外伤性硬膜下积液演变的慢性硬膜下血肿

目的 探讨外伤性硬膜下积液演变为慢性硬膜下血肿的几率、机理和临床特点。方法 回顾性分析32例外伤性硬膜下积液演变为慢性硬膜下血肿患者的临床资料及有关文献。结果 本组16.7%的外伤性硬膜下积液病例演变为慢性硬膜下血肿;积液演变为血肿的时间为伤后22－100d;经钻颅血肿引流均治愈。结论 外伤性硬膜下积液是慢性硬膜下血肿的来源之一。发病年龄两极化,常发生在积液量少、保守治疗的慢性型病例中,致病方式常为减速性损伤及合并的颅脑损伤很轻微是外伤性硬莫膜下积液演变为慢性硬膜下血肿患者的临床特点。     

去大骨瓣减压术后硬膜下积液的诊治分析

目的探究去大骨瓣减压术后并发硬膜下积液时可靠且有效的治疗策略。方法收集本院9年内因重型颅脑损伤行去骨瓣减压手术的患者,针对术后并发硬膜下积液者,根据病情制定不同的治疗策略,并观察治疗效果。结果针对术后并发硬膜下积液的患者,结合病情分别采用保守治疗、腰大池置管引流、早期颅骨修补或同时行硬膜下腔腹腔分流和颅骨修补术,对于引流无效或颅骨修补后短期内出现脑积水者做出及时处理,所有病人硬膜下积液消失或明显减少,临床症状显著好转。结论对于去大骨瓣减压术后并发硬膜下积液的,稳定型和消退型患者保守治疗有效,对于进展型及演变型硬膜下积液,腰大池引流和硬膜下腔腹腔分流术疗效确切,同时早期颅骨修补术也不失为一种新的有效选择。     

61例小儿外伤性硬膜下积液的诊治

目的探讨小儿外伤后硬膜下积液的诊断和外科治疗。方法总结61例小儿外伤性硬膜下积液,均由CT或MRI确诊,根据积液量和病程,采取手术治疗,观察疗效。结果前囟侧角穿刺16例,颅骨钻孔硬膜下腔置管外引流38例,7例开颅清除硬膜下积液,切除积液囊壁。术后痊愈46例,好转10例,无效0例,死亡2例。结论小儿外伤性硬膜下积液患儿可根据不同的积液量和病程,采用相应的治疗措施,如原发脑病损伤不重,治疗及时、合理,预后良好。     

颞肌瓣填塞治疗外伤性硬膜下积液22例分析

外伤性硬膜下积液是颅脑损伤后常见的类型，在颅脑损伤中的发病率2％，既往一般采用钻孔外引流或硬膜下腔-腹腔分流术。采用钻孔引流术，硬膜下积液容易复发，有些导致拔管困难；硬膜下腔-腹腔分流则损伤大，并发症多，对老年病人效果差。本院从2004年开始采用颞肌瓣填塞，治疗外伤性硬膜下积液，效果比较好。     

外伤性硬膜下积液83例治疗体会

颅脑损伤后引起脑脊液积聚在硬膜下腔，称为外伤性硬膜下积液。据文献报道，外伤性硬膜下积液占颅脑损伤的3．7％～10．0％。笔者在2001年1月至2004年12月收治了83例资料完整的外伤性硬膜下积液患者，对其临床特点及治疗方法分析如下．     

外伤性硬膜下积液演变成慢性硬膜下血肿的临床分析

本院自1993年1月至2003年1月,共收治外伤性硬膜下积液(TSE)135例,其中17例转化为慢性硬膜下血肿(CSDH)。现结合患者的临床资料和有关文献报道如下。1临床资料1.1一般资料:17例中,男12例,女5例;年龄1～10岁6例,11～60岁2例,60岁以上9例。受伤原因:坠落伤6例,打击伤3例,车祸伤8例。其中减速性损伤12例。患者均否认在外伤性硬膜下积液演变为慢性硬膜下血肿期间有头部再次受伤史。1.2临床表现:17例患者均表现为在外伤性硬膜下积液症状的基础上,出现症状加重或新症状、体征,或原症状、体征减轻或消失后再次出现或加重。患者演变为慢性硬膜下血…     

急性硬膜下血肿快速消散25例的临床分析

目的探讨急性硬膜下血肿快速自然消散机理及临床特点。方法回顾性分析25急性硬膜下血肿快速自然消散临床特点及CT、MRI表现。结果 25例急性硬膜下血肿,17例在72小时内均自行消散,8例出现了脑内血肿或有多发性脑内血肿,其中2例脑内血肿手术治疗。结论急性硬膜下血肿在意识、瞳孔、生命体征及CT的严密监测下可以保守治疗,病因与CSF向蛛网膜下腔移行,冲洗及颅内压增高致血肿重新分布有关。     

神经外科：颅脑外伤

术前应用大剂量甘露醇改善急性硬膜下血肿的临床预后评估；伤后早期出现的迟发性颅内血肿28例分析；外科治疗颅底骨折并视神经损伤18例；经颅眶尖减压治疗外伤性眶尖综合征；轻中度颅脑损伤的MRI表现和预后的相关性研究     

外伤性硬膜下积液52例治疗体会

目的对外伤性硬膜下积液治疗方法进行分析。方法选择外伤性硬膜下积液患者52例,积液量：〈30ml 21例,30～59ml 6例,60～100ml 17例,〉100ml 8例。保守治疗40例,手术治疗12例,其中单侧硬膜下腔-腹腔分流3例,单侧钻孔引流7例,双侧钻孔引流2例。结果保守治疗40例中29例积液消失,7例积液减少,2例积液无明显变化,2例伤后2～3月形成慢性硬膜下血肿,钻孔引流术后治愈;手术治疗12例中10例一次治愈,2例术后复发,改行硬膜下腔-腹腔分流后治愈。结论外伤性硬膜下积液在不同时期需要采取不同的治疗方法;保守治疗期间CT动态复查十分重要,腰穿和高压氧治疗有一定作用,必要时需手术治疗。     

37例外伤性硬膜下积液的治疗体会

目的探讨治疗外伤性硬膜下积液的治疗体会。方法方法对37例外伤性硬膜下积液患者分别采取非手术或手术治疗。回顾性分析患者的临床资料。结果 37例中,非手术治疗20例,随访6个月,总有效率95.00%;1例变为慢性硬膜下血肿。17例患者均钻孔置管外引流并随访6个月,5例复发,其中4例联合腰大池穿刺置管持续引流或硬膜下腔-腹腔分流术等手术治疗,1例行开颅硬膜下积液囊壁(包膜)切除术后治愈。结论充分评估病情、严格掌握非手术或手术治疗指证、选择恰当治疗方式,可提高外伤性硬膜下积液的治疗效果,有效改善患者预后。     

Traumatic subdural hydroma: Clinical characteristics and classification

Background

Traumatic subdural hydroma (TSH) is a common complication of head injuries. The aim of this study was to examine the clinical characteristics and classification of TSH.

Methods

One hundred and ninety-two patients with TSH were treated in Qilu hospital during a 13-year period (1989-2001). We reviewed each patient's clinical records and radiological findings.

Results

Based on clinical features and dynamic observation of CT scanning, TSHs were classified into four types: resolution, steadiness, development and evolution. The resolution type often occurred in the prime of life, and the patients had normal intracranial pressure and good prognoses after conservative treatment. The elderly made up the majority of the steadiness type. Their main clinical manifestations included headaches, dizziness, nausea, vomiting, abnormal mentality, etc. Generally, no positive nervous systemic sign related to TSH was observed. The prognoses of the steadiness type treated by conservative therapy were also satisfactory. The development type was common in babies and children and mainly manifested as progressively increasing intracranial pressure, mild hemiplegia, aphasia and abnormal mentality. The patients with development type often needed surgical treatment where there was an associated risk of dying from accompanying cerebral parenchymal damage or postoperative complications once in a while. The evolution type with chronic subdural haematoma occurred between 22 and 100 days after TSH and in the cases of small hydromas treated conservatively, with mild accompanying cerebral damage, characterised by the polarised age, and chronic increased intracranial pressure, there was always a good prognosis after surgery.

Conclusions

The mechanism, clinical characteristics, treatment methods and prognoses varied with the different types of TSH.     

Traumatic subdural hydroma developing into chronic subdural hematoma

Objective: To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma(CSDH). Methods: We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature. Results: 16.7 % of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage. Conclusions : TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.     

Evaluation of a distal pericallosal aneurysm visualized with 3-dimensional digital subtraction angiography: case report and treatment implications

BACKGROUND: Digital subtraction angiography (DSA) is considered the gold standard in the evaluation of cerebrovascular structures. Recently, 3-dimensional DSA (3D-DSA) has been increasingly used to obtain detailed information about the morphology and dimensions of intracranial aneurysms. We report the case of a patient who presented with a distal pericallosal artery aneurysm, which appeared by 2D imaging to be a fusiform, possible mycotic aneurysm. This was then revealed to be a saccular bifurcation aneurysm by 3D-DSA. This additional information changed the treatment plan for this patient from medical management to a surgical approach. CASE DESCRIPTION: The patient is a 56-year-old man with a history of hypertension and alcohol abuse with withdrawal seizures, who presented with a large intracranial hemorrhage on initial computed tomography scan. After stabilization with intracranial pressure management, the patient underwent magnetic resonance angiography and 4-vessel DSA. These initial studies showed a distal, fusiform pericallosal aneurysm consistent with a mycotic aneurysm. Rotational DSA was then used to generate 3D images of the structure that revealed a saccular bifurcation aneurysm. This enabled the decision to offer operative treatment rather than conservative medical management. DISCUSSION: This report highlights the value of 3D-DSA in establishing the appropriate treatment plan for patients with unique cerebral aneurysms. The higher resolution images used in this case provided information that was crucial in shifting the treatment focus from medical management, for what appeared to be a mycotic aneurysm by traditional DSA, to surgical intervention, for a clear hemodynamic aneurysm at a vessel bifurcation seen with 3D-DSA. Accurate pre-interventional evaluation and differential diagnosis are critical to designing the most effective lowest risk treatment plan. The standard method in the diagnosis of cerebral aneurysms has been DSA. Yet, higher resolution images of unclear or high-risk aneurysms are often required to guide clinical decision making. The emergence of new, less invasive endovascular techniques for securing intracranial aneurysms has placed greater emphasis on precisely defining the shape and dimensions of an aneurysm. Three-dimensional DSA is currently the highest resolution imaging modality available for the evaluation of intracranial aneurysms. CONCLUSION: 3D-DSA was used to evaluate a small, distal pericallosal artery aneurysm and revealed a saccular bifurcation aneurysm not visualized with magnetic resonance angiography and conventional DSA. This additional resolution permitted the team to consider a surgical approach for a patient who would otherwise have been treated medically. This high-resolution technique is particularly useful in guiding clinical decision making in the context of aneurysms that carry a relatively broad differential diagnosis, potentially high interventional risk, and unclear morphology.     

A practical technique for continuous monitoring of cerebral tissue pressure in neurosurgical patients

Summary A new technique for continuous monitoring of cerebral tissue pressure is presented. It is based on a new type of piecoresistive microtransducer with low baseline and temperature drifts. In 7 patients cerebral tissue pressure and ventricular fluid pressure were recorded simultaneously.Comparison of these two different pressures showed extremely good correlation with coefficients always better than 0.95. Due to another type of pulsewave cerebral tissue pressure was constantly 4 to 12 mm Hg lower than ventricular fluid pressure. Routine use of cerebral tissue monitoring in 12 neurosurgical patients with brain tumours postoperatively showed good clinical correlation of cerebral tissue pressure without any additional complications.The authors recommend continuous monitoring of cerebral tissue pressure as a safe and simple method of intracranial pressure monitoring in neurosurgery.     

大面积脑梗死38例临床分析

目的探讨大面积脑梗死的病因、临床特点、治疗及预后的关系。方法回顾性分析2007年1月～2009年12月笔者所在科室收治的38例大面积脑梗死患者的临床表现、头颅影像学检查结果及治疗和预后资料。结果 38例患者中,心源性栓塞12例,动脉源性栓塞7例,颅内动脉狭窄3例,来源不明的或非栓塞性16例。30例采用内科保守治疗,好转27例,死亡3例,均为严重脑疝患者。8例因颅内高压进行性加重转外科行开颅减压术,好转7例,死亡1例。结论大面积脑梗死发病突然,病情严重,并发症重,致残、致死率高,急性期治疗的关键是控制颅内压,降低脑水肿,防止脑疝形成,促进病变脑组织功能恢复。对内科治疗效果差者应尽早转外科行减压术,以改善预后。     

rCBF in impending brain death

Summary Regional cerebral blood flow (rCBF) was measured in three patients after relief of elevated intracranial pressure and restoration of normal cerebral perfusion pressure. Two patients, studied within 4 hours after closed head injury were found to have marked impairment of cortical blood flow and elevation of cerebrovascular resistance. We suggest that this picture is indicative of impending brain death, and may be the result of a long period of severe cerebral ischemia. The third patient, who had a shorter period of intracranial hypertension occurring during anaesthetic induction, responded to reduction of ICP quite differently with a transient relative hyperaemia. The physiopathological explanations for these two different types of flow response and their possible clinical significance are discussed.     

Systems analysis of cerebrovascular pressure transmission: an observational study in head-injured patients

In an observational study in head-injured patients, cerebrovascular pressure transmission was investigated using a systems analysis approach whereby the blood pressure (BP) waveform was used as a measure of an input stimulus to the cerebrovascular bed (CVB) and the intracranial pressure (ICP) waveform as the response to that stimulus. The transfer function is a measure of how much pressure is transmitted through the CVB at a given frequency and is calculated using Fourier analysis of the pressure waveforms. The transfer function allows quantification of the pressure transmission performance of the CVB, thus providing a basis for comparison between normal and abnormal function. Fifteen hundred samples of ICP and BP waveforms were collected from 30 head-injured patients via microcomputer. Off-line spectral analysis of the waveform database revealed four main classes of transfer function: those with an overall flat transfer function (curve type 1); those with an elevated low-frequency response (curve type 2); those with an elevated high-frequency response (curve type 3); and those exhibiting both an elevated low- and high-frequency response (curve type 4). Curve types 2 and 4 were most often associated with raised ICP (greater than 20 mm Hg), whereas curve types 1 and 3 were most often affiliated with ICP less than 15 mm Hg. Studies of this type may provide insight into the pathophysiology of the CVB and ultimately aid in the prediction and treatment of raised ICP.     

Noisy intracranial tumours

Summary Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9 patients with meningiomas. All patients with gliomas, including the subgroup of patients with low-grade gliomas, as well as patients with aneurysms, had significantly different sound recordings in comparison to control patients. Recordings from glioma patients did not differ significantly from recordings of aneurysm patients.Radiological evaluation of the tumours was performed in order to establish which tumour characteristics were associated with abnormal sound recordings. It was found that the type of tumour, i.e., histology or malignancy grade, was a significant associated factor, whereas other tumour characteristics such as size, mass effect and amount of oedema were not.In conclusion, patients with specific types of intracranial tumours produced abnormal sounds which could not be distinguished from abnormal sounds recorded in patients with aneurysms. These results may be important for the interpretation of sounds recorded for the detection of intracranial pathology, especially for aneurysm screening.     

Spontaneous intracerebral haemorrhage. An update of conservative treatment

In our article we analysed the current conservative therapeutic options in spontaneous intracerebral haemorrhage as well as a few controversies regarding the efficiency of some types of treatment. Spontaneous intracerebral haemorrhage represents a major neurosurgical emergency. In spite of the severe prognosis of the disease, there is reason for optimism. There are important improvements in treatment of arterial hypertension, and cerebral lesions. The aim of the conservative medical treatment is to maintain good oxygenation, decreased arterial pressure, control of the intracranial hypertension, cerebral oedema, prevention of seizures. All these contribute to improving the vital and functional prognosis.