Supratentorial Intracerebral Schwannoma : Its Fate and Proper Management

Intracerebral schwannomas are rare and there have been none reported in Korea. We present the case of a 25-year-old man with newly developed right-side weakness and recent seizure aggravation. His seizures started approximately 9 years prior to admission. At that time, a 1 cm diameter intra-axial enhancing mass at the left precentral gyrus was found on magnetic resonance image (MRI). After 9 years of observation and treatment with antiepileptic medication, an MRI taken due to symptom aggravation revealed peri-tumoral cyst formation with tumor enlargement. The tumor was surgically removed. Subsequently, right-side weakness diminished and there was good seizure control. Pathologic diagnosis was schwannoma. Schwannoma is a very rare tumor and there are no pathognomonic findings on radiologic images; thus, it is challenging to make a correct diagnosis. However, considering the natural course and excellent prognosis after surgical treatment of this kind of intra-axial mass with benign features, early surgery for diagnosis and proper treatment is highly recommended.     

Meningeal Supratentorial Hemangioblastoma in a Patient with Von Hippel-Lindau Disease Mimicking Angioblastic Menigioma

Hemangioblastomas are sporadic tumors found in the cerebellum or spinal cord. Supratentorial hemangioblastomas are rare, and those with meningeal involvement are extremely rare and have been reported in only approximately 130 patients. Here, we report the case of a 51-year-old female patient with supratentorial meningeal hemangioblastoma detected 5 years after surgical resection of an infratentorial hemangioblastoma associated with von Hippel-Lindau disease. Patients with von Hippel-Lindau syndrome are at risk for developing multiple hemangioblastomas, with new tumor formation and growth and possible meningeal infiltration. Regular lifelong follow-up in at-risk patients is recommended and should include the differential diagnosis of dural-based tumors such as angioblastic meningioma and metastatic renal cell carcinoma.     

Supratentorial pressures: Part I: Differential intracranial pressures

Dynamic supratentorial pressure changes may differentially alter tissue pressure and intraventricular fluid pressure. To evaluate these pressures, we used a floppy cuff intracerebral catheter and an intraventricular catheter in the cat and rhesus monkey. Baseline intraventricular pressures exceeded intracerebral pressure in both species. Intraventricular pressure was 3-4 mmHg in cats and 6-14 mmHg in monkeys, while the intracerebral pressure was in the range 0-4 mmHg in both. Saline injection into the spinal or cranial subarachnoid space resulted in a greater increase in ventricular fluid pressure, and the time for return to baseline was one and a half times longer in the intraventricular compartment. Jugular venous and abdominal compression resulted in a greater rise in the ventricular pressure than intracerebral pressure Inflation of subdural balloons and intracerebral injection of silicone caused a differential pressure across the brain with the pressure being greatest in the ipsilateral hemisphere and lowest in the contralateral hemisphere. Rapidly evolving epidural masses produced varied results. We did not evaluate compensatory pressure changes in these animals. Those pressures that involve cerebrospinal fluid (CSF) dynamics alter intraventricular pressure more than tissue pressure. Alternatively, rapidly forming masses tend to increase tissue pressure near the mass more than intraventricular pressure.     

川芎嗪对幕上肿瘤切除术患者血清S100β蛋白、神经元特异性烯醇化酶、超氧化物歧化酶、丙二醇含量及氧供需与能量代谢的影响

目的 观测川芎嗪(tetramethy/phrazine,TMP)对幕上肿瘤切除术患者围术期血清S100β蛋白(S100β protein,S100β)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、超氧化物歧化酶(superoxdie dismutase,SOD)和丙二醇( malondialdehyde,MDA)含量及脑氧供需平衡与能量代谢的影响.方法 择期行幕上肿瘤切除术患者24例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法分为对照组(A组)和TMP组(B组),每组12例.采用丙泊酚静脉复合全麻,切开硬脑膜中20 min内,A组输入0.9％生理盐水250 ml;B组输入含80 mg盐酸TMP的等量生理盐水.分别于全麻诱导前(T1)、气管插管后(T2)、切开硬脑膜即刻(T3)、切硬脑膜后1 h(T4)、缝硬脑膜时(T5)、术后24 h(T6)同步采集颈内静脉球部血和足背动脉血检测血气、乳酸、血糖浓度、血氧饱和度及氧分压,计算血氧含量、血氧含量差及脑氧摄取率、葡萄糖摄取率、脑乳酸生成率、脑乳酸氧指数;同时留置颈内静脉球部血检测血清S100β、NSE及SOD、MDA含量;并记录各时点平均动脉压、心率、红细胞压积与血红蛋白.结果 ①脑氧摄取率:与T1[(36±5)％、(35±5)％]比较,两组均在T2[(24±6)％、(25±5)％]下降,而在T6[(42±5)％、(41±6)％]上升(P＜0.05).组间各时点无统计学差异(P＞0.05).②颈内静脉血氧含量差:与T1[(6.0±1.0)vo1％、(6.4±1.1 )vol％]比较,两组均在T2[ (4.2±1.1)vol％、(4.5±1.0)vol％]下降,而B组在T5 (5.3±0.8)vol％、T6(5.4±0.8)vol％也较T1下降(P＜0.05);组间各时点无统计学差异(P＞0.05).③脑乳酸生成率:两组于T2[(-0.033±0.008)％、(-0.026±0.007)％]、T3[(-0.031±0.006)％、(-0.028±0.005)％]、T4[(-0.025±0.005)％、(-0.026±0.006)％]、T5[(-0.022±0.008)％、(-0.027±0.008)％]与T6 [(0.021±0.005)％、(-0.024±0.003)％]均低于T1[ (0.073±0.009)％、(0.067±0.010)％];组间各时点间无统计学差异(P＞0.05).④脑乳酸氧指数:两组于T2[(-0.021 3±0.009 1)、(-0.014 1±0.004 1)]、T3[(-0.013 2±0.004 2)、(-0.012 3±0.003 3)]、T4[(-0.011 4±0.002 9)、(-0.012 4±0.004 3)]、T5[(-0.011 2±0.003 4)、(-0.014 3±0.005 1)]与T6[(-0.010 3±0.003 0)、(-0.011 0±0.002 0)]均低于T1 [(0.021 6±0.007 3)、(0.022 5±0.007 0)],组间各时点间无统计学差异(P＞0.05).⑤SOD:A组于T3(77±13)、T4(69±9)、T5(65±12)、T6(75±14) U/ml较T1(99±9) U/ml下降(P＜0.05),B组于T3(84±12)、T4(79±12)、T5(76±12) U/ml较T1(98±10) U/ml下降(P＜0.05),但与A组相同时点比较,下降程度较小(P＜0.05),且于T6(90±17) U/ml恢复至术前水平(P＜0.05).⑥MDA:A组各时点间无统计学差异(P＞0.05);B组于T4[(5.6±0.7)vs(6.9±1.3)]、T5[(5.6±0.5)vs(6.7±1.5)]、T6[ (5.7±0.5)vs(6.5±0.9)]μmol/L均低于A组相同时点(P＜0.05).⑦B组S100β于T4[(1.60±0.43)vs(1.81±0.10)]、T5[(1.60±0.57)vs(1.86±0.08)]、T6[(1.59±0.05)vs(1.89±0.07)] μg/L及NSE于T4[(17.4±1.1 )vs (20.3±1.1)]、T5[(16.7±1.2)vs(21.3±0.9)]、T6[ (15.9±1.2)vs (22.2±0.7)]μg/L均低于A组相同时点(P＜0.05).结论 TMP能提高幕上肿瘤切除术围术期患者血清SOD活性,降低MDA含量及血清S100β、NSE浓度,但不能纠正能量代谢与脑氧供需失衡.     

Liponeurocitoma del ventrículo lateral izquierdo. Revisión del primer caso descrito en España y análisis de la bibliografía

Supratentorial liponeurocytoma is a rare tumor, predominantly appearing in young males. It most commonly affects the lateral ventricles, with involvement of the third ventricle being exceptional. It is defined as a low-grade neuroglial tumor, with areas of associated lipomatosis. The most common clinical manifestation is that resulting from the presence of secondary intracranial hypertension and hydrocephalus. We present the first case reported in Spain of this tumor type and one of the few appearing in the literature so far.We report the case of a 33-year-old male patient, suffering from crural sensitive symptoms and recent onset headache. The radiographic study revealed the presence of a large supratentorial tumor; intraventricular, multicystic, heterogeneous and with areas of associated lipomatosis. The patient underwent surgery and complete tumor resection was achieved. The definitive diagnosis was of supratentorial liponeurocytoma.The presence of a supratentorial intraventricular tumor with areas of fatty degeneration should lead us to consider this type of tumor in the differential diagnosis. Complete tumor resection is considered to be the treatment of choice.     

应用不同冲洗液预防幕上开颅手术颅内感染的效果分析

目的 比较应用不同浓度庆大霉素冲洗液及甲硝唑冲洗液预防幕上开颅手术颅内感染的效果.方法 将2011年10月到2013年6月海军总医院神经外科收治的197例幕上开颅手术患者分为4组:生理盐水对照组(n=50)、甲硝唑组(n=48)、庆大霉素4万U组(n=49)、庆大霉素8万U组(n=50).各组术中予以相应冲洗液处理.比较各组术后发热、细菌培养、术后颅内感染的情况.结果 生理盐水对照组感染发生率为16.0％,甲硝唑组为12.5％,庆大霉素4万U组为4.1％,庆大霉素8万U组为2.0％.庆大霉素8万U组颅内感染发生率明显低于生理盐水对照组和甲硝唑组(P均＜0.05),庆大霉素4万U组颅内感染发生率明显低于生理盐水对照组(P＜0.05).结论 8万U庆大霉素冲洗液作为神经外科幕上开颅手术常规冲洗液,具有较好的预防术后颅内感染的作用.     

头颅CT非标准基线定位法在脑出血血肿穿刺术中的应用

目的探讨头颅CT非标准基线定位法在高血压脑出血血肿穿刺引流术中的应用。方法应用头颅CT非标准基线定位法对56例头颅CT扫描时非标准基线的高血压脑出血幕上血肿的患者进行体表定位后穿刺引流,并进行穿刺准确率分析。结果血肿穿刺成功率达100%,穿刺引流管均放置于血肿腔内,定位穿刺点偏差〈1 cm.结论头颅CT非标准基线定位法适用于头颅CT非标准基线的高血压脑出血幕上血肿的患者进行体表定位后穿刺引流,适合无立体定向仪的基层医院救治高血压脑出血患者时的术前定位。     

舒芬太尼与芬太尼对幕上脑肿瘤患者诱导麻醉后颅内压的影响比较

目的比较舒芬太尼与芬太尼对幕上脑肿瘤患者诱导麻醉后颅内压的影响。方法统计分析2012年3月至2014年3月我院收治的80例幕上脑肿瘤患者的临床资料。结果四组患者插管后即刻、机械通气后5min、15min的ICP均明显比麻醉诱导前低(P<0.05);FR组、FS组、SR组患者开硬脑膜后的颅内压(Intracranial pressure,ICP)明显比麻醉诱导前低(P<0.05);FR组和FS组患者插管后15min、开骨瓣后、开硬脑膜后的脑灌注压(Cerebral perfusion pressure,CPP)均明显比麻醉诱导前低(P<0.05);SR组和SS组患者插管后5min、15min、切皮前、后、开骨瓣后、开硬脑膜后的CPP均明显比麻醉诱导前低(P<0.05);SS组患者插管后即刻、插管后5min、15min的CPP均明显比FR、FS、SR组低(P<0.05)。结论舒芬太尼较芬太尼对幕上脑肿瘤患者诱导麻醉后颅内压具有更为显著的影响。     

电针对幕上肿瘤切除术患者七氟烷麻醉的影响

目的:观察电针对开颅手术患者麻醉维持期和苏醒期的影响.方法:将80例幕上肿瘤切除术患者随机分为A组和S组,每组40例.两组患者均吸入2%七氟烷维持麻醉.A组患者从麻醉诱导开始前至手术结束进行电针刺激,选择合谷连外关,金门连太冲,足三里连丘墟;S组患者不进行电针.记录各时间点七氟烷呼气末浓度、最低肺泡有效浓度(MAC)、脑电双频指数(BIS)以及麻醉恢复期情况.结果:七氟烷呼气末浓度和MAC,A组在开颅期、颅内期各时间点均显著低于S组(P<0.05,P<0.01),平均节省七氟烷用量9.62%.A组的BIS值在个别时间点(钻骨孔后、开骨瓣后、剪开硬膜)高于S组(均P<0.05).A组的恢复期各观察时间均明显少于S组(均P<0.01).麻醉恢复期A组无躁动发生,发生恶心呕吐1例;S组发生躁动2例、恶心呕吐3例.结论:对幕上肿瘤切除术的患者进行穴位电刺激复合七氟烷麻醉,可减少七氟烷用量,显著缩短麻醉恢复时间,提高麻醉恢复质量.     

Central liponeurocytoma as a clinical entity

Introduction

Liponeurocytomas are mostly localized in cerebellar hemispheres and the second most common location is the vermis. It is rarely observed within the intracranial ventricles. Here, we present a case of liponeurocytoma located in the right lateral ventricle and the systematic review of the literature.