皮肤扩张术修复头皮合并颅骨缺损

目的探讨头皮合并颅骨缺损的修复方法。方法对2000年至2007年治疗的6例头皮合并颅骨缺损患者，采用皮肤扩张术修复头皮，钛网修补颅骨缺损。结果6例患者中，1例患者出现皮瓣下积液，经抽吸、加压包扎后愈合；其余病例未出现感染、血肿及皮瓣坏死等并发症，外观满意。结论皮肤扩张术和钛网联合应用是修复头皮合并颅骨缺损的较好方法。     

颅骨缺损状态下区域血流速度变化

目的 :探讨颅骨缺损病理状态下区域血流速度变化。方法 :应用TCD测定不同缺损面积的颅骨缺损病人术前患侧及健侧和术后患侧ICA、ACA、MCA、PCA、BA平均血流速度。结果 :≥ 35cm2 病人患侧颅内血管平均血流速度高于正常 ,而健侧颅内血管平均血流速度正常。 <35cm2 病人患侧及健侧颅内血管平均血流速度均在正常范围。结论 :颅骨缺损病理状态下常可引起区域血流速度改变 ,血流速度改变是指导颅骨缺损修补的重要依据     

人颅骨电阻抗频率特性及其与解剖结构关系研究

在电阻抗断层成像(EIT)技术应用于脑部成像的研究中，颅骨的电阻抗对驱动电流的屏蔽效应非常严重，严重影响了成像效果(特别是中心区域)。本研究采用离体人颅骨，二电极法，用频响分析仪(Solartron 1255B)经电阻抗接口(Solartron 1294)，在0．1Hz～1MHz频率范围内进行测量，描记出颅骨电阻抗频响特性曲线，初步观察了颅骨电阻抗随时间变化的趋势，研究了颅骨解剖结构同其电阻抗之间的关系。结果表明：颅骨电阻抗幅值随时间明显增大；其特征频率应在10KHz附近，颅骨组织的解剖结构对颅骨电阻抗有重要的影响，含有板障层的厚颅骨由于颅骨内、外板中富含毛细血管的原因，其电阻抗较不含板障层的薄颅骨电阻抗小。本研究结果为解决颅骨高阻抗的屏蔽效应问题提供了可能的参考和依据。     

Bilateral brain abscesses complicating the use of crutchfield tongs

The case of a 4-year-old girl who developed bilateral brain abscesses complicating skull traction is reported. Crutchfield tongs were used to reduce a fracture dislocation at C2–3. Presenting symptoms consisted of headaches and focal seizures. Surgical treatment and antibiotics using serial CT led to a satisfactory outcome. This is the first reported case of this complication in a child. The current literature is reviewed.To whom offprint requests should be addressed at Avda. Pio Baroja 4, 30011 Murcia, Spain     

Pediatric cranial osteoblastoma: Technical note of surgical treatment and review of the literature

Osteoblastoma of the skull is a rare entity, and they account only for 2-4% of all the cases of osteoblastoma. We perform a comprehensive review of the pertinent literature on the subject and we report a case of a 3-year-old girl presenting with a 6-month history of a supraorbital mass and exophthalmos due to an osteoblastoma of the frontal and ethmoid bones involving the orbit and anterior skull base. A 3D printed model of the patient's skull was used for the preoperative planning and reconstruction strategy. Total en-bloc resection of the tumor followed by immediate reconstruction was achieved. No recurrence was detected 3 years after the surgery. Gross total resection is strongly advised with skull osteoblastoma, especially in young age, because of the risk of the recurrence and malignant transformation. 3D printing is proven to be a valuable tool to enhance surgical performance by avoiding complications while achieving total resection with accurate reconstruction. Long-term follow-up is important to detect recurrences and improve the management of these young patients.     

颅底肿瘤93例临床分析

目的：总结93例颅底肿瘤的诊治经验。方法：对我科近8年收治的颅底肿瘤病人进行回顾总结。结果：颅底肿瘤良性居多,外科手术是首选,显微外科手术提高了全切率,减少丁并发症．结论：显微外科手术是治疗颅底肿瘤的首选方法。     

小儿鼻颅底针形内窥镜的检查与手术

目的：探讨应用针形内窥镜对小儿鼻颅底疾病进行探查与手术的方法及疗效。方法：在外径１．９ｍｍ的进口针形内窥镜及电视同图像系统监视下,对８例小儿（７ｄ￣１２岁）鼻颅底有关疾病进行探杳与手术。结果：先天性后鼻孔闭锁３例中,１例好转,３例痊愈。外伤性脑脊液鼻漏１例,经修补痊愈先天性脑膜脑膨出２例,确诊后１例暂缓治疗。另１例行内窥镜手术痊愈。颅底神经母细胞瘤２例取材作病理检查确诊。结论：在电视图像监视下应用     

Choice of neurosurgical approach in the treatment of cranial base lesions

The authors describe a series of surgical approaches that they found particularly useful for the exposure and removal of lesions involving the skull base. These are: 1) fronto-naso-orbital approach; 2) frontotemporo-orbito-zygomatic approach; 3) subtemporal transpetrosal approach; 4) temporo-suboccipital transpetrosal approach (retrolabyrinthine presigmoid; transsigmoid; translabyrintine amend transcochlear presigmoid); 5) dorsolateral approach to the foramen magnum and lower clivus.As the approaches are complex and carry potential risks of morbidity, not only it is important to have a good knowledge of basic anatomy but also to closely follow the indications for each one. In this type of surgery where it is often difficult to achieve complete removal of the lesion by a single route of attack, more than one approach may be employed in different surgical steps. Finally, all these approaches demand extremely scrupulos surgical reconstruction to avoid dangerous postoperative complications that may jeopardize the previous work of the surgeon.     

Enlarging skull fractures in children

Large skull fractures are conventionally followed radiographically until healing occurs. Fractures which enlarge or remain unhealed are commonly termed leptomeningeal cysts or growing skull fractures. This study of ten children with this injury and a review of the literature shows that a true leptomeningeal cyst is seldom present and that skull fractures do not grow. Moreover, careful history-taking and physical examination will correctly identify all enlarging or unhealed skull fractures of childhood without the need for plain radiographs or computed tomography of the skull.     

Cranial burst fracture in infants: acute recognition and management

In the past, the diagnosis of growing skull fracture or diastatic fracture has included a subset of injuries better referred to as cranial burst fracture. Cranial burst fracture, typically associated with severe injury in infants less than 1 year of age, is a closed, widely diastatic skull fracture accompanied by acute cerebral extrusion outside the calvarium. We treated 11 such infants at the LeBonheur Children's Medical Center and 2 at the Children's National Medical Center from January 1986 through December 1994. Infants ranged in age from 1 to 17 months, with an average age of 5.7 months. All presented with marked scalp swelling and a Glasgow Coma Scale score of 10 or less. Twelve had a history consistent with severe injury (motor vehicle accident, 7, abuse 5). The cause of injury in one patient remains unproven. Surgery (reduction of herniated cerebral tissue, repair of large dural laceration, and cranioplasty) was usually performed within 10 days of injury, a time period long enough to assure hemodynamic stability and resolution of acute cerebral swelling, yet sufficiently brief to avoid the chronic changes (scarring, parasitization of scalp vessels by damaged cortex) associated with a growing skull fracture. Prompt repair of cranial burst fracture may prevent ongoing brain injury such as has been neuropathologically demonstrated in patients with growing skull fracture. Magnetic resonance imaging establishes the diagnosis of cranial burst fracture in equivocal cases, rendering unnecessary a waiting period to see if scalp swelling resolves. Our experience, together with information in the neuropathological and neurosurgicla literature, suggests that cranial burst fracture is associated with severe trauma, requires expeditious treatment, and has been underdiagnosed in the past, leading to growing skull fracture, a condition requiring more extensive surgery.