幕上原始神经外胚层瘤CT、MRI特征

目的探讨幕上原始神经外胚层瘤(SPNET)的MRI及CT特征。方法回顾性分析8例经手术病理证实的SPNET的MRI及CT表现。结果SPNET的影像学表现有以下特点:①肿瘤多位于幕上额、颞叶,多呈类圆形,病灶周围无水肿或水肿较轻,边界清楚。②肿瘤实质MR T1WI呈等信号或稍低信号,T2WI呈等或稍高信号,CT示肿瘤实质呈稍高密度,增强后强化明显。③肿瘤多伴有不同程度囊变。④部分肿瘤内有出血或钙化。结论SPNET的影像学有一定特征,影像学和临床表现的结合有助于术前与其他肿瘤区分,提高诊断的准确性。     

CT监护立体定向幕上入路抽吸治疗高血压脑干血肿

目的探索高血压脑干血肿的外科治疗方法。方法采用ＣＴ监护立体定向幕上入路抽吸术治疗高血压脑干血肿３８例。男２７例，女１１例；年龄２８～６７岁，平均４５．５岁；血肿位于中 丘脑１７例，桥脑２１例；发病距手术时间最短３小时，最长４８小时。结果术后经临床、ＣＴ、ＭＲＩ随访６～３５月，存活１７例，死亡２１例，死亡率５５．３％。结论ＣＴ监护立体定向幕上入路抽吸是治疗高血压脑干血肿的一种有效措施     

p16蛋白与星形细胞瘤生物学行为的相关性研究

目的：探讨ｐ１６蛋白与人脑星形细胞瘤生物学行为的相关性。方法：采用免疫组织化学技术检测６２例星形细胞瘤标本中ｐ１６，Ｒｂ，ｃｙｃｌｉｎＤ１基因产物及Ｋｉ－６７抗原的表达情况。探讨Ｐ１６－ｃｙｃｌｉｎＤ１／ＣＤＫ４－ｐＲｂ细胞周期调控通路的调控机制和ｐ１６蛋白与星形细胞瘤生物学行为的相关性。结果：（１）星形细胞瘤中ｐ１６－ｃｙｃｌｉｎＤ１／ＣＤＫ４－ｐＲｂ细胞周期调控通路存在异常调节和表达，以单个异     

幕上骨瓣开颅清除骑跨横窦硬膜外血肿

目的探讨骑跨横窦的硬膜外血肿的手术治疗方法。方法对我科2003年12月至2005年12月收治的6例骑跨横窦硬膜外血肿病人均采用枕部幕上马蹄形皮骨瓣开颅,先清除幕上血肿,再经静脉窦与颅骨内板之间的空隙清除幕下硬膜外血肿。结果6例患者平均手术时间80min,术中失血少。术后5例血肿基本清除,1例幕上残留少量硬膜外血肿。出院时5例恢复良好,1例中残。结论采用枕部幕上马蹄形皮骨瓣开颅,能够顺利清除幕上、下硬膜外血肿,且手术时间短,清除血肿迅速,操作简单,出血少,术后不遗留颅骨缺损。     

川芎嗪、尼莫地平单一或联合应用对幕上肿瘤切除术患者血清S100β蛋白、NSE的影响

目的探讨川芎嗪、尼莫地平单一或联合应用对幕上肿瘤切除术患者围术期颈内静脉球部血清S100β蛋白(S100β)与神经原特异性烯醇化酶(NSE)的影响。方法择期行幕上肿瘤切除术患者48例,随机均分为川芎嗪组(C组)、尼莫地平组(N组)、川芎嗪联合尼莫地平组(CN组)和对照组(D组)。C组将80mg盐酸川芎嗪加入生理盐水250ml中,于切开硬脑膜时20min内静脉输入;N组在麻醉开始时输注尼莫地平15μg·kg-1·h-1,于手术结束时停药;CN组应用川芎嗪与尼莫地平,方法同C组与N组;D组在与CN组同一给药时点输入等量生理盐水。分别于全麻诱导前(T1)、气管插管即刻(T2)、切开硬脑膜即刻(T3)、切硬脑膜后1h(T4)、缝硬脑膜时(T5)、术后24h(T6)采集颈内静脉球部血测定血清S100β、NSE浓度。结果 D组与C组T3～T6时S100β与NSE高于T1时(P<0.05)。而N组与CN组T3、T4时S100β与NSE高于T1时(P<0.05)。C组、N组与CN组T4～T6时S100β与NSE均低于D组(P<0.05),CN组T3～T6时S100β与NSE均低于C组(P<0.05),N组T3时S100β、NSE及T6时NSE均低于C组(P<0.05)。结论幕上肿瘤切除术中单独输注川芎嗪或尼莫地平可降低颈内静脉球部中脑损伤指标浓度,且尼莫地平优于川芎嗪,联合用药脑保护作用强于单一用药。     

Quantified analysis of a carotid angiogram

Summary To compensate for differences in anatomy and magnification, a hand-held programmable calculator remodels the profile of the lateral view of a skull to fit the outline of a reference skull. The statistical analysis of 85 normalized carotid angiograms yields a numbered map of supratentorial structures. It is then possible to obtain, within 20 min and without sophisticated equipment, an objective analysis of any new angiogram.     

Hemangioblastoma of the lateral ventricle

A case of hemangioblastoma of the right lateral ventricle is presented. Only five other cases of intraventricular hemangioblastoma have been reported. The literature on supratentorial intraventricular hemangioblastoma is reviewed.     

幕上胶质瘤继发癫痫相关因素分析

目的了解神经外科不同种类、级别幕上胶质瘤癫痫的发生率,探讨幕上胶质瘤继发性癫痫发作的相关危险因素。方法回顾性分析四川大学华西医院2010年因幕上胶质瘤接受开颅手术且资料完整的病例258例。分析其相关危险因素。结果本研究中幕上胶质瘤癫痫发病率为34．1％（88／258）,患者年龄低、肿瘤级别低、肿瘤位于额部、影像学检查发现肿瘤累及皮质、钙化、占位效应不明显、瘤周水肿不明显等,为幕上胶质瘤患者癫痫易发因素。结论针对癫痫发生易发因素的防治,有望减少手术后癫痫的发生。     

Angioarchitectural characteristics associated with initial hemorrhagic presentation in supratentorial brain arteriovenous malformations

Objective

The difference in arterial supply, venous drainage, functional localization in supratentorial and infratentorial compartments may contribute to the conflicting results about risk factors for hemorrhage in published case series of brain arteriovenous malformation (bAVM). Further investigation focused on an individual brain compartment is thus necessary. This retrospective study aims to identify angioarchitectural characteristics associated with the initial hemorrhagic event of supratentorial bAVMs.

Materials and methods

The clinical and angiographic features of 152 consecutive patients with supratentorial bAVMs who presented to our hospital from 2005 to 2008 were retrospectively reviewed. All these patients had new diagnosis of bAVM. Univariate (χ² test) and multivariate analyses were conducted to assess the angiographic features in patients with and without initial hemorrhagic presentations. A probability value of less than 0.05 was considered statistically significant in each analysis.

Results

In 152 patients with supratentorial AVMs, 70.6% of deep and 52.5% of superficial sbAVMs presented with hemorrhage. The deep location was correlated with initial hemorrhagic presentation in univariate analysis (χ² = 3.499, p = 0.046) but not in the multivariate model (p = 0.144). There were 44 sbAVMs with perforating feeders, 39 (88.6%) of which bled at a significantly higher rate than those with terminal feeders (χ² = 25.904, p = 0.000). 87.5% (21/24) of exclusive deep venous drainage presented with hemorrhage, a significantly higher rate than those of the other type of venous drainage (χ² = 11.099, p = 0.004). All 10 patients with both perforating feeders and exclusive deep draining vein presented with initial hemorrhage. Hemorrhagic presentation was correlated with perforating feeders (p = 0.000) and exclusive deep draining vein (p = 0.007) in multivariate analysis as well.

Conclusions

Supratentorial bAVMs with perforating feeders and deep venous drainage have a higher risk of hemorrhage. In contrast with many previous reports, AVM location was not associated with hemorrhagic presentation in adjusted analyses. The correlation between deep location and initial hemorrhage in univariate analysis might be caused by the involved perforating feeders and deep draining vein in the deep located AVMs.     

幕上室管膜下静脉大体解剖观察

目的：观察幕上室管膜下静脉的大体解剖，为其在脑血管造影中的表现提供血管形态学资料。方法：解剖观察5例成人头颅标本，2例灌注钡剂和明胶液，2例灌注墨汁明胶液，1例未灌注，记录幕上室管膜下静脉位置，走行及汇入部位。结果：幕上室管膜下静脉大体解剖标本多数制作成功，幕上室管膜下静脉位于侧脑室壁内室管膜下，包括透明隔静脉，隔后静脉，房内侧静脉，海马静脉，尾状核前静脉，尾状核横静脉，丘纹静脉，直接外侧静脉，房外侧静脉和脑室下静脉，静脉位置，走行及汇入部位各具特征，尾状核横静脉，隔后静脉，房外侧静脉，尾状核前殂脉回流位置和脑室下静脉起始位置可出现多种。结论：观察结果为幕上室管膜下静脉在脑血管造影中的表现提供形态学依据。