高级别颅内动脉瘤暂行保守治疗后手术或血管内栓塞预后的观察

目的观察颅内囊状动脉瘤Hunt-HessⅣ~Ⅴ级患者保守治疗12 h后再行手术或血管内治疗的预后。方法回顾性分析2012年1月至2014年1月收治的Hunt-HessⅣ~Ⅴ级颅内囊状动脉瘤32例患者(Ⅳ级24例,Ⅴ级8例)的临床资料,其中16例患者入院保守治疗12 h后再行手术或栓塞治疗(暂缓手术组),16例患者急诊行手术或栓塞治疗(即刻手术组),对两组患者治疗前和治疗后第1、3、6个月进行神经功能预后进行评价。结果治疗后第1个月暂缓手术组与即刻手术组格拉斯哥预后评分差异无统计学意义[(3.7±1.4)、(3.8±1.2)分,t=1.372,P0.05)];治疗后第3个月两组Rankin预后评分差异无统计学意义[(3.7±1.7)、(3.6±1.5)分,t=1.361,P0.05)];但治疗后第6个月两组Rankin预后评分差异有统计学意义[(3.5±1.5)、(4.2±1.8)分,t=2.234,P0.05)]。结论高级别囊状动脉瘤性蛛网膜下腔出血的患者采用保守治疗12 h后再行血管内栓塞或手术治疗,在术后第6个月的预后优于入院急诊直接行手术或栓塞治疗。     

脑动脉狭窄患者血清中炎性因子干扰素-γ、白细胞介素-6和肿瘤坏死因子-α的水平分析

目的:研究不同类型脑动脉狭窄患者血清中干扰素(interferon,IFN)-γ、白细胞介素(interleukin,IL)-6和肿瘤坏死因子( tumor necrosis factor,TNF)-α的水平,分析这几种炎性因子在不同类型脑动脉狭窄患者血清中的变化规律.方法:按脑动脉狭窄部位分为颅内狭窄组(26例),颅外狭窄组(30例),颅内、外混合狭窄组(27例)及单纯大脑中动脉( middle cerebral artery,MCA)狭窄组(25例),另外包括对照人群33例.通过酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清中IFN-γ、IL-6和TNF-α的含量并采用SPSS 11.5统计分析软件进行分析比较.结果:对血清中3种因子的检测发现,颅内狭窄组、颅外狭窄组、混合狭窄组和MCA狭窄组血清中的IFN-γ和IL-6均显著高于对照组(P=0.000),但在各狭窄组间IFN-γ差异无统计学意义,而颅内狭窄组的IL-6含量低于其他狭窄组(P＜0.05).对TNF-α的检测发现,只有颅内狭窄组和MCA狭窄组显著高于对照组(P＜0.05),而颅外狭窄组和混合狭窄组与对照组相比差异无统计学意义(P＞0.05).结论:上述实验结果提示IFN-γ、IL-6和TNF-α可能参与某些类型脑动脉狭窄的形成过程.     

内镜潜水技术在垂体外科手术中的应用

目的 探讨内镜潜水技术在垂体外科手术中的应用方法、适应证、疗效和并发症.方法 回顾性分析99例内镜下经鼻垂体手术病人的临床资料,均计划采用内镜潜水技术.其中垂体腺瘤91例,垂体Rathke囊肿8例.结果 术中实际应用内镜潜水技术84例,随访3～6个月,其中肿瘤全切除60例,次全切除19例,部分切除5例.术中出现脑脊液漏1例,修补后无脑脊液漏.术后视力损害加重1例,治疗后恢复至术前水平.术后出现一过性尿崩症23例.15例因解剖和操作等原因未能实施潜水技术.结论 内镜潜水技术安全实用,可提高病变切除程度,相关并发症少,器械的水中操作技术仍需改进.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

不同类型脑血管狭窄患者血清中的NO含量及NOS活性

目的研究不同脑血管患者血清中血管活性因子NO含量及TNOS／iNOS活性的变化,分析这几种因素在脑血管狭窄中的可能作用机制。方法通过生化分析检测血清中一氧化氮（NO）的含量及组织型一氧化氮合酶（TNOS）和诱导型一氧化氮合酶（iNOS）的活性。结果血清NO及TNOS和iNOS的检测发现,混合组（P=0．000）和MCA组（P=0．001）血清总的NO含量显著增高;颅内组（P=0．004）和MCA组（P=0．002）血清iNOS活性显著增加;颅内组血清TNOS活性显著减弱（P=0．032）,混合组（P=0．011）和MCA组（P=0．018）TNOS活性显著增加。结论多种相关因子的参与是目标人群某些类型脑血管狭窄发生机制的重要组成部分。这为寻找脑血管狭窄的多因素多环节作用机制提供了坚实的理论基础。     

内镜下经鼻蝶入路鞍结节脑膜瘤切除术

目的总结内镜下经鼻蝶入路切除鞍结节脑膜瘤的方法、疗效、手术指征和并发症。方法回顾性分析6例鞍结节脑膜瘤的临床资料,均选择内镜下经鼻入路。结果 SimpsonⅠ级切除5例,SimpsonⅣ级切除1例。术后视力减退改善4例,加重1例;视野障碍改善1例,无变化4例;视力视野术后未查1例。术后并发脑脊液漏2例,暂时性垂体前叶功能减退1例,死亡1例。随访5例,时间6个月～3年,经MRI复查肿瘤均无复发。结论内镜下经鼻蝶入路是鞍结节脑膜瘤外科治疗方法之一,具有手术创伤小、手术时间短及可达SimpsonⅠ级切除的优点。但本方法并不适合所有鞍结节脑膜瘤,需有严格的手术指征。     

脑血管狭窄患者Nf1全基因的DHPLC分析(附5例报告)

目的 探讨脑血管狭窄患者Nf1基因的突变热点及突变方式.方法 从全血中提取DNA,采用变性高效液相色谱分析(DHPLC)对5例脑血管狭窄病例进行Nf1全基因突变筛查;对DHPLC检测有差异洗脱峰型的区域进行测序分析.结果 5例无危险因素的脑血管狭窄患者Nf1全基因筛查发现:①1例出现5号外显子无义突变位点,c.541C-T;②5例均有14号和15号外显子之间内含子的基因突变;③4例有7号外显子c.702G-A的同义突变位点;④1例出现32号(c.4177G-A,Val-Ile)和46号外显子(c.6918T-G,Asn-Lys)的错义突变.结论 在目前无其他基础疾病的脑血管狭窄患者体内的Nf1基因并非以稳定野生型存在,而是具有不同类型的突变,这些突变集中在第5、7、14、32和46等外显子上.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

后颅窝扩大成形术治疗Arnold-Chiari畸形合并脊髓空洞症的临床研究

目的研究Arnold—Chiari畸形合并脊髓空洞症显微外科手术中后颅窝底及寰椎后弓切除对脑组织和寰枕部稳定性的影响及钛网后颅窝扩大成形术对保持后颅窝结构、功能稳定的临床应用。方法对12例Arnold—Chiari畸形钛网后颅窝及寰椎后弓扩大成形患者与156例未成型患者的术后临床症状、枕颈部的稳定性及生活质量进行对照。结果12例扩大成型患者术后临床症状不明显,生活质量高;而未成型者多有头痛、头晕、枕颈交界部不适等症状以及惧怕枕颈部遭受外力的恐惧心理。结论钛网后颅窝及环椎后弓扩大成形术可相对维持后颅窝的生理结构,减少患者的临床症状,提高生活质量。