Predictors of thermal response and lesion size in patients undergoing magnetic resonance-guided focused ultrasound thalamotomy

Magnetic resonance-guided focused ultrasound (MRgFUS) is being increasingly utilized in the treatment of movement disorders such as essential tremor (ET) and Parkinson’s disease (PD). Whilst skull density ratio (SDR) has previously been correlated with achieving lesional temperature rises, other patient factors such as brain and cerebrospinal fluid (CSF) volume have not previously been investigated. We aimed to investigate the effect of brain and CSF volumes on lesional temperature rises, as well as the effect of brain and CSF volumes and SDR on post-treatment lesion sizes. Fifty-four consecutive patients were studied with patient and treatment-related variables collected along with post-treatment lesion sizes. Linear regression analysis identified that SDR alone was associated with lesional temperatures. Both SDR and brain atrophy were associated with post-treatment lesion sizes on linear regression analysis. On multiple linear regression analysis SDR was significantly associated with post-treatment lesion size, and the association between brain atrophy and lesion sizes approached significance, a finding that warrants further investigation.     

神经外科ICU病人术前访视的方法及效果评价

目的　评价神经外科ICU术前访视的效果 ,证实其有效性并总结其方法。方法　随机分组 ,收集记录访视组和对照组的相关资料后进行统计学分析。结果　访视组病人对术后采取物理约束、禁食水、保留导尿、谢绝家属探视等护理措施的合作率为 94 .5 % ,对照组是 38.5 % ,在物理约束、禁食水和谢绝家属探视 3个方面差异尤其显著 ;访视组病人中使用镇静剂的有3例 ,占 3.8% ;对照组中则有 19例 ,占 2 3.8%。结论　神经外科ICU术前访视可以有效提高病人及家属与医护人员的合作 ,证明了心理护理在护理工作中的重要性 ,更细致的工作会使护理更加人性化 ,更富有人文关怀的人道主义精神。     

Clinical use of a neuronavigation system in hemangioblastoma resection of posterior cranial fossa

Abstract

The aim of this study was to retrospectively evaluate the effectiveness of the Stryker Leibinger neuronavigation system in surgical resection of hemangioblastomas of the posterior fossa. The study included 16 cases of solid hemangioblastoma of posterior cranial fossa treated since we began using Stryker Leibinger neuronavigation system-assisted microneurosurgery in 2003. These cases were compared on the basis of time, blood loss, and complications to 19 similar cases of solid hemangioblastoma that underwent conventional microneurosurgical resection prior to 2003. All patients in the experimental (neuronavigation-assisted) group underwent surgical resection without complications while the control groups' resections all involved blood loss related to the longer operation time. Neuronavigation also resulted in a clear field of surgical vision and clear lesion boundaries, making it easier to remove lesions and reduce accidental injury of adjacent normal structures. The application of navigation technology is very valuable for solid hemangioblastoma operations not only by shortening operative time, thereby significantly reducing operative blood loss, but also by making surgical excision easier, reducing damage to adjacent normal structures, and decreasing surgical complications and mortality.     

听神经瘤的微侵袭外科治疗

目的改进听神经瘤的手术技巧,减少手术创伤,提高手术效果。方法 58个听神经瘤均经枕下乙状窦后Keyhole入路,在全程电生理监测下应用"4S(4 steps)"法切除肿瘤:1S:显露、切开、剥离内耳门周围硬脑膜;2S:磨除内听道后壁,游离其内肿瘤组织,找到面、听神经;3S:囊内彻底切除肿瘤组织,使之"囊皮化";4S:免电凝、无张力顺行剥除"囊皮",保护面、听神经及其血供,会师内耳门,全切肿瘤。结果全组无手术死亡、偏瘫病例。肿瘤全切除57例(98.3%),面神经解剖保留58例(100%),听神经解剖保留35例(60.7%);最后一次随访时面神经功能保留(House BrackmannⅠ~Ⅱ级)48例(82.7%),有效听力保留19例(32.7%);术前有残存听力者,有效听力保留17例(40.4%)。结论采用枕下乙状窦后"Keyhole"入路、4S法微侵袭技术切除听神经瘤创伤小,肿瘤全切及面听神经功能保留率高。     

神经外科进修医生临床带教的几点体会

结合几年来的带教实践,就如何提高临床带教质量谈几点粗浅的看法,强调加强进修医生理论知识以及规范化的神经外科实践技能、提高进修生的综合思维能力、科研能力和医德的培训非常重要。     

中医药院校附院神经外科实习医生带教探讨

目的探讨中医药院校附院神经外科实习医生的带教。方法对实习医生注重入科教育、定期小讲课、定期教学查房、临床病例及危重病例讨论、临床提问、出科理论考试及技能考试相结合等措施。结果建立完整的带教管理体系对树立实习生良好的医疗服务理念,掌握神经外科常见疾病的诊治、了解学科国内外相关新进展,培养实习医生临床思维能力、实践能力等有良好的效果。结论只有严格要求,才能提高神经外科实习医生临床实习质量。     

High risk factors for pulmonary fungous infection in intensive care units of neurosurgery

By analyzing the high risk factors for pulmonary fungous infection in intensive care units of neurosurgery, the strategy of early diagnosis and treatment was explored. According to the domestic diagnostic standard on pulmonary fungous infection, clinical data on 58 patients with the infection in our department were analyzed. One hundred and seventeen strains of fungi were separated from the 58 cases. Candidiasis was the most frequent type, accounting for 92.3% of the cases. Conditions such as the severity of primary diseases, long-time coma, long-term use of broad-spectrum antibiotic, abuse of glucocorticoid, the open airway, and some invasive intubations, may be regarded as high risk factors for pulmonary fungous infection. Fluconazole showed good clinical effects on the treatment of fungous infection. To eliminate these high risk factors, early diagnosis and the use of prophylactic antifungal agents can help reduce the incidence of pulmonary fungous infection. Translated from Chinese Journal of Nosocomiology, 2006, 16(4): 385–388 [译自: 中华医院感染学杂志]     

Postmortem inspection for neurosurgery: a training model for endoscopic dissection technique

In 63 specimens, 74 aneurysms, and five other lesions, postmortem microsurgical and endoscopic inspection (PMI) was done. This work not only allowed for safe pathoanatomic findings, but moreover showed characteristics of a training method developed according to a model with clear standards. PMI gives training in: 1. Understanding of pathoanatomic topography and syntopy 2. Analysis of imaging findings 3. Analysis of approaches (approach planning) 4. Paraendoscopic methods (video surgery) 5. Clipping training 6. Analyzing the ergonomy of the setting and instrumentation In the series presented, aneurysms were the focus of attention. Postmortem inspection trains nearly all manipulative and cognitive abilities necessary for operative management of this difficult lesion. The acceptance and applicability of this method for resident training must be evaluated in the future. Electronic Publication     

Intraoperative magnetic resonance: the future of surgery

Intraoperative magnetic resonance imaging (iMRI) is a new development in medicine that bridges the specialties of surgery and radiology. Deficiencies in the visualization of anatomical architecture and the perception of tumour boundaries in conventional open surgery have led to the integration of imaging within surgery. The superior soft tissue and multiplanar imaging features of magnetic resonance (MR) make this imaging modality superior to that of alternatives. The unique properties of MR to detect heat change and perfusion, and diffusion characteristics of tissue enhance the usefulness of this medium. Concurrent developments in computer aided image guidance and thermoablative technology, herald the era of minimally invasive tumour ablation. Applications have been developed for areas such as neurosurgery, general surgery, gynaecology and urology.