经冠状缝-额中回入路神经内镜手术治疗高血压性基底节区出血的标准化流程分析

目的 总结一种简单实施、有效的、标准的经冠状缝-额中回入路神经内镜手术治疗高血压性基底节区出血的标准化流程。方法 回顾性分析2019年4月至2021年4月按统一标准实施的经冠状缝-额中回入路神经内镜手术治疗的48例高血压性基底节区出血的临床资料。术中未使用神经导航及3D-slicer等软件辅助定位。结果 术后24 h内复查头CT显示残余血肿量中位数为2.4（1.1~3.9）ml;血肿清除率中位数为94.0%（90.0%~98.0%）。无术后再出血。出院时GCS评分中位数为13（11~14）分。术后随访6~30个月（中位数15个月）,mRS评分0~2分35例,3~4分10例,5~6分3例。结论 神经内镜下经冠状缝-额中回入路手术治疗高血压性基底节区出血是一种简单易行的手术方式,无需神经导航及3D-slicer等软件辅助定位,可以取得良好的手术效果。     

颅内多发动脉瘤合并颅底脑膜瘤1例报告并文献复习

颅内多发动脉瘤合并脑膜瘤在临床上较为少见。该文报道1例颅内多发动脉瘤合并颅底脑膜瘤患者的临床资料及治疗过程，并结合相关文献进行探讨。 [国际神经病学神经外科学杂志, 2023, 50(4): 44-49]     

Histopathological features of middle cerebral artery and superficial temporal artery from patients with moyamoya disease and enlightenments on clinical treatment

The histopathological features of the middle cerebral artery (MCA) and superficial temporal artery (STA) from moyamoya disease (MMD) and their relationships with gender, age, angiography stage were explored. The causes and the clinical significance of vasculopathy of STA were also discussed. The clinical data and specimens of MCA and STA from 30 MMD patients were collected. Twelve samples of MCA and STA from non-MMD patients served as control group. Histopathological examination was then performed by measuring the thickness of intima and media, and statistical analysis was conducted. The MCA and STA specimens from MMD group had apparently thicker intima and thinner media than those from the control group. There was no significant pathological difference between the hemorrhage group and non-hemorrhage group, and between the males and females in MMD patients. Neither the age nor the digital subtraction angiography (DSA) stage was correlated with the thickness of intima in MCA and STA. MMD is a systemic vascular disease involving both intracranial and extracranial vessels. Preoperative external carotid arteriography, especially super-selective arteriography of the STA, benefits the selection of donor vessel.     

脑室内中枢神经细胞瘤诊治分析简

目的探讨脑室内中枢神经细胞瘤（ICN）的诊断及手术治疗效果。方法回顾性分析我科手术治疗并经病理学确诊的9例ICN患者的临床资料。结果肿瘤全切除6例,次全切除3例。无手术死亡病例。1例术前放疗肿瘤体积明显缩小,4例术后辅助放疗。所有患者术后随访3～44月,平均18．7月;2例复发,行γ刀切除;2例并发脑积水行脑室一腹腔分流术;其余患者恢复良好,无肿瘤复发或进展。结论ICN多以慢性颅内高压症状起病,缺乏局灶性神经系统缺损症状,但大多ICN术前根据特征性影像学表现可获得诊断。手术应作为治疗的首选方法,并力争在安全前提下全切除,可获得良好预后。     

双C臂复合手术室在颅内外高流量搭桥术治疗颈内动脉海绵窦段巨大动脉瘤中的使用

目的 探讨双C臂复合手术室在颅内外高流量搭桥术治疗颈内动脉海绵窦段巨大动脉瘤中的应用效果。方法 回顾性分析在双C臂复合手术室采用颅内外高流量搭桥术治疗的5例颈内动脉海绵窦段巨大动脉瘤的临床资料。结果 术中3例经DSA证实桥血管通畅,2例桥血管狭窄,在经过重新缝合后通畅。术后症状改善3例,无明显变化2例。1例仍有轻度眼睑下垂,1例眼周仍有麻木感。结论 应用双C臂复合手术室进行颅内外高流量搭桥术可以确保桥血管的通畅性,提高颈内动脉海绵窦段巨大动脉瘤的治疗效果。     

影响中枢神经细胞瘤术后复发的相关因素分析

目的探讨影响中枢神经细胞瘤术后复发的相关因素。方法回顾性分析2005至2012年显微手术治疗并经术后病理学确诊的35例中枢神经细胞瘤患者的临床资料,并应用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析影响肿瘤术后复发的相关危险因素。结果肿瘤全部切除20例,部分切除15例。32例随访至2014年5月,随访时间为19∽103个月;1例失访;肿瘤复发12例。单因素及多因素分析均显示非典型组织学特点及手术部分切除肿瘤是影响中枢神经细胞瘤复发的危险因素。结论最大程度安全手术切除肿瘤可获得良好的预后;对于残留或复发的较小的肿瘤,γ刀治疗可以取得较好的效果。     

Treatment Strategies for Huge Central Neurocytomas

Central neurocytomas(CNs), initially asymptomatic, sometimes become huge before detection. We described and analyzed the clinical, radiological, operational and outcome data of 13 cases of huge intraventricular CNs, and discussed the treatment strategies in this study. All huge CNs(n=13) in our study were located in bilateral lateral ventricle with diameter ≥5.0 cm and had a broad-based attachment to at least one side of the ventricle wall. All patients received craniotomy to remove the tumor through transcallosal or transcortical approach and CNs were of typical histologic and immunohistochemical features. Adjuvant therapies including conventional radiation therapy(RT) or gamma knife radiosurgery(GKRS) were also performed postoperatively. Transcallosal and transcortical approaches were used in 8 and 5 patients, respectively. Two patients died within one month after operation and 3 patients with gross total resection(GTR) were additionally given a decompressive craniectomy(DC) and/or ventriculoperitoneal shunt(VPS) as the salvage therapy. Six patients received GTR(+RT) and 7 patients received subtotal resection(STR)(+GKRS). Eight patients suffered serious complications such as hydrocephalus, paralysis and seizure after operation, and patients who underwent GTR showed worse functional outcome [less Karnofsky performance scale(KPS) scores] than those having STR(+GKRS) during the follow-up period. The clinical outcome of huge CNs seemed not to be favorable as that described in previous reports. Surgical resection for huge CNs should be meticulously considered to guarantee the maximum safety. Better results were achieved in STR(+GKRS) compared with GTR(+RT) for huge CNs, suggesting that STR(+GKRS) may be a better treatment choice. The recurrent or residual tumor can be treated with GKRS effectively.     

建立供神经内镜培训的脑出血尸头模型及培训方法

目的 探讨供神经内镜培训的脑出血尸头模型建立方法及模拟培训效果。方法 采用新鲜冰冻尸头标本，耳上小骨窗开颅后将人工配制“血液”样液体注入经脑皮层造瘘后的空腔内，建立脑出血模型。然后进行经额神经内镜下手术清除脑出血培训，记录学员神经内镜下血肿清除时间及对模型实用性的评价。结果 完成9例双侧脑出血尸头模型，共18名学员（7名有内镜手术经验），按每2人一组（助手和术者），先后并互换角色，完成两侧神经内镜血肿清除的手术操作。平均血肿清除时间（21.32±1.85）min。有内镜经验学员用时[（20.23±0.52）min]较无经验学员用时[（22.02±0.55）min]明显缩短（P<0.05），先当助手学员用时[（19.91±0.30）min]较先当术者学员用时[（22.73±0.47）min]明显缩短（P<0.001）。18名学员均表示能从此次培训中获益并推荐此模型作为神经内镜培训模型，其中17名（94.45%）学员认为镜下模型“血肿”与真实血肿极其相似。结论 建立脑出血尸头模型，可全真模拟神经内镜下脑出血手术，能有效提高学员神经内镜的基本技术和操作技巧