Suboccipital craniotomy in the surgical treatment of Chiari I malformation

Object  The object of this study was to present craniotomy for Chiari type I patients. Materials and methods  Six patients with Chiari type I underwent suboccipital craniotomy. All patients showed clinical improvement, and none had any complications. Two patients had syringomyelia; it disappeared in entirety. We describe the procedure for posterior fossa decompression. Results  Three-dimensional volumetric analysis using Vitrea workstation for postoperative posterior fossa volumes was calculated and was seen to have been increased on an average, from pre-operative (168 cc) to postoperative volume (192 cc). Conclusion  We thus conclude that suboccipital craniotomy results in resolution of the Chiari symptoms yet achieves effective expansion of posterior fossa.     

一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗体会

目的 探讨一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗方法.方法 回顾性分析13例急性颅内血肿术中继发对侧迟发性颅内血肿患者的临床资料,采用一次开颅清除双侧血肿.结果 术后按Glasgow(COS)评定预后,其中良好4例,中残4例,重残2例,植物生存1例,死亡2例.结论 采用一次开颅治疗一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的效果显著,可以提高患者的生存率和生活质量.     

大骨瓣减压术治疗大面积脑梗死

目的：探讨采用大骨瓣减压并颞肌贴敷术治疗大面积脑梗死的效果及手术时机。方法：对16例经CT、MRI证实为大面积脑梗死患者采用约12cm×15cm大骨瓣减压并颞肌贴敷的方法进行手术治疗。结果：16例患者13例存活,3例死亡。7例早期手术者均存活。结论：大骨瓣减压并颞肌贴敷术是治疗大面积脑梗死的有效方法,早期手术效果更好。     

超早期翼点小切口经侧裂-岛叶入路显微手术治疗高血压基底节区脑出血的疗效观察

目的探讨高血压基底节区脑出血（HBGH）新的手术治疗方法和疗效。方法60例HBGB患者中,30例经超早期翼点小切口经侧裂-岛叶入路显微手术清除血肿（侧裂组）,另30例经常规骨瓣开颅、皮质造瘘口直视下手术清除血肿（皮质组）。结果侧裂组近期和远期疗效均明显优于皮质组（P〈0．05）。结论超早期翼点小切口经侧裂一岛叶入路显微手术治疗HBGH创伤小、疗效佳、预后好。     

小骨窗开颅术治疗高血压脑出血的疗效观察

目的探讨小骨窗开颅术治疗高血压脑出血的疗效。方法对2003年1月至2007年12月采用小骨窗开颅术治疗高血压脑出血的61例患者的临床资料进行回顾性分析。结果61例患者中死亡9例;半年后日常生活能力（ADL）分级Ⅰ级23例,Ⅱ级11例,Ⅲ级13例,Ⅳ级3例,Ⅴ级2例。结论小骨窗开颅术是治疗高血压脑出血的主要手术方式之一,手术时机应选择超早期或早期,术前意识、血肿部位及血肿量等是影响手术疗效的主要因素,年龄对疗效有一定影响。     

Fatal cerebral injury from blows to the site of a nonadherent bone fragment from a previous craniotomy

A young man with a prior left temporal craniotomy was brought to the emergency room after being beaten, including a blunt trauma to the head. After receiving a cranial X-ray, the patient was discharged home. He was found in a deep coma eight hours later. Autopsy revealed an approximately 4 x 5 cm bone fragment fixed to the left temporal bone, except at the inferior margin, where it had no osseous connection. There were a 44 g subdural hematoma in the left frontotemporal region, small hematomata within the left temporal lobe, and bilateral subarachnoid hemorrhage. Microscopically, we detected ruptured choroid plexus at the surface of the left temporal lobe. We speculated that the combination of the unfixed bone fragment and hyperplastic choroid plexus after craniotomy increased the decedent's vulnerability to external trauma at that site.     

Cosmetic and radiological outcome following the use of synthetic hydroxyapatite porous-dense bilayer burr-hole buttons

Summary Background. Cranial neurosurgical procedures utilising burr-holes lead to development of cosmetically unacceptable puckered scars on the scalp over burr-hole sites. Ceramics, especially Hydroxyapatite (HA) are good bone substitutes owing to their biocompatibility and osteoconduction i.e. ability to lay down bone over the implant by fibrovascular invasion and later bone formation. The Sree Chitra Tirunal Institute for Medical Sciences and Technology in India has pioneered research in this direction and has developed a unique porous-dense bilayer HA burr-hole button. This study evaluates the safety, cosmetic effect, as well as the radiological outcome following implantation of these bilayer HA buttons. Method. Sixty-five HA buttons were implanted in 22 patients who underwent cranial neurosurgical procedures at the Sree Chitra Tirunal Institute for Medical Sciences and Technology. We assessed the cosmetic outcome (absence of puckered scar over burr hole sites, absence of allergic reactions or infections associated with the implant) as well as the radiological outcome with X-rays at specified intervals and looked for interference in the postoperative neurological imaging due to the implants. Results. There were no adverse events related to the HA buttons in the form of allergic reactions or infections. The implants persisted as radio-dense opacities on skull X-rays of recipients for up to two years. It did not lead to artefacts on postoperative CT or MR imaging of the brain. In particular, the HA buttons could be subtracted on Digital Subtraction Angiography and did not obstruct visualisation of the cerebral vasculature. Conclusion. The bi-layer porous-dense HA buttons are useful in preventing cosmetic defects over burr-hole sites on the scalp after cranial neurosurgical procedures. It does not interfere with current radiological imaging methods in the postoperative phase.     

标准大骨瓣减压治疗重型颅脑损伤的疗效分析

目的探讨标准大骨瓣减压较常规骨瓣减压治疗重型、特重型颅脑损伤的疗效和优势。方法回顾性分析本科近年收治263例重型颅脑损伤（GCS≤8分）患者,治疗组135例[含特重治疗亚组（GCS≤5分）54例]采用标准大骨瓣开颅术减压,对照组128例（含特重对照亚组49例）采用常规骨瓣减压。术后6个月,比较GCS评分和并发症。结果治疗组疗效为71.1%高于对照组的58.6%,差异有统计学意义（P〈0.05）。特重治疗亚组疗效为63.0%显著高于特重对照亚组的36.7%,差异有统计学意义（P〈0.01）。治疗组因继发颅内高压而再次手术的发生率为2.22%低于照组的10.94%（P〈0.05）,术后治疗组发生迟发性血肿和对侧硬膜下积液的发生率为9.63%高于对照组的1.56%（P〈0.05）。2组患者术后其他并发症的发生率比较,差异无统计学意义（P〉0.05）。结论大骨瓣减压治疗重型,尤其是特重型颅脑损伤,能提高治疗效率;减少因继发颅内高压而再次手术的发生;但术后迟发血肿和对侧硬膜下积液增多。     

眶上微骨窗入路显微手术切除鞍上脑膜瘤

目的 介绍经眶上微骨窗入路切除鞍上脑膜瘤的显微外科技术和经验.方法 经眉内小切口5例,经翼点入路16例,采用眶上约3.5 cm×2.5 cm小骨窗开颅,显微外科技术切除鞍上脑膜瘤21例,肿瘤最大径2.8～6.2 cm,回顾分析其临床资料.结果 所有肿瘤显露良好,Simpson Ⅰ级切除5例,Simpson Ⅱ级切除15例,Simpson Ⅲ级切除1例.无手术死亡及严重并发症,术前视力障碍患者术后均有不同程度改善.术后随访6个月至5年,平均3.8年,影像学上肿瘤残留1例.结论 眶上微骨窗入路可替代传统额下或翼点入路切除鞍上脑膜瘤并具有手术创伤小、术后恢复快等优点.     

微创颅内血肿清除术与传统开颅术治疗高血压脑出血的疗效对比研究

目的对比观察微创颅内血肿清除术与传统开颅术治疗高血压脑出血的临床疗效。方法2004年1月—2009年1月,140例高血压脑出血患者随机分为传统组和微创组,每组70例,比较两组的临床疗效及神经功能恢复情况。结果微创组治疗的总有效率明显高于传统组,两组比较差异有统计学意义（P〈0.05）。微创组的死亡率明显低于传统组,两组比较差异有统计学意义（P〈0.05）。两组治疗后14天、28天神经功能缺损评分均较治疗前明显下降,差异有统计学意义（P〈0.05）。微创组治疗后14天、28天神经功能缺损评分均低于同期传统组神经功能缺损评分,两组比较差异有统计学意义（P〈0.05）。结论微创颅内血肿清除术能够明显提高治疗的有效率,降低死亡率,同时改善了患者的神经功能缺损程度。