颅内后循环动脉瘤的临床特征及显微外科治疗

目的 探讨颅内后循环动脉瘤的临床特征、显微外科治疗的方法及其效果.方法 对2000年1月至2008年10月手术治疗的10例颅内后循环动脉瘤的临床资料进行回顾分析.结果 动脉瘤位于基底动脉分叉部4例,大脑后动脉P1-P2交界处2例,小脑后下动脉3例,小脑前下动脉1例.以蛛网膜下腔出血为临床表现者8例,以脑神经麻痹等占位效应为表现者2例;8例行单纯动脉瘤夹闭术,2例行动脉瘤夹闭及残颈包裹术.术后随访6个月至8年,恢复良好6例,中度伤残2例,重度残疾1例,死亡1例.结论 后循环动脉瘤手术较为困难,应选择合适的入路,充分显露动脉瘤和载瘤动脉,术中尽可能保护脑干、脑干穿支动脉及脑神经,以减少手术后致死致残率.     

前床突旁区的显微解剖及其临床意义

目的:为前床突旁区(Paraclinoid Region)病变显微外科手术提供解剖学基础.方法:对15例(30侧)干性颅骨标本的骨性结构直接测量;对15例(30侧)湿性头颅标本在手术显微镜下解剖并测量.结果:①前床突(ACP)的长度为(10.29±0.78)mm,宽度为(9.03±0.71)mm;视柱(OS)的长度为(5.66±0.67)mm,宽度为(5.72±0.73)mm.②床突段颈内动脉(ICA)位于远、近侧硬脑膜环之间,长度为(5.14±0.74)mm.③远侧硬脑膜环厚而坚韧,厚度为(0.52±0.08)mm;近侧硬脑膜环薄而松弛,厚度为(0.22±0.06)mm,呈袖套状被覆于床突段ICA表面,在二者之间可有海绵窦静脉丛突入.④眼动脉直径为(1.78±0.46)mm,93%从远侧硬脑膜环远端发出.结论:①床突段颈内动脉多数情况下应属于海绵窦内结构.②大多数眼动脉起源于床突上段ICA.     

诊断超声对大鼠孕期胎盘组织中NO的阶段性影响

目的 通过检测大鼠孕早期超声辐照后其胎盘组织中一氧化氮合酶（nitric oxide synthetase,NOS）活性及一氧化氮（nitic oxide,NO）含量的阶段变化,旨在为临床孕早期超声诊断的安全性评价提供一定的实验依据。方法 将孕鼠分期采用生化技术检测其胎盘组织中相关生化指标的变化。结果 NOS活性与NO含量测定,孕早期实验组均明显低于对照组（P＜0．01）,中晚期与对照组相比已无显著性差异。结论 孕早期接受一定剂量的超声辐射可使NO含量和NOS活性下降。     

微血管减压术治疗椎-基底动脉延长扩张症致三叉神经痛患者的效果分析

目的初步探讨微血管减压术治疗椎-基底动脉延长扩张症(VBD)导致三叉神经痛患者的安全性和有效性。方法回顾性连续纳入2013年1月至2016年8月在首都医科大学宣武医院神经外科收治由VBD导致的三叉神经痛患者16例。所有患者术前接受MR血管成像检查,明确三叉神经与周围血管的解剖关系。采用枕下乙状窦后入路行微血管减压术,术后随访12~52个月。采用巴罗神经学研究所三叉神经痛评分(BNI)标准,评价患者的术前、术后及随访期间的疼痛程度。结果 16例患者中,15例术后即刻疼痛消失,BNI疼痛分级为Ⅰ级;1例术后疼痛无明显缓解,术后半年疼痛逐渐消失;1例术后听力较术前下降。随访时间为12~52个月,有3例分别于术后6、12、36个月疼痛复发,经射频治疗后疼痛消失。结论微血管减压术治疗VBD导致的三叉神经痛具有较好的安全性和手术疗效,但有一定疼痛复发率,其原因有待进一步研究。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

NF1~180mut表达载体构建及其在脑血管细胞中的表达

目的 前期研究中发现一合并脑血管狭窄的Ⅰ型神经纤维瘤病家系,为探索血管狭窄的病因,本研究构建该家系患者NF1基因共同突变产物NF1~180mut的过表达质粒,观察该质粒在脑血管细胞中的表达。方法 设计NF1~180mut全长序列的相应引物,采用pEGFP-N1作为载体框架,构建pEGFP-N1/NF1~180mut表达载体,通过Western blot法及共聚焦检测其蛋白表达;之后采用脂质体转染重组质粒于脑血管平滑肌细胞或内皮细胞中观察NF1~180mut在两种脑血管细胞中的表达。结果 ①成功构建了NF1~180mut表达载体;②该表达载体可在脑血管内皮细胞及平滑肌细胞内表达;③初步通过细胞计数研究及增殖实验显示NF1~180mut对脑血管平滑肌细胞和血管内皮细胞的生长及增殖有一定的作用。结论 本研究中构建了NF1-Q181X突变后的产物NF1~180mut表达载体,为进一步深入研究NF1~180mut导致脑血管狭窄发生的通路提供了良好的体外研究工具。     

Ⅰ型神经纤维瘤病合并右侧颈内动脉巨大动脉瘤一例

患者女,29岁。因＂右侧颈部搏动性肿物,声音嘶哑2年＂于2011年11月23日在首都医科大学宣武医院神经外科就诊入院。患者于出生后即发现全身存在浅棕色斑片状色素沉着（牛奶咖啡斑）,无皮下结节;出生后发育过程中,逐渐出现脊柱侧弯后突畸形。否认有高血压、糖尿病、冠心病等病史。患者的父亲、叔父、伯父皆为神经纤维瘤病患者。入院时体检：右侧颈部可触及约5 cm×3 cm大小的搏动性肿物,右侧睑裂较对侧小,眼球略内陷,双侧瞳孔等大、等圆,光反应正常,咽反射迟钝。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

小脑后下动脉瘤的显微外科治疗5例报道

目的探讨小脑后下动脉瘤（PICAA）的临床特征、显微外科治疗的方法及其效果。方法对1998年1月-2008年10月在我院手术治疗的5例小脑后下动脉瘤的资料进行回顾分析。结果5例患者中，4例行动脉瘤夹闭术，1例行动脉瘤夹闭及残颈包裹术。术后经6个月至10年的随访，恢复良好（GOS评分5分）4例，中度伤残（GOS评分4分）1例，无手术死亡（GOS评分1分）病例。结论小脑后下动脉瘤发病率较低，手术入路的选择与动脉瘤的位置密切相关。术中应尽可能保护脑干、脑干穿支动脉及后组颅神经。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.