丘脑及脑干占位病变的显微与激光手术

本文总结１８例丘脑及脑干占位性病变的显微与激光手术治疗体会。其中４例位于丘脑，中脑者２例，桥脑者６例，延髓者６例。除１例桥脑胶质瘤术后第三个月死于肿瘤复发呼吸衰竭，１例丘脑肿瘤于术后１年死于再手术后感染外，其他皆有良好的神经功能恢复．１２例于术中后２～３周作ＣＴ／ＭＲ检查，显示有明显改善．随访５个月～２年无症状复发表现．本文就丘脑及脑干占位病变的手术适应证、手术入路及激光应用作重点讨论．     

大型听神经瘤的手术治疗

报告１９９１年１月至１９９４年１２月手术切除的大型听神经瘤１４０例，无术后死亡。肿瘤全切除率８４．３％，面神经保留率８７．３％，术前有听力者听神经保留率６４．１％。绝大多数（９６％）的病例采用一侧枕下乙状窦后入路，作者总结了肿瘤全切除和保留面神经的经验，同时强调手术前后处理也至关重要。（１）危重患者可先行侧脑室－腹腔分流缓解颅压后再开颅手术；（２）术后密切观察病情变化，及时发现和清除术后血肿；（３）术前有后组颅神经麻痹者术后宜早期做气管切开；（４）伤口局部皮下积液在炎症已控制的情况下可行囊腔－腹腔分流术。     

经颈前入路显微外科手术治疗老年颈椎病

目的 介绍并讨论前路显微外科手术治疗老年颈椎病。方法 对６０例病人实施了颈间盘、后纵韧带及椎体后缘骨赘显微手术切除椎体融合术,对２４例病人实施了椎体切除显微手术减压椎体融合钛板固定术。结果 ６６例（７９％）术后症状改善,１４例（１７％）无变化,２例（２％）症状加重,２例（２％）死亡（１例死于冠心病,１例死于肺栓塞）。统计学分析表明,病人手术前后神经功能状况的差异有显著性,术后明显优于术前（Ｐ〈０．     

类固醇与胸腺放疗联合疗法治疗22例胸腺切除后无效的重症肌无力

本文报告用类固醇和胸腺放射联合疗法治疗２２例胸腺切除后无效的重症肌无力患者的疗效。２个月内的近期有效率高达１００％。经１～１２年的长期随访，达完全缓解和显著改善者１９例，占８６．４％。停用一切药物长达２～１０年而无任何症状者７例，占３１．８％。     

颞叶的局部解剖与癫痫的手术治疗(颞叶切除术的一些改进)

目的：复习颞叶的局部解剖，探讨颞叶切除方法的改进。方法：（１）手术技巧的改进：①首先寻找侧脑室颞角；②经颞上回切除颞叶外侧皮质；③在直视下切除颞叶内侧结构（杏仁、海马、钩回及海马旁回等）。（２）在ＥＣｏＧ监测下，反复描记ＥＣｏＧ，尽可能切除致痫组织。结果：满意者３８％，显著改善者占４０％，良好者占１０％，效差６％，无改善者６％。并发症：偏瘫加重１例，无菌性脑膜炎３例，记忆力下降４例，无手术死亡。结论：熟悉颞叶解剖，应用改进的颞叶切除法，术后的并发症少，控制癫痫效果好     

开颅术后发生颅内远隔部位血肿12例分析

开颅术后发生颅内远隔部位血肿１２例分析王国良我科１９９０年１１月～１９９６年４月，共进行８３６例择期开颅手术，其中１２例（１．４％），术后发生颅内远隔部位血肿，均经ＣＴ证实，及时手术清除血肿后效果满意，现报告如下。临床资料本组男８例，女４例。年龄２１...     

高血压脑出血术后脑梗死20例分析

本院自１９９５年１０月至１９９９年１０月共出现２０例高血压脑出血术后脑梗死病例，现总结讨论如下。１ 一般资料 本组男１５例，女５例。年龄４９～７８岁，平均６５岁。均在发病后４～１０小时内给予手术治疗，术后甘露醇常规应用。均在术后３～６ｄ发现脑梗死情况，经积极治疗，死亡４例，植物生存１例，偏瘫卧床１５例。２讨论２．１诊断 高血压脑出血术后３ｄ症状无减轻或有明显加重时，均要考虑脑梗死发生。本组２０例复查ＣＴ均可见大面积低密度区，与原出血灶临近，与大血管供血分布区一致。２．２机制 大量血肿及其刺激所致的周…     

经硬膜外入路切除海绵窦肿瘤(附18例报告)

目的 报告１８例海绵窦肿瘤的经硬膜外入路显微外科治疗的经济。方法 回顾性分析自１９９４￣１９９８年８月经硬膜外入路切除１８例海绵窦肿瘤的临床及影像学特征、手术方法、手术结果及手术并发症等。结果 全部肿瘤全切除，无手术死亡，术后４５％颅神经症状得到改善，４５％颅神经症状同术前，１０％颅神经症状加重，１１％术后出现新颅神经症状。随访２月至４８月（平均２４月）无复发。结论 海绵窦肿瘤可采用单一硬膜外入路     

颅咽管瘤全切术后水钠平衡紊乱的治疗

目的 探讨颅咽管瘤全切术后水钠平衡紊乱的临床特点及治疗方法。方法 术前,手术当及术后每日定时检测血钠及观查尿量变化并根据其变化进行治疗。结果 ６０例颅咽管瘤手术患者中,（１）４７例术后出现尿崩症,有３８例病人术后２周恢复,７例术后４周内恢复,１例术后１年内恢复,１例病人术后７天死亡。（２）５２例术后出现血钠紊乱,其中,４８例术后４周同恢复,２３例术后２个月内恢复,１例１年后恢复。结论 颅咽管瘤全切     

脑立体定向手术治疗精神分裂症远期疗效研究

脑立体定向手术治疗精神分裂症远期疗效研究许之驹任赐儿陈镜松我院１９８５年４～１０月和广州医学院合作进行了１８例脑双侧扣带束立体定向破坏术治疗精神分裂症［１］。术后近期（术后１年）有效１２例，中期（术后５年）有效９例［２］。现已过了１０年，将远期疗效观...     

A clinical study on long-term outcome in patients with syringomyelia associated with Chiari malformation]

To investigate the long-term outcome in patients with syringomyelia associated with Chiari malformation (chronic tonsilar herniation), we investigated the actual factors of the patient's problems by a questionnaire for the patient. Replies to the questionnaires were obtained from 44 patients with syringomyelia who had been treated with expansive suboccipital cranioplasty with dural plasty (with plugging of the central canal in 20 patients). In 25 cases (68%) in whom the motor dysfunction of the upper extremities remained, the symptoms improved in 16 cases (43%) and were unchanged in 9 cases (24%). In 18 cases (64%) in whom the motor dysfunction of the lower extremities remained, the symptoms improved in 10 cases (36%) and were unchanged in 8 cases (29%). In 31 cases (78%) in whom the sensory disturbance remained, the symptoms improved in 19 cases (48%) and were unchanged in 12 cases (30%). The motor dysfunction of the upper extremities persisted significantly in more patients having a duration of illness over 2 years than in patients with those less than 2 years. Sensory disturbance persisted significantly in more patients with a duration of illness over 3 years than in patients with that less than 3 years. These results suggest that firstly, sensory disturbance (disturbance of the posterior horn) is most apt to remain, then motor dysfunction of the upper extremities (disturbance of the anterior horn) and followed by motor dysfunction of the lower extremities (disturbance of the pyramidal tract). We conclude that patients should be treated before having irreversible spinal cord disturbance.     

Results after surgery for lumbosacral lipoma: the significance of early and late worsening

We retrospectively reviewed 32 patients operated on for lipoma of the conus and lipomyeloschisis, the two main anatomical subtypes of congenital lumbosacral lipomas associated with tethered cord syndrome. Surgery was proposed to patients when they were symptomatic, and in most cases for progressive symptoms. The evolution of the different symptoms was studied separately. In most patients, symptoms improved or stabilized after surgery; in some, however, postoperative worsening, at least of some of the symptoms, was seen. This postoperative worsening became apparent either early or late after the operation, and was not associated with surgical trauma or postoperative complications. We suggest it was caused mainly by the natural course of the disease (especially in the case of the orthopedic deformities), and in some cases by retethering. Our series is not large enough to detect statistical significance for the different symptoms or for the anatomical subgroups. Importantly, according to our analysis by the different symptoms, the operation did not seem to protect the patients from later development of new deficits. This can be interpreted as an argument against prophylactic surgery in asymptomatic patients. Received: 11 August 1998     

精神分裂症的强迫症状临床分析

对符合ＣＣＭＤ－２诊断标准的３９例伴有强迫症状的精神分裂症患者同不伴有强迫症状的精神分裂症患者进行对照分析，发现伴有强迫症状者其疗效和预后优于不伴发者。精神分裂症所伴发的强迫症状其内容荒谬、空洞，而且这些患者缺乏自知力及相应的情感体验。本研究结果还表朋强迫症状多发生在精神分裂症的疾病进展期，和以往的国内外报道不一致。     

蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析

目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.

Abstract：

Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.     

神经内镜颞下锁孔Kawase入路切除岩斜区脑膜瘤

目的探讨内镜颞下锁孔Kawase入路切除岩斜区脑膜瘤的方式及治疗效果。方法回顾性分析用内镜经颞下锁孔Kawase入路切除5例岩斜区脑膜瘤患者的临床资料和术后效果及并发症。结果本组患者中4例患者的肿瘤完全切除,1例患者肿瘤次全切除;无死亡病例。术后复查CT示手术区域和手术路径均无脑组织挫伤。1例复发脑膜瘤患者术后出现嗜睡、右侧肢体偏瘫,经治疗后意识恢复正常、右侧肢体肌力改善;3例患者术后出现新发颅神经轻度损害表现,经治疗后2例好转、1例无明显改善;1例患者术后无任何并发症,且术前症状术后明显改善。术后随访13~20个月,患者均正常生活,未见肿瘤复发或快速生长。结论内镜颞下锁孔Kawase入路手术具有微创、暴露范围广、视野清晰等优点,治疗岩斜区脑膜瘤的效果良好、安全性高。     

Wallis动态稳定系统置入治疗腰椎失稳症的效果

背景：为保证可控制范围内的脊柱运动,改变失稳节段运动的负荷模式,并限制其异常活动,同时避免相邻节段椎间盘退变的发生,多种后路腰椎非融合固定装置被研发并用于临床。 目的：探讨Wallis动态稳定系统治疗腰椎失稳症的临床效果。 方法：选择中山大学附属第一医院脊柱外科收治的腰椎失稳症患者10例,男3例,女7例,年龄43~65岁,其中失稳节段1例为L1/2和L4/5,1例为L2/3,1例为L3/4,其余均为L4/5;合并相同节段腰椎间盘突出症2例,腰椎管狭窄症7例,相邻节段腰椎管狭窄症3例;失稳节段均行后路椎管减压、Wallis置入固定治疗。观察治疗前后视觉模拟VAS评分、下腰痛JOA评分、Oswestry功能障碍指数变化;失稳节段和相邻节段的活动范围及L4/5节段椎间盘后高度的变化。 结果与结论：10例患者均获得随访,随访时间2~13个月,平均9.2个月。手术时间平均128 min(90~185 min),术中平均出血量264 mL (50~600 mL)。腰痛均消失,术后患者的症状和体征均有明显改善;1例置入治疗后3个月因L4/5右侧腰椎管狭窄症复发,再行开窗减压术后症状消失。治疗后VAS评分较术前显著降低(P=0.003);JOA评分较术前显著增加(P=0.002),ODI评分较术前显著降低(P=0.008)。术后L4/5节段的活动范围与术前相比明显减少(P < 0.05),而术后相邻节段L3/4、L5/S1的活动范围与术前相比差异无显著性意义(P > 0.05)。提示Wallis动态稳定系统置入治疗腰椎失稳症能够取得比较满意的临床效果。     

小骨窗微创治疗高血压脑出血效果分析及DTI技术应用初探

目的探讨小骨窗微创治疗高血压脑出血与内科保守治疗相比,在缩短患者住院时间、降低住院费用方面的优势;并初步探讨DTI技术在高血压脑出血患者肢体功能预后评估中的应用价值。方法 35例高血压脑出血患者(观察组)入院后6 h内行小骨窗微创治疗,与同时期行内科保守治疗的30例高血压脑出血患者(对照组)进行对照研究,比较平均住院时间及住院费用。微创治疗组患者于术后第1 d、第7 d复查头颅CT了解血肿清除情况。术后1个月行DTI锥体束成像,通过锥体束损伤情况评估患者肢体功能预后。结果观察组35例患者小骨窗微创手术均顺利完成,无术后再出血及死亡病例;术后复查头颅CT,血肿清除率在70%以上。术后1个月行DTI锥体束成像显示锥体束均存在不同程度损伤。6例患者以锥体束受压为主,术后肢体功能明显改善;24例患者锥体束受压、破坏同时存在,术后肢体功能有所改善;5例患者以锥体束破坏为主,术后肢体功能无改善。结论小骨窗微创治疗与传统内科保守治疗相比,可以显著缩短患者平均住院时间、降低住院费用,且手术效果满意。DTI技术能够形象直观地显示锥体束损伤情况,对肢体功能预后进行评估。     

垂体脓肿的诊断和治疗

目的 为提高对垂体脓肿的诊治水平。方法 报道9例垂体脓肿,结合文献对其临床表现、影像学特征、诊断和治疗进行分析讨论。结果 9例中2例术前诊断为垂体脓肿,7例诊断为其它鞍区病变。5例经鼻蝶手术,4例经额下或翼点入路手术。术后均给予抗菌素治疗。术后视神经功能障碍恢复不理想,其它症状均改善,无脓肿复发。结论 早期诊断、及时手术清除脓肿和术后应用抗菌素是治疗垂体脓肿的关键。     

Predictive value of the cerebrospinal fluid tap-test

Twenty-seven patients with normal pressure hydrocephalus were operated upon by a ventriculo-peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p less than 0.01: r = 0.96, p less than 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF-TT implied in all cases successful result of the shunt operation. It was concluded that CSF-TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.     

枕颈减压、脊髓空洞穿刺抽液治疗Chiari畸形合并脊髓空洞症

目的：探讨一种治疗Chiari畸形合并脊髓空洞症的新手术方法。方法：61例经MRI诊断为Chiari畸形合并脊髓空洞症患,均采用枕颈减压加脊髓空洞空刺抽液术治疗。结果：全部病例术后临床症状,体征均有不同程度改善;随访48例（术后1－5年）,明显转好45例,好转3例,其中8例术后2－4年经MRI复查,脊髓空洞消失2例,空洞明显缩小5例,轻微缩小1例,手术无并发症,无死亡,结论：枕颈减压加脊髓空洞空刺抽液术治疗Chiari畸形合并脊髓空洞症是一种有效的方法。