后颅窝病变开颅术治疗后患者发热的原因及其护理

目的 探讨后颅窝病变开颅手术患者术后发热的原因,并提出对应护理对策.方法 回顾性分析2008年4月至2011年10月在哈尔滨医科大学附属第一医院神经外科治疗的91例后颅窝开颅手术术后发热患者的临床资料,并总结其护理经验.结果 本组91例中有78例患者1周内痊愈,13例2周内痊愈;感染者5例,发热持续时间为(10.20±1.22)d,主要表现为稽留热型,占术后发热的5.49%;无菌性炎症者17例,占18.68%,主要表现为不规则热型,发热持续时间为(4.88±1.91)d;异物反应者35例,占38.46%,主要表现为不规则热型,发热持续时间为(4.89±1.59)d;中枢性高热者19例,占20.83%,主要表现为驰张热型,发热持续时间为(6.57±1.85)d;肺部感染者8例,占8.79%,主要表现为稽留热型,发热持续时间为(10.87±1.35)d;交感神经兴奋7例,占7.69%,主要表现为稽留热型,发热持续时间为(2.14±1.36)d.结论对后颅窝开颅手术术后发热患者要积极寻找发热原因,采用对应护理,及时预防和控制发热.     

小脑扁桃体下疝合并脊髓空洞症治疗分析

目的 探讨小脑扁桃体下疝合并脊髓空洞症的治疗.方法 回顾性分析1995年8月至2010年8月经治的29例小脑扁桃体下疝合并脊髓空洞症患者,均采用手术干预治疗,单纯行枕大孔减压术16例,行枕大孔减压加空洞-蛛网膜下腔分流术13例.术后随访6个月～3年观察治疗效果.结果 随访6个月～3年,单纯行后颅窝减压组中显效8例,有效6例,无效2例,恶化0例,总有效率为87.5％;后颅窝减压空洞-蛛网膜下腔分流组中显效6例,有效4例,无效2例,恶化1例,总有效率为76.9％,2组总有效率比较差异无统计学意义（P＞0.05）.结论 手术是小脑扁桃体下疝合并脊髓空洞症的首选治疗,因下疝和空洞致脊髓受损轻者减压术后恢复较好,而脊髓受损明显者则手术效果差.     

彩色多普勒超声诊断腘窝囊肿的临床应用价值

目的 探讨彩色多普勒超声(CDFI)诊断腘窝囊肿(PFC)的临床应用价值.方法 回顾性分析总结经穿刺、手术及病理证实的92例101个腘窝囊肿的二维及彩色多普勒血流声像图资料.结果 根据超声囊肿与深部膝关节腔的关系,将本组分为两型:Ⅰ型-单纯滑囊囊肿型27例,囊肿独立存在于腘窝软组织间,不与关节腔相通；Ⅱ型-膝关节后疝型65例,囊肿与关节腔相通.本组囊肿内部透声好27例,内部透声混浊或/和有点状强弱回声及分隔65例.结论 超声对本病具有特异性诊断价值,而且能够确切分型.其分型对临床治疗具有重要指导意义.本方法优于其它影像学检查方法,可作为治疗前诊断与治疗后随访首选的诊查手段.     

慢性鼻窦侵袭性真菌病并发颞下窝真菌感染2例

颞下窝真菌感染属于侵袭性真菌感染，临床少见，多发生于糖尿病、恶性肿瘤、烧伤或长期糖皮质激素治疗的患者，其病原菌源于鼻窦真菌[1-2]。近年来侵袭性真菌性鼻一鼻窦炎（invasive fungalrhino-sinusitis，IFRS）及其并发症在国内外的发病率明显上升，其主要并发症是眶内、翼腭窝、颞下窝及颅内真菌感染。其中，颞下窝真菌感染较侵袭到眶内或颅内的真菌感染更为少见[3-4]。现将我科诊治的2例颞下窝真菌感染患者的资料报告如下。     

Retained periorbital and intracranial air-gun pellets causing sclopetaria and visual loss

Three healthy males presented on separate occasions to the emergency room at the King Khaled Eye Specialist Hospital (KKESH) after sustaining trauma by air-gun pellets. Clinical examination indicated sclopetaria in all the cases. The foreign bodies (air-gun pellets) were imbedded in different locations (subconjunctival, intraorbital, and intracranial). All cases resulted in a profound and permanent visual loss. The management of this traumatic injury is discussed and concurs with the published literature.     

小儿后颅窝囊肿特点和治疗探讨

目的探讨小儿后颅窝囊肿的临床特点、手术方式及疗效。方法回顾分析近10年内治疗的38例后颅窝囊肿病变患儿的临床资料。这38例患儿中行单纯囊肿一腹腔分流治疗13例，囊肿剥离开窗治疗14例（其中显微镜下剥离13例，内镜下剥离1例），神经内镜辅助下第三脑室底造瘘术结合分流术或囊肿剥离开窗治疗（联合手术组）11例（均为巨大囊肿合并脑积水者）。结果分流组再次手术率15．4％（2113），囊肿剥离开窗组再次手术率7．1％（1／14），联合手术组再手术率18．2％（2111）。术后平均随访3年以上，所有病人的囊肿均缩小。结论对小儿后颅窝囊肿治疗应根据囊肿部位、大小和脑脊液吸收功能情况制定以显微镜下囊肿剥离术为首选，配合内镜和分流术的个体化手术方案。     

Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum

The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo‐caudal third (Measure C). Intra‐subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter‐subject measures in which fissures were compared according to patients’ age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra‐subject differences were not significant for gender or age. No statistically significant differences were found for the inter‐subject measures between the measures of fissures according to patients’ age. However, our data revealed that males’ fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2‐mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and II fissure values (with a higher prevalence) were equal to or were greater than 2 mm in all three measures, or in two measures. Type III fissure values were only greater than or equal to 2 mm in Measure A, whereas all the Type IV fissure values were below 2 mm. Future studies are necessary to correlate the fissure types successfully proposed in the surgical ganglion pterygopalatinum approach.     

Sutural growth restriction and modern human facial evolution: an experimental study in a pig model

Facial size reduction and facial retraction are key features that distinguish modern humans from archaic Homo. In order to more fully understand the emergence of modern human craniofacial form, it is necessary to understand the underlying evolutionary basis for these defining characteristics. Although it is well established that the cranial base exerts considerable influence on the evolutionary and ontogenetic development of facial form, less emphasis has been placed on developmental factors intrinsic to the facial skeleton proper. The present analysis was designed to assess anteroposterior facial reduction in a pig model and to examine the potential role that this dynamic has played in the evolution of modern human facial form. Ten female sibship cohorts, each consisting of three individuals, were allocated to one of three groups. In the experimental group (n = 10), microplates were affixed bilaterally across the zygomaticomaxillary and frontonasomaxillary sutures at 2 months of age. The sham group (n = 10) received only screw implantation and the controls (n = 10) underwent no surgery. Following 4 months of post‐surgical growth, we assessed variation in facial form using linear measurements and principal components analysis of Procrustes scaled landmarks. There were no differences between the control and sham groups; however, the experimental group exhibited a highly significant reduction in facial projection and overall size. These changes were associated with significant differences in the infraorbital region of the experimental group including the presence of an infraorbital depression and an inferiorly and coronally oriented infraorbital plane in contrast to a flat, superiorly and sagittally infraorbital plane in the control and sham groups. These altered configurations are markedly similar to important additional facial features that differentiate modern humans from archaic Homo, and suggest that facial length restriction via rigid plate fixation is a potentially useful model to assess the developmental factors that underlie changing patterns in craniofacial form associated with the emergence of modern humans.