且能较好地保护神经功能和降低手术并发症的发生.     

以癫痫发作为主的幕上海绵状血管瘤的显微手术治疗

【目的】探讨以癫痫发作为主的幕上海绵状血管瘤显微手术方法和疗效。【方法】对1999年至2009年本院收治的以癫痫发作为主的幕上海绵状血管瘤共38例,在显微镜下行切除术,术中彻底切除病灶和周围的胶质瘢痕以及含铁血黄素层。【结果】术后影像学检查显示38例海绵状血管瘤均全切除;癫痫发作得到控制,癫痫缓解率超过90％。【结论】显微手术切除海绵状血管瘤及其周围的胶质瘢痕和含铁血黄素层是控制癫痫发作的有效方法。     

脑内海绵状血管瘤的诊断与治疗

【目的】探讨脑内海绵状血管瘤的临床表现、影像学特点及治疗方法。【方法】回顾性分析本院1997年4月至2005年3月诊治的14例脑内海绵状血管瘤的临床诊治过程。【结果】14倒病例中，10倒经手术切除病变并经病理学证实，效果良好。2例行γ-刀治疗，病灶不缩小，临床症状未见明显改善。2例病人拒绝手术及γ-刀治疗，随访期间未见新的症状及病灶扩大。【结论】手术切除颞叶、额叶、顶叶脑内海绵状血管瘤较安全，既可切除痛灶，还可根据情况切除致痈灶，使难治性癫痫获得缓解或消除癫痫发作，脑内海绵状血管瘤对放射治疗不敏感，对无症状或轻微症状者临床上可以不作处理。     

脑内型海绵状血管瘤的治疗

目的探讨脑内型海绵状血管瘤治疗方法。方法总结23例脑内型海绵状血管瘤的临床表现、神经影像学特征及显微治疗方法。结果全切除19例（82％）,大部分切除2例（9％）,部分切除1例（5％）。结论显微手术治疗颅内海绵状血管瘤是更为安全和有效的方法,疗效满意。     

超声在脑深部海绵状血管畸形切除术中的应用价值

目的:探讨术中超声在神经外科手术切除脑深部海绵状血管畸形的价值.资料与方法:选择10例脑深部海绵状血管畸形的患者,术中超声确定血管畸形的部位、大小、边界、与周边毗邻重要结构的关系,测量距皮层的距离,选择适宜的皮层或脑沟作为入路,超声动态监测手术切除情况,同时判断病变切除程度\有无残留及血肿.结果:10例脑深部海绵状血管畸形在术中超声引导下精确定位,并通过显微外科技术全部切除病灶；术后8例基本恢复正常,1例出现轻度运动性失语,1例出现肢体轻度瘫痪,经康复治疗后基本恢复正常.结论:术中超声引导显微外科手术切除脑深部血管畸形能提高定位的准确性,减少手术副损伤,提高全切率,是一种安全有效的方法.     

神经导航下显微外科手术切除颅内海绵状血管瘤67例分析

目的：探讨神经导航在颅内海绵状血管瘤显微外科手术中的应用的价值。方法：应用神经导航（德国产）辅助显微外科手术切除67例颅内海绵状血管瘤,分析手术疗效。结果：67例患者的全部病灶定位准确,均顺利完成手术,无手术死亡病例。术后1周复查强化CT或MRI,显示无病灶残留的迹象。术后所有病人临床症状得到改善,术后出现肌力下降（11例）、言语欠流利（2例）等神经功能受损患者经神经康复治疗均治愈,其余患者术后无神经功能受损表现。结论：神经导航辅助显微外科手术切除颅内海绵状血管瘤定位准确,且能动态示踪并微侵袭地切除病灶,保护神经功能和降低手术并发症的发生率。     

颅内海绵状血管瘤30例显微外科治疗

目的探讨颅内海绵状血管瘤显微手术治疗方法。方法总结30例颅内海绵状血管瘤的临床表现、神经影像学特征及显微治疗方法。结果全切除22例（73．3％）,大部分切除7例（23．3％）,部分切除1例（3．4％）。结论显微手术治疗颅内海绵状血管瘤是更为安全和有效的方法,未完全切除者术后给予放射治疗,疗效满意。     

脑干海绵状血管瘤12例显微手术治疗分析

目的：探讨脑干海绵状血管瘤显微手术治疗的适应证及预后。方法：对12例行显微手术治疗的脑干海绵状血管瘤患者的临床资料及手术效果进行分析总结。结果：8例全切,3例次全切,其中的1例于术后第3天再出血而死亡,另1例大部分切除。术后早期神经功能障碍改善5例,同术前4例,加重3例。随访6~38个月,仍有2例患者未恢复至术前状态。结论：对有手术指征的脑干海绵状血管瘤,积极的显微手术治疗效果良好。     

Endoscope-assisted supraorbital keyhole approach for the resection of benign tumors of the sellar region.

The objective of the study was to evaluate the effectiveness of the supraorbital "keyhole" approach with endoscope assistance in surgical treatment of benign tumors around the sellar region. Thirty-five patients, including 19 pituitary tumors, 11 craniopharyngiomas and five tuberculum sellae meningiomas, were enrolled in this study. The tumors were resected through an endoscope-assisted supraorbital keyhole approach via a small skin incision within the eyebrow. Complete removal of the sellar region tumors was achieved in all 35 cases by endoscope-assisted supraorbital keyhole approach. Mean length of hospital stay after surgery was 10.2 days (range 5 - 17). There was no patient with evidence of residual or recurrent tumor during the follow-up period. There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery. Though some patients suffered from insipidus, hyperprolactinemia, subcutaneous edema or other postoperative complications, they eventually recovered with or without drug administration. The supraorbital "keyhole" approach with endoscopic assistance in the surgical treatment of benign tumors around the sellar region is an ideal pattern.     

Endoscope‐assisted supraorbital keyhole approach for the resection of benign tumors of the sellar region

The objective of the study was to evaluate the effectiveness of the supraorbital “keyhole” approach with endoscope assistance in surgical treatment of benign tumors around the sellar region. Thirty‐five patients, including 19 pituitary tumors, 11 craniopharyngiomas and five tuberculum sellae meningiomas, were enrolled in this study. The tumors were resected through an endoscope‐assisted supraorbital keyhole approach via a small skin incision within the eyebrow. Complete removal of the sellar region tumors was achieved in all 35 cases by endoscope‐assisted supraorbital keyhole approach. Mean length of hospital stay after surgery was 10.2 days (range 5 – 17). There was no patient with evidence of residual or recurrent tumor during the follow‐up period. There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery. Though some patients suffered from insipidus, hyperprolactinemia, subcutaneous edema or other postoperative complications, they eventually recovered with or without drug administration. The supraorbital “keyhole” approach with endoscopic assistance in the surgical treatment of benign tumors around the sellar region is an ideal pattern.     

New approaches in cardiac surgery for the therapy of congenital heart disease

Recent developments in the field of pediatric cardiac surgery and pediatric cardiology have led to significant changes in the surgical approach to the various cardiac malformations. There is a clear trend towards surgical treatment at a younger age of the patient, towards complete correction of malformations instead of staged procedures with initial palliation and delayed correction. Perioperative cardioprotection has improved significantly as has postoperative management in specialized pediatric cardiac intensive care units. As a result of this, mortality and morbidity of pediatric cardiac surgery have been in steady decline, although complexity of cardiac surgery in even smaller children has increased. Preoperative diagnostic work-up of the cardiac malformation can nowadays be achieved in an always increasing number of patients without invasive cardiac catheterization and based exclusively on ultrasound findings alone. A new element comes from the possibilities of therapeutic cardiac catheterization, which now allows for a combined therapeutic approach using therapeutic catheter procedures either to perform preparatory interventions prior to surgery or to treat surgical complications in the postoperative course. Refinements in the use of surgical implants have led to new possibilities of correction of complex malformations early in life, especially with regard to the use of biological prosthesis for valvar or outflow tract replacement.     

Management of parotid gland tumors in infants and children.

Seventy-four pediatric patients with parotid gland tumors were seen during a 52-year period. Seventy percent of the lesions were benign and 30% were malignant. When the primary treatment is either subtotal or total parotidectomy, the recurrence rate was 2.3%. The facial nerve should be dissected free of parotid parenchyma and preserved, except if the lesion was malignant--a situation in which the nerve might have to be sacrificed totally or in part to ensure adequate tumor removal. No patient died of a benign or malignant lesion in this series, and the morbidity after surgical removal of primary tumors of the parotid gland in children and infants was low.     

Rare asymptomatic giant cerebral cavernous malformation in adults: two case reports and a literature review

Cavernous malformations are benign vascular malformations. Giant cavernous malformations are very rare. All reported cases have been symptomatic because of the large size and compression of the surrounding brain tissue. We report two asymptomatic cases of giant cavernous malformation that were both misdiagnosed as neoplasms because of their atypical presentations. The first case was a 54-year-old man whose computed tomography and magnetic resonance imaging scans revealed an inhomogeneous lesion of 6 cm diameter and mild enhancement in the left frontal lobe. A left lateral supraorbital and transcortical approach was applied and the lesion was completely removed. The second case was a 36-year-old man with an irregular large mass in the parasellar region. Craniopharyngioma was suspected and gross total resection was performed. Post-surgical pathological analyses confirmed the diagnoses as cavernous malformations. Both patients recovered uneventfully. The rare asymptomatic giant cavernous malformations reported here in adults had benign behavior for this specific disease entity. The different clinical characteristics of ordinary cavernous malformation and adult and pediatric giant cavernous malformation imply complex and distinct genetic backgrounds. Concerns should be raised when considering giant cavernous malformation as a differential diagnosis for atypical large lesions. Surgical resection is recommended as the primary treatment option.     

Pediatric febrile seizures and childhood headaches in primary care

Febrile seizures and migraine headaches in children are two of the most common neurological diagnoses seen by primary care practitioners. It is essential that a knowledge base be developed to better care for this population. This article reviews pediatric febrile seizures, including management and treatment recommendations and childhood headaches, with an emphasis on migraine headaches. Diagnosis, management, and referral criteria are also reviewed.     

脑干海绵状血管瘤的临床表现及预后分析

目的 探讨脑干海绵状血管瘤患者临床表现及影响预后的相关因素.方法 回顾分析2008年9月-2010年9月27例脑干海绵状血管瘤患者临床资料.结果 20例(74.1%)患者CT显示出血及血肿.急性或突然神经功能废损22例,渐进性功能障碍15例.病情平稳4例.显微手术12例,放射治疗6例,保守观察9例.长期随访25例,2...     

老年人脑动静脉畸形的治疗

目的总结老年人脑动静脉畸形的治疗经验。方法对2002年12月至2005年8月收治的17例老年脑动静脉畸形病例进行回顾性研究。结果17例患者年龄55~74岁,平均年龄63.4岁,其中男性12例,女性5例。17例患者中11例出现脑出血而急诊入院,4例因突发癫痫急诊入院,仅2例因头痛平诊入院。入院后有10例病患通过急诊显微神经外科手术清除脑内血肿同时切除畸形血管团,除1例放弃治疗,1例行介入栓塞 γ刀治疗外,其他病例于入院后1周内择期显微神经外科手术清除病灶及畸形血管团。术后死亡2例,1例因大面积脑梗塞而死亡,另1例因就诊时脑出血已继发脑疝,于术后死亡。术后发生偏瘫1例。其他病患无严重神经功能废损而顺利康复出院。结论老龄不一定是手术的绝对禁忌症,通过显微神经外科手术治疗老年人脑血管畸形,可以达到切除病灶,预防出血,从而改善患者生活质量的目的。     

神经内窥镜辅助下锁孔入路显微手术治疗颅内动脉瘤

目的探讨神经内镜辅助锁孔手术治疗颅内动脉瘤的疗效。方法对28例颅内动脉瘤患者应用神经内窥镜辅助锁孔入路手进行颅内动脉瘤夹闭术。根据颅内动脉瘤所在位置,选择经翼点锁孔入路,进行显微手术。结果 28例患者均顺利实施手术,对瘤颈均做了良好夹闭,3例术中动脉瘤破裂,无手术死亡病例。患者术前症状与体征基本减轻或消失,无一例发生与手术入路有关的并发症。GOS评分：5分17例（68.4%）,4分6例（17.1%）,3分5例（9.8%）。术后患者GCS评分为（12.8±1.2）分,与术前的（10.1±2.0）分比较,差异有统计学意义（P〈0.05）。结论神经内窥镜辅助锁孔入路显微手术,可充分暴露动脉瘤及其周围结构,减少神经结构及穿支血管的损伤,明显提高颅内动脉瘤的手术效果,值得临床推广。