实时超声联合神经导航监测在颅内肿瘤显微手术中的应用

目的 探讨实时超声联合神经导航在颅内肿瘤显微手术中定位及实时监测的作用。方法 筛选空军军医大学西京医院神经外科2014年10月至2016年7月收治的35例术中实时超声监测联合神经导航辅助显微手术切除的颅内肿瘤作为观察组，并以同期35例神经导航引导但未行术中实时超声监测的颅内肿瘤作为对照组。结果 观察组肿瘤全切率[91.42%（32/35）]与对照组[82.85%（29/35）]无明显差异（P<0.05）。观察组手术时间[（284.1±20.58）min]较对照组[（306.5±11.92）min]明显缩短（P<0.05）。术前，观察组KPS评分[（58.74±2.076）分]与对照组[（56.34±1.381）分]无明显差异（P>0.05）；术后1周，观察组KPS评分[（83.21±6.217）分]和对照组[（76.49±4.638）分]较术前均明显提高，而且，观察组明显高于对照组（P<0.05）。两组术后均未发生严重并发症（如出血、感染等），围手术期没有死亡病例。术后3个月门诊复查，均未见肿瘤复发。结论 术中超声可精准定位并实时引导，监测肿瘤残余，提高手术效率并最大限度地保护神经功能。     

脊髓神经管原肠性囊肿的显微手术治疗及分析

目的探讨脊髓神经管原肠性囊肿的临床、组织病理及形态学特点,分析手术切除方式对预后的影响。方法回顾性分析自1998年1月至2010年12月8例脊髓神经管原肠性囊肿病例的临床资料。其中4例首发症状为局部脊髓节段疼痛伴肢体乏力、感觉减退、肌肉萎缩,3例以神经根性疼痛症状发病,1例表现为Brown-Sequard综合征。8例患者的影像学表现均为髓外硬膜下型,均给予脊髓后路手术切除。结果全部手术的8例患者中,5例全切,2例部分切除行囊腔旷置,1例部分切除行囊腔蛛网膜下腔分流术。术后8例患者症状均有不同程度缓解,影像学、电话及门诊随访6例(4例完全切除、1例部分切除行旷置术、1例部分切除行囊腔-蛛网膜下腔分流术)(25.0±9.0)月(12～38)月,症状均无再次加重。结论神经管原肠性囊肿可通过后正中入路手术全切或部分切除获得治愈,应尽早手术治疗。     

经外侧裂显微手术治疗高血压脑出血

目的研究减少高血压脑出血手术中的创伤和最大限度保护脑功能的手术方式。方法利用标准翼点人路骨瓣开颅,经外侧裂显微手术治疗40例高血压脑出血,报告术后患者的生存质量和预后。结果40例患者的重残率、死亡率明显下降,术后24hGCS计分明显提高。结论经外侧裂显微手术治疗脑出血可以有效的保护血肿周围脑组织和重要的豆纹动脉穿通支,减少因手术引起的继发性血管损害和血肿周围脑组织梗死,是一种损伤小、疗效好、预后良好的微创手术方法。     

Destroscope虚拟现实系统在显微神经外科教学中的应用

显微神经外科手术操作相对复杂,对精度及微创的要求较高.而其手术教学及操作培训的手段有限.虚拟现实技术以其独有的优势,在显微神经外科教学中具有重要意义.通过介绍手术虚拟及操作培训的价值及意义,并结合虚拟现实技术在显微神经外科的应用实例,阐述了其在显微神经外科教学中的作用、优势及其应用前景.     

Microneurosurgery in combination with endovascular embolisation in the treatment of solid haemangioblastoma in the dorsal medulla oblongata

Objective

To investigate the treatment of solid haemangioblastomas in the dorsal medulla oblongata using microneurosurgery in combination with endovascular embolisation.

Methods

Clinical data from 11 patients with solid haemangioblastomas in the dorsal medulla oblongata who were treated with endovascular embolisation followed by microneurosurgery were analysed retrospectively. Clinical results were evaluated using the modified Rankin scale. The patients were preoperatively evaluated by neuroimaging methods such as magnetic resonance imaging (MRI), contrast MRI and digital subtraction angiography (DSA). General anaesthesia was induced, the patients were tracheally intubated, and the abnormal vessels were embolised. Surgery to resect the haemangioblastoma was conducted after the blood-clotting index returned to normal levels (generally one month after the interventional treatment).

Results

Embolisation was accomplished in all 11 patients. DSA analysis revealed that most of the tumour vessels and tumour stains disappeared without any complications. The haemangioblastomas were completely resected. None of the patients received blood transfusion or died during surgery. The neurological deficit was reduced or eliminated in 10 patients, but 1 patient died after experiencing an acute myocardial infarction on the tenth postoperative day. No recurrence occurred during follow-up in patients who underwent total tumour resection. Postoperative grades using the modified Rankin scale were improved in all 10 patients. However, several complications occurred, including communicating hydrocephalus, incision infection, pneumonia and cerebrospinal fluid leakage from the incision. Notably, normal perfusion pressure breakthrough (NPPB) did not develop during or after endovascular embolisation or surgery.

Conclusion

Preoperative endovascular embolisation is a safe and effective adjunct treatment. Employing this treatment, solid haemangioblastomas in the dorsal medulla oblongata can be safely and completely resected.     

Cross-face nerve grafting in facial paralysis —A long-term follow-up

Summary The long term results of 21 cases of cross-face nerve grafting are presented and analyzed to evaluate the value of the procedure. The follow-up period extended beyond 3 years in all cases as the final assessment of the facial reanimation is only possible after a very long time interval. A satisfactory or good reanimation of the face occurred in 80% of the patients. In well defined cases the procedure may be considered a valuable tool in the rehabilitation of the paralyzed face.     

桥脑小脑角区神经内镜应用解剖学的初步研究

目的 研究桥脑小脑角区神经内镜“锁孔”入路的神经和血管等解剖结构,探索神经内镜到达该区的可行性及相应的解剖定位标志。方法 成人尸头8例,新鲜少年尸头2例,经双侧颈总动脉、椎动脉灌注10％乳胶 红色染料 硫酸钡粉剂。用0°、30°硬镜交替配合使用,对桥脑小脑角区的解剖结构进行观察。结果 当枕下“锁孔”入路骨窗直径为15mm时,神经内镜在桥脑小脑角区操作自如,能暴露全部的桥小脑角区,包括桥脑的腹侧区、斜坡以及对侧的解剖结构。结论 ①硬膜下腔中,内镜准确到位的要点是内镜按照定位标志或沿途定位路标前进。②桥脑小脑角区的神经从头侧至尾侧和从内侧到外侧把桥脑小脑角区分成三个腔隙:头侧腔隙、中间腔隙和尾侧腔隙,每个腔隙均有主要血管和一组颅神经通过。     

大型脑动静脉畸形直接显微手术治疗的效果分析

目的通过总结大型脑动静脉畸形的显微手术经验,探讨脑动静脉畸形显微手术的效果以及正常灌注压突破对显微手术的影响。方法回顾性分析93例采用显微外科手术治疗的大型脑动静脉畸形病例,按照Spetzler—Martin分级,3级者37例,4级者35例,5级者21例。结果术后出现再出血及急性脑肿胀者3例（3．2％）,死亡2例。术后对91例患者进行随访,根据GOS分级,恢复良好82例（90．1％）,中残7例（7．7％）,重残2例（2．2％）。结论显微外科手术是治疗大型脑动静脉畸形的有效手段,术前精确的判断及术中精细的操作是手术成功的关键。正常灌注压突破对大型脑动静脉畸形直接显微手术无显著影响。     

经额胼胝体-透明膈入路显微切除第三脑室及侧脑室肿瘤

目的 探讨经额胼胝体-透明膈入路显微切除第三脑室并累及侧脑室肿瘤的临床疗效及优点.方法 选择皖南医学院弋矶山医院神经外科自2005年10月至2009年4月收治的第三脑室并累及侧脑室肿瘤患者12例.采用经额胼胝体-透明膈入路行显微切除手术.结果 肿瘤全切除4例,近全切除3例,大部分切除5例,无手术死亡患者.结论 该手术入路由生理间隙进入,显微镜下直视操作,术野暴露清晰且对周围结构损伤小,切除第三脑室及侧脑室内肿瘤较安全,并发症少.     

术中超声联合神经导航辅助显微手术切除颅内肿瘤的临床研究

目的探讨术中超声联合神经导航在颅内肿瘤切除手术中的作用和价值。方法选择16例颅内肿瘤患者,利用MRI介导的神经导航系统引导开颅,采取合适的皮层入路,应用显微神经外科技术切除颅内肿瘤,利用术中超声判断病变切除的程度和范围,随访患者术后情况。结果所有病灶均在神经导航引导下开颅,神经导航术前对病变定位准确率为100%,骨窗暴露满意;术中超声能纠正术前神经导航定位的漂移;在其引导下14例获得全切除,2例获得次全切除;术后1例有对侧肢体肌力下降,1例轻度运动性失语,无颅内感染及死亡病例。结论术中超声联合神经导航辅助显微神经外科手术能提高颅内肿瘤定位的准确性,减少手术副损伤,提高肿瘤全切率,是一种安全有效的方法 。