"篮筐"技术在颅内动脉瘤介入治疗中的应用

Objective To study the ways,mechanism,indication,curative effect of " Basket" skill applied in the interventional therapy for intracranial aneurysm. Methods Intracranial aneurysm with 1 : 1 ≥ neck/body ≥ 1 : 2 ," 3 D coil" was used to form a basket in it;in that with 1:2 > neck/body,common "2D coil" was applied. And the following coils were applied with hydrocoil or fibered coil combined with common platinum coil to increase the embol-ism density. Results In 156 cases with 158 aneurysms,143 aneurysms were 100% embolized (90. 5% ) ;131 ca-ses discharged with GOS 5 score(84.0% ),and 2 cases died ( 1.3% ). Conclusion " Basket" skill can increase the embolization density in aneurysm,reducing the residual of the neck,getting embolizated fully and improving the prognosis.     

"篮筐"技术在颅内动脉瘤介入治疗中的应用

Objective To study the ways,mechanism,indication,curative effect of " Basket" skill applied in the interventional therapy for intracranial aneurysm. Methods Intracranial aneurysm with 1 : 1 ≥ neck/body ≥ 1 : 2 ," 3 D coil" was used to form a basket in it;in that with 1:2 > neck/body,common "2D coil" was applied. And the following coils were applied with hydrocoil or fibered coil combined with common platinum coil to increase the embol-ism density. Results In 156 cases with 158 aneurysms,143 aneurysms were 100% embolized (90. 5% ) ;131 ca-ses discharged with GOS 5 score(84.0% ),and 2 cases died ( 1.3% ). Conclusion " Basket" skill can increase the embolization density in aneurysm,reducing the residual of the neck,getting embolizated fully and improving the prognosis.     

小骨窗微创术与传统开颅术治疗高血压脑出血的疗效比较

2002年1月～2006年3月，我们对206例高血压脑出血病人进行了小骨窗开颅术或传统骨瓣开颅术，其中男126例，女80例；年龄55～85岁，平均66岁。高血压病史明确172例，在临床及术中排除其他脑血管骨窗直径2．5～3cm，切开脑皮质约1．5cm，     

CT对重型颅脑损伤后颅内压和预后估价

目的：探讨ＣＴ 对重型颅脑损伤后颅内压和预后的估价。材料与方法：ＣＴ 扫描１３０ 例重型颅脑损伤患者,分析其脑室脑池形态、脑室／ 颅腔比率、中线结构移位等变化特征,对颅内压和预后进行估价,并与颅内压监测结果对照。结果：ＣＴ 显示三脑室、基底池受压明显或消失、脑室／ 颅腔比率越小、中线结构移位越严重者,颅内压升高越明显;颅内压越高,预后越差,生存质量越低。结论：ＣＴ 能够估价颅内压,并由此指导治疗,判断预后。     

脑膜瘤术前超选择性颈外动脉栓塞术的临床应用

目的 探讨脑膜瘤术前超选择性颈外动脉栓塞术在临床手术的应用价值及脑膜瘤供血情况。方法 ２３例经ＣＴ或ＭＲ诊断的脑膜瘤,术前均先行颈外动脉造影并超选择性栓塞术。结果 所有术前作颈外动脉栓塞的脑膜瘤,肿瘤体积缩小,手术切除容易,术中出血减少,手术时间缩短。     

"篮筐"技术在颅内动脉瘤介入治疗中的应用

Objective To study the ways,mechanism,indication,curative effect of " Basket" skill applied in the interventional therapy for intracranial aneurysm. Methods Intracranial aneurysm with 1 : 1 ≥ neck/body ≥ 1 : 2 ," 3 D coil" was used to form a basket in it;in that with 1:2 > neck/body,common "2D coil" was applied. And the following coils were applied with hydrocoil or fibered coil combined with common platinum coil to increase the embol-ism density. Results In 156 cases with 158 aneurysms,143 aneurysms were 100% embolized (90. 5% ) ;131 ca-ses discharged with GOS 5 score(84.0% ),and 2 cases died ( 1.3% ). Conclusion " Basket" skill can increase the embolization density in aneurysm,reducing the residual of the neck,getting embolizated fully and improving the prognosis.     

破裂性颅内动脉瘤介入术中再破裂的危险因素分析及应急处理

目的 探讨破裂性颅内动脉瘤介入术中再破裂的危险因素、应急处理办法及疗效.方法分析自2005年至2009年广东医学院附属医院神经外科收治的236例行介入治疗的破裂性颅内动脉瘤患者的临床资料,应用非条件logistic逐步回归方法分析其介入术中再破裂的危险因素,并总结其中发生再破裂的16例患者(6.78%)的处理措施及疗效. 结果 破裂性颅内动脉瘤介入术中再破裂的危险因素为:微小动脉瘤(OR=6.353,95%CI:1.26～31.894,P=0.025),A1、M1远端动脉瘤(OR=35.449,95%CI:3.053～411.642,P=0.004),动脉粥样硬化(OR=5.961,95%CI:1.215～29.260,P=0.028),轻度脑血管痉挛(OR=13.048,95%CI:1.220～139.574,P=0.034),重度脑血管痉挛(OR=14.826,95%CI:1.871～117.488,P=0.011).16例患者均采用鱼精蛋白快速中和肝素及迅速完成动脉瘤的栓塞,其中12例Hunt-HessⅢ级以上者予急诊行脑室外引流术,结果6例死亡,1例植物生存状态,9例恢复良好. 结论 动脉硬化,脑血管痉挛,微小动脉瘤,A1、M1远端动脉瘤等因素容易导致破裂性颅内动脉瘤介入术中再破裂.快速中和肝素及迅速完成动脉瘤的栓塞,对重症患者行急诊脑室外引流术是应对介入术中动脉瘤再破裂的关键,有利于病死率降低,预后改善.

Abstract：

Objective To study the risk factors of intraprocedural re-rupture (IPR) of ruptured intracranial aneurysms, and the emergency management on this event and its efficacy. Methods The clinical data of 236 patients with ruptured intracranial aneurysms, admitted to our hospital from 2005 to 2009 and treated with embolization, were retrospectively analyzed; non-conditional logistic regression analysis was performed to analyze the risk factors of IPR of ruptured intracranial aneurysms. And the emergency management of IPR and its efficacy were concluded in 16 patients with IPR. Results The risk factors of IPR of ruptured intracranial aneurysms included small aneurysms with a diameter smaller than or equaling to 3.0 mm (OR=6.353, 95% CI: 1.266-31.894, P=0.025), aneurysms at distal part of Al and M1 segment of the anterior cerebral artery or middle cerebral artery (OR=35.449, 95% CI:3.053-411.642, P=0.004), atherosclerosis (OR=5.961, 95% CI: 1.215-29.260, P=0.028), mild vasospasm (OR=13.048, 95% CI: 1.220-139.574, P=0.034) and severe vasospasm (OR=14.826, 95% CI:1.871-117.488, P=0.011). Immediate reversal of heparin anticoagulation with protamine sulfate and rapid completion of coiling were performed in 16 patients (6.78%) occurred IPR. Emergent external ventricular drainage was performed in 12 patients having above Hunt-Hess grade Ⅲ:6 patients died; 1 was under persistent vegetative state and 9 fully recovered. Conclusion Small aneurysms, atherosclerosis,cerebral vasospasm and aneurysms at the distal part of Al or M1 segment may easily lead to IPR of ruptured intracranial aneurysms. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation, and emergent external ventricular drainage performed in severe patients are confirmed to be the keys, which can decrease the death rate and improve the prognosis.     

GCS≥8分小儿单纯性幕上硬膜外血肿的穿刺引流治疗

目的探讨GCS≥8分小儿外伤性单纯性幕上硬膜外血肿的临床特征及治疗方法。方法分析89例该病患者的临床资料,全部病例经头颅CT确诊,随机分成两组,对照组(A组)44例,锥孔后应用尿激酶加生理盐水灌注引流治疗;治疗组(B组)45例,锥孔后应用尿激酶加自体血清灌注引流治疗。结果B组患者的硬膜外血肿清除速度及GCS评分改善程度均明显优于A组(P<0.05)。结论该病患者的临床特征不典型,需结合头颅CT确诊。锥孔后尿激酶加自体血清灌注引流能更快地清除血肿,创伤较小。     

海绵窦外侧壁硬膜间脓肿一例

海绵窦外侧壁硬膜间脓肿一例陈立一张远征患者女，２５岁。１９９６年１月１７日入院。入院前３个月无诱因出现左头面部间歇性钝痛，左眼胀痛，左面麻木，半个月后出现左上睑下垂。查体：左上睑下垂，左瞳孔３ｍｍ，直间接对光反射迟钝，右瞳孔２ｍｍ，对光反射灵敏，左面...