立体定向穿刺引流治疗深部多发性脑脓肿

目的采用采用立体定向穿刺引流治疗探部及多发性脑脓肿.方法使用颅表定位器,对31例深行部及多发性脑脓肿立体定向穿刺引流术,术后持续冲洗引流3～14天,常规应用敏感肮生素.结果本组31例,共38个脓肿,均一次穿刺成功,经冲洗引流后,2例因脓肿腔不闭合而行手术治疗.余经CT复查证明脓腔消失,随访至今未见脓腔复发.结论多发性脑脓肿及小型的深部脑脓肿,直接手术有一定的困难,尤其是脓肿位于脑重要的功能区,手术风险更大.CT引导下立体定向穿刺引流治疗脑脓肿,以其操作方便,定位准确,损伤小,疗效可靠而显示其明显的优越性,特别是对儿童及年老体弱者     

多发性脑脓肿的综合性治疗（附5例分析）

目的 探讨立体定向穿刺引流术联合抗生素综合性治疗多发脑脓肿的效果。方法 回顾性分析2018年4月至2020年10月收治的5例多发性脑脓肿的临床资料。急性脑炎期应给予广谱、足量抗感染治疗；脓肿包膜形成时，采取立体定向穿刺引流术，术后采用高通量测序技术检测病原菌，并根据结果调整抗生素。结果 5例中，3例进行两次引流术，2例进行单次引流术。术后高通量测序技术明确致病菌，经充足疗程的抗感染治疗，脓肿灶逐步消失，未发生脑疝，全部治愈出院。术后6个月随访，除1例遗留肢体轻瘫外，其余4例无肢体活动障碍。结论 对于多发性脑脓肿，尽早明确诊断、选择合理的治疗方式是提高脑脓肿治疗效果的关键；高通量测序技术为抗生素调整提供依据，并对感染源治疗有指导作用；立体定向穿刺引流术可以缩短疗程，减少抗生素应用时间，提高治疗效果。     

脑脓肿7例手术治疗体会

目的 探讨脑脓肿的治疗方法和疗效.方法 脓肿穿刺冲洗引流术4例,脓肿切除术3例.结果 6例痊愈,1例复发,二次手术后痊愈.结论 脑脓肿不宜早期手术,应先抗生素治疗2～4周,待脓肿壁形成后再手术. 摘要： 1 资料与方法 1.1 一般资料 男4例,女3例;年龄24～59岁;血源性1例,外伤性2例,上感3例,耳源性1例;顶叶3例,基底节1例,颞枕部2例,额叶1例.7例均行头颅CT及增强CT扫描,2例行MRI扫描. 1.2 治疗方法 全身应用抗生素治疗2～4周后,3例行脓肿切除术,4例应用YL-1型颅脑穿刺针行立体定向脓肿穿刺冲洗引流术.术后继续全身应用抗生素2～4周,抗癫治疗1.5～2 a.     

脑脓肿立体定向外科治疗

目的进一步评价立体定向外科手术在脑脓肿治疗中的作用并探讨脑脓肿的最有效治疗方法。方法自1999年1月至2005年3月共外科手术治疗脑脓肿患者24例，其中男19，女5例，年龄7～76岁（平均44．5岁）。单发脓肿21例；多发脓肿3例。共行立体定向引导脓肿穿刺及引流手术20例：脓肿穿刺14例，穿刺置管引流6例；开颅手术切除脓肿4例。结果全部手术均获得成功，一例患者2W后复发施行了第二次定向手术，另一例于立体定向手术结束时出现癫痫大发作。出院时所有患者临床症状全部消失或明显改善，头颅CT或MRI复查显示脓肿腔消失。22例患者接受了4个月至3年的随访（平均14个月），均未见脓肿复发。结论立体定向脑脓肿穿刺抽吸和引流手术应为脑脓肿的首选治疗。     

增强磁共振引导下脑脓肿的立体定向穿刺手术治疗

目的 探讨增强磁共振引导下立体定向穿刺手术治疗脑脓肿的临床疗效。方法 回顾性分析18例增强磁共振引导下立体定向穿刺手术治疗的脑脓肿临床资料,包括年龄、性别、临床表现、病程、脓肿数量及部位、感染诱因及预后。结果 18例脑脓肿均穿刺成功,其中单发15例,多发3例。血源性4例,医源性5例,隐源性7例,耳源性及鼻源性各1例。治愈16例,死亡2例。结论 在现代神经影像学的辅助下,立体定向穿刺抽吸治疗脑脓肿是一种安全、微创、可靠的治疗方法。     

脑脓肿7例手术治疗体会

目的 探讨脑脓肿的治疗方法和疗效.方法 脓肿穿刺冲洗引流术4例,脓肿切除术3例.结果 6例痊愈,1例复发,二次手术后痊愈.结论 脑脓肿不宜早期手术,应先抗生素治疗2～4周,待脓肿壁形成后再手术.     

立体定向下神经内镜治疗多房性脑脓肿(附14例临床分析)

目的探讨立体定向辅助下神经内镜手术治疗多房性脑脓肿临床可行性。方法对我科2006年11月至2010年10月多房性脑脓肿14例,采用立体定向辅助下神经内镜手术治疗回顾分析。结果均一次穿刺成功,手术后脓腔消失,经随访8个月至3年,13例脓肿壁完全消失,术后1例复发。结论认为立体定向辅助下神经内镜手术治疗多房性脑脓肿具有定位准确、安全、创伤小等优点,此方法操作可行,疗效理想。     

立体定向手术治疗脑干脓肿6例临床分析

目的总结立体定向手术对脑干脓肿的治疗效果。方法对6例临床诊断为脑干脓肿的患者进行立体定向脓液抽吸＋局部抗生素冲洗等治疗,并进行临床随访。结果5例经手术证实为细菌性脓肿,1例为结核性脓肿,无死亡病例,无手术并发症。所有病人在随访期内未见脓肿复发,术后症状完全恢复4例,2例遗留轻度偏瘫。结论立体定向外科手术治疗脑干脓肿安全有效。     

脑脓肿的MRI诊断和立体定向手术治疗

目的 探讨核磁共振(MRI)弥散加权成像(DWI)与表观弥散系数(ADC)值在脑炎病理变化全过程中的诊断价值,进一步评价立体定向脓液抽吸及引流术在脑脓肿治疗中的作用.方法 利用脑炎在核磁共振DWI及ADC值上的表现,对14例23个脓肿灶的磁共振表现进行分析.共行立体定向引导脓肿穿刺及引流手术20例:脓肿穿刺14例,脓肿腔穿刺引流6例.结果 脑脓肿不同期的MRI DWI表现和ADC值有明显不同.20例手术均获得成功,术后头颅CT或MRI复查显示脓肿腔消失.所有病人在随访期内(4个月至3年,平均14个月)未见脓肿复发.结论 脑炎各个时期有其不同的MRI表现,DWI及ADC值已成为脑炎各期诊断的一个重要诊断依据.立体定向脑脓肿穿刺抽吸和引流手术应为脑脓肿的首选外科手段.     

脑脓肿的立体定向穿刺引流术

1926年Dandy首先采用穿刺治疗脑脓肿获得成功,近50年来,脑脓肿的治疗取得显著的进步,尤其CT及RMI应用于临床以来,对脑脓肿的大小部位、数量、脓壁的厚薄以及脓肿周围脑水肿程度均一目了然,但在脑脓肿的治疗方面仍存在很多争议。手术和药物治疗各有其局限性。近10余年来CT导引下立体定向吸引及引流术(以下简称定向术)在脑脓肿诊治中的应用,使该病的各种治疗方法得以重新评价。本文对脑脓肿定向术的优点,原则及注意事项进行综述。     

Conservative treatment of brain abscesses

The authors present 6 patients with brain abscesses treated conservatively. There were multiple brain abscesses in 4 patients. The patients were in good general condition without marked symptoms of high intracranial pressure. The conservative treatment lasted 4 to 11 weeks under CT control and careful observation of clinical status. 5 patients were cured, 4 of them without any neurological deficit and 1--with visual field defect after bilateral brain abscesses in occipital lobes. 1 patient died in spite of drainage of the biggest of multiple abscesses. The authors confirmed the value of conservative treatment in selected cases of brain abscess, specially in multiple brain abscesses. The early beginning of such treatment seems to be specially important.     

Primacy of medical treatment of cerebral abscesses (19 cases)

Therapy in 19 consecutive cases of cerebral abscess was limited to medical treatment whenever possible, using high doses of a combination of several antibiotics. Long-term follow up by serial computed tomography was performed. Antibiotic treatment alone was effective in 8 patients with multiple hemispheric abscesses of metastatic origin, though one patient seen late with three large abscesses die on the 4th day. In 8 cases with single abscesses, medical treatment alone was effective: 5 had lesions less than 4 cm in diameter; in 2 cases with lesions 4 to 5 cm in diameter, additional abscess puncture was carried out. One patient required early excision of an occipital abscess, and 2 cases of pontocerebellar angle abscesses were also treated surgically. Antibiotic therapy alone was effective in 1 patient with a large brain stem abscess. Treatment of cerebral abscess has largely changed since the availability of computed tomography, with a progressively more important place being accorded to antibiotic therapy alone. The stage of the abscess does not appear to be a decisive factor in the choice of treatment, medical therapy appearing to provide a definitive cure with a minimum of sequelae in the majority of cases. Abscess puncture may be an adjunct to antibiotic therapy in large abscesses with clinical signs.     

Multiple pyogenic brain abscesses: an analysis of 21 patients.

Multiple pyogenic brain abscesses constituted 11.7% (21 patients) of a series of 179 consecutive patients with brain abscess treated from 1976 to 1984. The commonest cause of these abscesses was congenital cyanotic heart disease (38%), followed by middle ear infection (19%). Two thirds of these patients were in the first two decades of life. The clinical presentation was similar to brain abscesses in general, there being no clinical features suggestive of multiple lesions. In 85% the abscesses were supratentorial. Infratentorial abscesses alone or in association with supratentorial abscesses were invariably otogenic in origin. Aspiration of the largest abscesses supplemented with appropriate antibiotics was the treatment of choice in 16 patients; secondary excision of the largest abscesses was required in six patients. Primary excision was performed in three patients when the abscesses were in close proximity to each other. Two patients were managed with antibiotics alone. The overall mortality was 23.8%.     

Staphylococcus cohnii as a cause of multiple brain abscesses in Weber-Christian disease

We report a patient with multiple brain abscesses due to Staphylococcus cohnii. While these brain abscesses markedly responded to the antibiotics, this patient was subsequently suffered from subcutaneous inflammatory nodules in the adipose tissue, which diagnosed him as having Weber-Christian disease (WCD). This is the first report that subcutaneous inflammatory nodules in the adipose tissue, which lead the diagnosis of WCD, followed multiple brain abscesses. To our knowledge, S. cohnii has not yet been reported to cause multiple brain abscesses in humans. Although the etiology of WCD is unknown, an immune mechanism has been implicated in the pathogenesis. Therefore, we should notice that patients with WCD could be immunocompromised hosts with a higher risk to suffer from severe opportunistic infections.     

Clinical features and outcome analysis of 90 cases with brain abscess in central China

The purpose of this study was to investigate the clinical features and outcomes of brain abscess in patients in central China. Ninety consecutive patients with brain abscess were studied retrospectively. The rate of positive bacterial culture in the present series was 12%. The outcome of superficial abscesses was better than those of abscesses in deep-seated locations (p<0.01); multiple brain abscesses led to significantly poorer outcomes than unilocated abscesses (p<0.01). There was no significant difference between the paediatric group and the adult group (p>0.05). Differences in outcomes between intrathecal injection combined with systemic administration of antibiotics vs. only venous administration could not be found (p>0.05). The clinical effectiveness of tertiary-generation cephalosporin+vancomycin+metronidazole for bacterial brain abscess was 88%. Therefore, combined antibiotics in cases with no evidence of positive culture in brain abscess are strongly recommended.     

Brain abscesses in children — a cooperative study of 83 cases

This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.     

脑脓肿个体化手术治疗

目的总结手术治疗的69例脑脓肿,探讨脑脓肿手术病例的选择和治疗效果。方法分析69例脑脓肿的临床资料,采用立体定向穿刺术16例;开颅脑脓肿切除术25例;小骨窗开颅引流术28例,进行回顾性分析。结果立体定向穿刺术治愈15例,1例复发;开颅脑脓肿切除术治愈20例,好转2例,3例复发。小骨窗开颅引流术治愈25例,好转2例,1例复发。结论脑脓肿的治疗应根据患者年龄、全身状况、有无并发症、脑脓肿大小、部位、形态以及是否多发,采取个体化的治疗方式;个体化治疗有助于提高治疗效果。     

Utilization of multidisciplinary surgical techniques to successfully manage 20 brain abscesses in a child

Purpose

This study describes a case of multiple brain abscesses in a four-year-old boy who presented with a history of fever and disorientation.

Methods

Medical investigations revealed severe leukocytosis and the presence of 20 hypodense lesions in the boy’s cerebrum. Initial medical treatment included intravenous antibiotics, antiepileptics, and dexamethasone. The boy underwent five surgical interventions within a period of 5 weeks that included frameless stereotactic craniotomies for aspiration and resection of the abscesses.

Results

At the 3-month follow-up, the boy displayed no neurological deficits and no lesions were detected in his brain.

Conclusions

This study reveals the importance of instituting a standardized protocol to determine the urgency of surgical intervention in cases of brain abscess so that surgical treatment can be applied in the appropriate time period. This case also shows that rewarding results can be obtained in treating brain abscesses in children when the proper treatment method is initiated in the appropriate amount of time.     

脑深部电极监测在致痫灶定位中的应用

目的评估脑深部电极置入后对定位致痫灶及指导手术治疗的可靠性和安全性。方法对108例药物难治性癫病人行脑深部电极置入,其中采用立体定向电极置入77例,神经导航电极置入11例,术区徒手置入20例。根据头皮脑电图监测情况和脑深部电极提供的手术路径,行致灶切除。结果根据监测情况,头皮脑电图不能定位而通过深部电极定位98例,两者定位于不同区域7例,两者均不能定位3例。术后病理：局灶性皮质发育不良38例,颞叶内侧硬化42例,结节性硬化11例,神经节细胞胶质瘤7例,胶质增生9例,错构瘤1例。术后随访91例,时间6～36个月,Engle分级：Ⅰ级66例,Ⅱ级25例;复查脑电图,痫样异常放电消失或明显改善。术后并发脑出血5例,硬膜外血肿6例,蛛网膜下腔出血3例,电极因发作脱出或拔出1例,剧烈头痛3例,无死亡病例。结论初期评估不能明确定位的脑深部致痫灶,通过脑深部电极定位是安全、可靠的。