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。     

重度颅脑损伤：应该预防癫痫吗？

重度颅脑损伤患者有较高概率发生癫痫,是否需要抗癫痫药物预防癫痫发作存在争议。文章认为,重度颅脑损 伤患者早期（7 d内）在应用镇痛镇静治疗基础上无需加用抗癫痫药物,晚期无预防性应用抗癫痫药物的必要。而确 诊为癫痫者则需应用抗癫痫药物规范治疗。     

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。     

复发听神经瘤的临床特征分析与显微外科手术治疗

目的 探讨不同类型复发听神经瘤的临床特征及其显微外科手术治疗方法.方法 回顾性分析2010年1月至2016年10月华中科技大学同济医学院附属同济医院神经外科收治的29例复发听神经瘤患者的临床资料.初次手术全切除后复发11例（全切复发组）,初次不全切除后复发18例（非全切复发组）.比较两组患者的年龄、原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变、两次手术间隔时间、并发症、House-Brackmann面神经功能分级（H-B分级）.结果 全切复发组的平均年龄大于非全切复发组[分别为（52.2±10.8）岁和（33.0±5.5）岁,P〈0.05],前者两次手术间隔时间也明显大于后者[分别为（93.3±30.0）个月和（45.0±15.6）个月,P〈0.001].两组的原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变的比率、并发症发生率、面神经功能良好（H-B分级Ⅰ、Ⅱ级）比率的差异均无统计学意义（均P〉0.05）.29例患者的随访时间为3-37个月,平均（11.7±3.1）个月.肿瘤全切除28例,近全切除1例.术中面神经解剖保留率为93％ （27/29）.术后实用听力保留率为7％ （2/29）,面神经功能良好的比率为41％ （12/29）.结论 听神经瘤不全切除后残留复发者的两次手术间隔时间明显较全切除者短.在保护神经功能的前提下,初次全切除是听神经瘤患者获得最佳临床疗效的首选方法.对于复发听神经瘤建议早期积极手术.     

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.     

枕下乙状窦后入路锁孔手术切除听神经瘤

目的 探讨枕下乙状窦后入路锁孔手术切除听神经瘤的方法及效果。方法 回顾性分析2016年1月至2018年6月经枕下乙状窦后入路锁孔手术治疗的116例听神经瘤的临床资料,根据术前增强MRI分为中小型听神经瘤组（最大径≤3 cm;83例）和大型听神经瘤组（最大径>3 cm;33例）。结果 中小型听神经瘤组肿瘤全切除率为97.6%（81/83）,面神经解剖保留80例（96.4%）。术后1周面神经功能良好（H-B分级Ⅰ~Ⅱ级）59例（71.1%）。大型听神经瘤组肿瘤全切除率87.9%（29/33）,面神经解剖保留28例（84.8%）,术后1周面神经功能良好18例（54.5%）。结论 对于中小型听神经瘤,采用枕下乙状窦后入路锁孔手术可实现肿瘤完全切除和良好的面神经功能保护。对于大型听神经瘤,在良好体位、充分释放脑脊液、电生理监测等辅助下,采用乙状窦后入路锁孔手术也可实现肿瘤安全满意切除和面神经功能保护。     

囊性听神经瘤的显微手术策略与临床分析

目的探讨囊性听神经瘤的临床特点及其显微外科手术的治疗方法。 方法回顾性分析2013年1月~2017年12月华中科技大学同济医学院附属同济医院神经外科收治的囊性听神经瘤69例。所有囊性听神经瘤均行手术治疗，采用枕下乙状窦后入路。结果肿瘤全切61例（88.4%），次全切除6例（8.7%），部分切除2例（2.9%）；面神经解剖保留率为64例（92.7%）。术后2周采用面神经功能House Brackmann分级，其中Ⅰ Ⅱ级47例（68.1%），Ⅲ Ⅳ级16例（23.2%），Ⅴ Ⅵ级6例（8.7%）；术后后组脑神经功能障碍4例（5.8%），术后实用听力保留患者4例（5.8%）。结论囊性听神经瘤应尽量早期积极手术，在充分保护面神经功能的前提下，力争全切肿瘤。同时术者丰富的显微外科技术，以及超声刀、激光刀、电生理监测等重要工具的应用，是保障囊性听神经瘤手术效果和保全神经功能的关键因素。