颅内动脉瘤血管内栓塞治疗及并发症分析

目的 探讨血管内栓塞治疗破裂后颅内动脉瘤及并发症发生机制及防治对策.方法 对76例破裂后颅内动脉瘤采用早期血管内栓塞治疗,回顾性分析发生的并发症原因及防治方法.结果 76例动脉瘤患者发生并发症8例,占10.5%.其中动脉痉挛3例,弹簧圈提前解脱1例,弹簧圈脱落1例,术中动脉瘤破裂1例,术后1周动脉瘤再次破裂死亡1例,大脑中动脉血栓形成1例.结论 正确理解并发症发生机制和熟练掌握操作技术是控制颅内动脉瘤血管内栓塞治疗并发症的关键.恰当的处理可避免严重后果.     

Epilepsy after operative treatment of ruptured cerebral aneurysms

Summary A retrospective analysis of 183 consecutive patients operated on for ruptured cerebral aneurysms and surviving at least one year revealed appearance of postoperative epilepsy in 14 cases (8 per cent) on an average of 10 months (range 0–23 months) after the operation. Factors associated with the development of secondary epilepsy were localization of the aneurysm on the middle cerebral artery, temporary clipping intraoperatively, wrapping technique to treat the aneurysm, and vasospasm seen on the postoperative control angiogram. Intraoperative and/or postoperative ischaemia seems to be the crucial phenomenon favouring the development of epilepsy. Identification of the risk factors may help to focus the anti-epileptic prophylaxis in cases prone to develop seizures.     

国产颅内血管内支架组织相容性研究

目的探讨国产血管内支架对血管壁的影响。方法在7只体重为28～37 kg的杂交香猪的上颌动脉或舌动脉内放置国产Q/TETA15-2002不锈钢颅内血管内支架,于放置后的第1、3、5、7个月取材,采用光镜及扫描和透射电镜,观察支架表面被覆的新生内膜及血管壁组织相容性。结果支架放置后第1、3、5、7个月未观察结果: (1)大体所见支架置入后被完全包裹,内膜层增厚,由新生内皮及胶原纤维覆盖;(2)光镜下见支架金属丝侧平滑肌细胞增生明显,未见以单核巨噬细胞浸润为特征的组织变性、坏死、变态反应性炎症现象;(3)电镜下可见新生内皮及胶原纤维覆盖支架;(4)血管内支架置入后血管损伤修复造成血管内径损失百分比有降低趋势。结论国产Q/TE- TA15-2002不锈钢颅内血管内支架组织相容性好,血管内壁表面光滑,未见血栓形成,血管内径损失程度低。     

高渗盐水与甘露醇对颅脑手术患者脑氧代谢的影响

目的 比较3％高渗盐水（HTS）与20％甘露醇对颅脑手术患者脑氧代谢的影响。方法 择期大脑半球胶质瘤切除术患者40例，ASAⅠ级或Ⅱ级，随机分为2组（n=20）：3％HTS组（HTS组）和20％甘露醇组（M组）。采用静吸复合麻醉，呼气末异氟醚浓度为1 MAC、血液动力学稳定15．min后，分别于15 min内静脉输注3％HTS 5．35 ml／kg或20％，甘露醇1 g／kg。L3，4珠网膜下腔置管测脑脊液压力（CSFP），行右颈静脉球穿刺置管、采血，测定颈静脉球氧饱和度。分别于输注前（T0）、输注完即刻（T1）、输注完15min（T2）、30min（T3）、60min（T4）、120min（T5）监测CSFP;于T0、T3-T5时监测平均动脉压，采集颈静脉球部和桡动脉血，进行血气分析，计算动脉-静脉氧含量差（Da-jvO2）、脑氧摄取率（CERO2）。结果 与T0比较，2组CSFP在T2-T5时降低，Da-jvO2和CERO2在T4，5时降低（P〈0．05）;与M组比较，HTS组CSFP在T2时降低（P〈0．05）。结论 3％HTS与20%甘露醇均可有效地降低颅内压，改善颅脑手术患者的脑氧代谢。     

Management of intracranial tuberculoma in children

Thirty-one patients were studied during a period of 3 years in order to identify features helpful for the diagnosis of tuberculoma. Sixteen had a history of pyrexia, 4 had had contact with cases of tuberculosis, the tuberculin test was positive in 15, the erythrocyte sedimentation rate (ESR) was elevated in 23, and 5 had concomitant tuberculous infections. Three had multiple lesions and 10 showed CT scan features suggestive of tuberculoma. Nineteen patients were successfully treated with drugs alone; seven needed surgery because they failed to respond to drugs clinically or because CT indicated no improvement. One patient proved to have a tumor, having shown an absence of response to drugs; four were operated on without drug trial because they were thought to have a tumor, and 1 needed surgery because of the mass effect of a very large tuberculoma. Infratentorial lesions associated with hydrocephalus were treated with ventriculoperitoneal shunts.     

Giant fusiform aneurysm of the vertebro-basilar artery presenting with stroke

The authors describe a case of giant fusiform aneurysm of the basilar artery presenting with ischemic symptoms. Angiography and CT revealed vertebro-basilar fusiform aneurysmal dilatation. Fusiform vertebro-basilar ancurysm is associated with various complications particularly brain stem infarction. Similar lesions in the literature are reviewed and the relationship between this clinical entity and cerebral ischemia, particularly brainstem infarction are discussed.     

Design and application of sensor for recording sounds over human eye and nose

The recording of sounds over the oribt of the eye has been found to be useful in the detection of intracranial aneurysms. A hydrophone for auscultation over the eye has been developed and is tested under controlled conditions. The tests consist of measurement over the eyes in three healthy volunteers at rest, during voluntary breathing, during eyeball movements and during sustained orbicular muscular contractions. Furthermore, measurements are performed at the side of the nose. Major features of the hydrophonic transducer are high sensitivity to physiological sounds and a high degree of insensitivity to environmental sounds propagated through the air. It can be concluded that the hydrophone may be useful for the early detection of intracranial aneurysms and also for apnoea detection.     

Aneurysm detection using one-bit correlation

Intercranial aneurysm present an especially serious clinical problem, since their rupture generally results in death or permanent brain damage. Recent work, conducted by the authors, indicated that this anomaly can be detected using spectral signature analysis. A low-cost turnkey noninvasive aneurysm-detection system is being tested for this purpose. Using polarity-coincident noise-added one-bit correlators, aneurysms have been successfully detected.     

Stability of intracranial self-stimulation following hypophysectomy

The possibility of a hypothalamo-pituitary involvement in the intracranial self-stimulation phenomenon was investigated. Threshold and optimal stimulation currents were identified by means of the method of limits, in rats with bipolar electrodes implanted in the lateral hypothalamus. Total or sham hypophysectomies were performed after the establishment of these current values, and found to have no effect on reinforcing brain stimulation. It was concluded that a hypothalamo-pituitary mechanism does not subserve reinforcing brain stimulation.