慢性扩展性脑内血肿

慢性扩展性脑内血肿（chronic expanding intracerebral hematoma,CEICH）是一种特殊类型的脑内血肿,具有慢性进展性发展的特性,临床上多数以进行性颅内压增高为主要表现.本文复习文献对CEICH的相关问题综述如下.     

急性大脑中动脉梗塞的急诊取栓治疗

急性大脑中动脉梗塞(Middle Cerebral Artery Occlusion, MCAO)的致残率和致死率较高.血管内应用尿激酶或重组组织型纤维蛋白酶原激活剂等溶栓治疗有一定的疗效,但常伴随很高的再通失败率及再出血等并发症.本文对急性MCAO患者急诊取栓术的疗效进行评估.     

经翼点-颧弓颞下入路切除颅中窝底鞍旁肿瘤

中颅窝底鞍旁肿瘤位置深,与周围重要结构关系紧密,尤其脑膜瘤、脊索瘤等具有颅底侵蚀性,手术处理较难。1995年至1998年间,我们采用病变同侧经翼点一颧弓颞下入路显微切除中颅窝底鞍旁肿瘤19例,取得较满意的疗效。1 临床资料1.1 一般资料 本组19例病人,男性12例,女性7例;年龄23～63岁,平均41.3岁。病程:3个月～7年,平均1年9个月。     

导航穿刺引流治疗高血压性脑出血

高血压性脑出血约占脑实质出血的60％，开颅清除血肿手术在技术上并不困难，但术后并发症较多，病死率也未降低。为此，我们对80例高血压性脑出血患者分别采用导航下穿刺引流和保守治疗，并对这两种治疗方法的临床效果进行比较，现将结果报道如下。     

颅-鼻联合入路切除巨大颅-鼻沟通性脑膜瘤1例

<正>1病历摘要女,34岁。因左侧鼻塞1个月入院。曾于外院诊断为颅-鼻沟通性脑膜瘤。入院体检:左鼻腔内见红色新生物,神经系统检查未见异常。头颅CT示:额     

眼上静脉入路Onyx联合弹簧圈填塞海绵窦治疗海绵窦区硬脑膜动静脉瘘

海绵窦区硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)临床表现以眼部症状多见,表现为受累侧突眼、球结膜充血、视力下降和复视等症状,首选治疗方法为经静脉入路血管内介入.治疗的关键在于采用各种栓塞材料填塞海绵窦处的瘘口,以彻底消除病变.我们采用眶上内侧缘切开眼上静脉置管后,血管内填塞弹簧圈和液体栓塞剂Onyx,治愈l例海绵窦区DAVF患者,现报道如下.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

颅内巨大表皮样囊肿2例报道

颅内表皮样囊肿是缓慢生长的先天性病变,约占原发性颅内占位性病变的0.2%~1.8%,巨大型者更少见。现将我科收治的2例颅内巨大表皮样囊肿患者报道如下。病例1男性,36岁,因头痛、恶心7个月于1989年2月7日入院。患者于1988年5月起间歇性头痛,以前额部及双颞侧为主,伴恶心,无呕吐,逐渐加重。入院前1个月头痛发作频繁,程度加重,无肢体抽搐和运动受限,视力无明显下降。入院体检:双侧视神经乳头水肿伴有火焰状出血,右侧鼻唇沟略浅,余神经系统检查未见明显异常。头颅CT检查:平扫示右额高、低混合密度占位,形状不规则,边界清楚,跨越中线至对侧,约10 c…     

Onyx栓塞幕上复杂性多瘘口动静脉瘘的治疗

目的介绍1例采用液态栓塞材料(Onyx)栓塞颅内大型多瘘口动静脉瘘(AVF)的治疗体会。方法患者以癫痫起病入院,影像学检查发现双侧额叶皮层高流量多瘘口AVF,分别由左右的大脑前动脉和左侧的大脑中动脉供应,引流静脉曲张并于右颞叶形成2个直径2.5 cm的静脉球,另外在左侧AVF的后方还伴有一小的AVF。采用液态栓塞剂Onyx分别栓塞左右额叶的瘘口。结果双侧大脑前动脉栓塞后,颅内大型AVF完全闭塞,无相关并发症。AVF后方的小AVF待随访后进一步治疗。临床随访12个月,患者恢复良好。结论新型液态栓塞剂Onyx对于供应动脉弯曲的颅内AVF具有良好的栓塞效果,且可控性好。远期疗效尚需进一步积累病例及长期随访加以验证。     

Onyx栓塞幕上复杂性多瘘口动静脉瘘的治疗

目的介绍1例采用液态栓塞材料(Onyx)栓塞颅内大型多瘘口动静脉瘘(AVF)的治疗体会.方法患者以癫痫起病入院,影像学检查发现双侧额叶皮层高流量多瘘口AVF,分别由左右的大脑前动脉和左侧的大脑中动脉供应,引流静脉曲张并于右颞叶形成2个直径2.5 cm的静脉球,另外在左侧AVF的后方还伴有一小的AVF.采用液态栓塞剂Onyx分别栓塞左右额叶的瘘口.结果双侧大脑前动脉栓塞后,颅内大型AVF完全闭塞,无相关并发症.AVF后方的小AVF待随访后进一步治疗.临床随访12个月,患者恢复良好.结论新型液态栓塞剂Onyx对于供应动脉弯曲的颅内AVF具有良好的栓塞效果,且可控性好.远期疗效尚需进一步积累病例及长期随访加以验证.