血管内栓塞治疗颅内前交通微小动脉瘤20例

[目的]探讨前交通微小动脉瘤介入治疗的疗效、安全性及技术要点.[方法]以可解脱弹簧圈栓塞治疗20例患者(20枚)前交通微小动脉瘤.[结果]栓塞治疗后即刻脑血管造影,动脉瘤致密填塞13例,动脉瘤部分栓塞7例.1例Hunt-Hess分级为Ⅴ级患者死亡,余患者出院前GOS(Glasgow Outcome Scale)评分:5...     

颅骨固定钛夹在颅骨成形术中的应用

目的 介绍一种新型颅骨固定钛夹在颅骨成形术中的应用.方法 回顾性分析10例颅骨外伤病人的临床资料,均采用颅骨固定钛夹行颅骨成形术.结果 颅骨固定牢靠,术后未见并发症.结论 新型颅骨固定钛夹可方便、牢固固定自体骨瓣.     

显微手术治疗前交通动脉瘤60例

[目的]探讨前交通动脉瘤显微手术治疗的手术方案.[方法]回顾性分析显微手术治疗的60例前交通动脉瘤临床资料.[结果]1例术前Hunt-Hess分级为Ⅴ级的患者死亡,余患者出院前GOS(Glasgow Outcome Scale)评分5分30例,4分21例,3分6例,2分2例.本组病例随访3～36个月,均无再次出血.25例患者均复查CTA,未见动脉瘤残留或复发.[结论]翼点入路显微镜下夹闭动脉瘤是治疗前交通动脉瘤的有效手段.     

高血压性脑干出血的个体化手术治疗

目的 探讨高血压性脑干出血的显微手术治疗的手术指征、手术技巧、手术方法和预后。方法 回顾性分析2011年 1月至2018年12月收治的54例高血压性脑干出血的临床资料。根据出血量及出血部位采用个体化手术治疗。结果 术后3个月，按GOS评分:脑室穿刺治疗的30例中，8例恢复良好，12例中残或重残，4例植物状态生存，6例死亡；开颅手术治疗的20例中，3例恢复良好，5例中残或重残，5例植物状态生存，7例死亡；脑干穿刺治疗的4例中，中残2例，重残1例，植物状态生存1例。结论 根据出血量及出血部位采用不同的方法治疗高血压性脑干出血，效果良好。     

巨大脑膜瘤102例显微手术治疗

目的 总结切除巨大脑膜瘤的显微手术经验和技巧。方法 回顾性总结分析我院自1990年6月至2006年6月收治的巨大脑膜瘤102例患者的临床资料。肿瘤直径均≥7cm，其中最大者直径〉14cm。结果 按照脑膜瘤切除的Simpson分级标准，肿瘤Ⅰ类切除76例，Ⅱ类切除19例，Ⅲ类切除7例。结果 良好80例，好转18例，死亡4例。结论 术中妥善保护好矢状窦及中央沟静脉等重要结构，精巧的显微手术技巧，积极处理并发症有助于提高巨大脑膜瘤全切除率，减少病残率。     

经椎动脉内持续注射盐酸法舒地尔治疗脑血管痉挛

目的 在活体动物模型中持续椎动脉内注射盐酸法舒地尔,观察其在不同时间点对蛛网膜下腔出血(SAH)引起的迟发性脑血管痉挛(CVS)的防治作用,并和静脉内给药对比.方法 将日本大耳白兔随机分为椎动脉7 d给药组、椎动脉5 d给药组、静脉给药组及对照组.枕大池2次注血法建立蛛网膜下腔出血模型,椎动脉给药组经微量注射泵分别于不同时间点开始给予盐酸法舒地尔或5%葡萄糖溶液,静脉给药组经耳缘静脉滴注盐酸法舒地尔,注血前及第5、7天各组均行脑血管造影及血管彩色超声检查,测算基底动脉内径变化的比例和血流峰值速度的变化.7 d时处死兔取基底动脉,行光镜、电镜检查,观察其病理改变.结果　动、静脉给药各组均对蛛网膜下腔出血引起的基底动脉痉挛有显著保护作用.在第5天,静脉给药组与椎动脉5 d给药组的保护作用差异无统计学意义(15.43±4.82)%比(10.37±6.92)%,但与椎动脉7 d给药组差异有统计学意义(2.02±6.21)%;在第7天,椎动脉5 d组与7 d组的保护作用差异无统计学意义(2.60±6.42)%比(0.44±5.12)%,但与静脉给药组差异有统计学意义(8.40±4.28)%.同时用血管彩色超声对各组基底动脉峰值流速进行监测,并行光镜、电镜等病理检查,也支持上述结果　.结论　脑血管痉挛动物模型中椎动脉内持续注射盐酸法舒地尔对蛛网膜下腔出血引起的脑血管痉挛的保护作用优于静脉内给药.

Abstract：

Objective To investigate and compare the effects of continuous intravertebral artery (CIV) injection of fasudil hydrochloride with intravenous injection of fasudil hydrochloride as well as control agents in treating delayed cerebral vasospasm ( CVS ) following subarachnoid hemorrhage (SAH).Methods Forty healthy Japanese white rabbits were selected and randomly divided into 4 groups: 7-day (continual CIV injection of fasudil hydrochloride after the first injection of blood for 7 days), 5-day (CIV injection of fasudil hydrochloride for 5 days on the 3rd day after the first injection), intravenous treatment (iv), and controls. There were 28 rabbits that underwent 84 cerebral angiographies. The basal artery was obtained, and its pathological changes were observed under the light and electron microscopies. Results Severe CVS occurred in the control group on the 5th and 7th day. CVS due to SAH was significantly alleviated after intravertebral artery and intravenous injection. The difference between the intravenous and intravertebral artery groups was significant on the 7th day but not on the 5th day. There was no significant difference in the preventive effect between the 5-day and 7-day groups, but this effect differed from the iv group, which was supported by the pathological examinations. Conclusion The effect of CIV injection of fasudil hydrochloride in treating delayed CVS due to SAH at different time points was better than intravenous administration.