胼胝体动静脉畸形的显微外科治疗

报告2例胼胝体AVM(其中1例多发)的27个病灶。5个位于膝部，4个位于膝部，18个位于压部．供血动脉主要来自大脑前动脉的胼周动脉，其次是大脑后动脉的脉络膜后动脉等分支，24个AVM采用显微外科手术作了全部切除，术后能正常生活达88．5%．无死亡，并对胼胝体AVM显微外科切除手术的体会进行了讨论。     

胼胝体动静脉畸形的显微外科治疗

报告26例胼胝体AVM（其中1例多发）的27个病灶。5个位于膝部,4个位于体部.18个位于压部。供血动脉主要来自大脑前动脉的胼周动脉;其次是大脑后动脉的脉络膜后动脉等分支。24个AVM采用显微外科手术作了全部切除。术后能正常生活者达88.5％,无死亡,并对胼胝体AVM显微外科切除手术的体会进行了讨论。     

胼胝体动静脉畸形

本文报告１９例胼胝体动静脉畸形（ＡＶＭ），２０个病灶（１例多发）。其中，膝部３个，体部２个，压部１５个，所有病人都有蛛网膜下腔出血，而以癫痫大发作为首症状者仅１例，以胼周动脉为主要供血动脉，大脑后动脉分支亦参与供血，除１例行供血动脉结扎术外，其余１９个ＡＶＭ均采用显微外科手术完整切除，无死亡，手术疗效满意。     

介入栓塞联合显微外科手术治疗硬脑膜动脉参与供血的高级别脑动静脉畸形单中心临床疗效

目的 分析硬脑膜动脉供血的高级别脑动静脉畸形(AVM)患者的临床特点,探讨介入栓塞联合显微外科手术治疗的临床疗效。方法 回顾性分析7例合并硬脑膜动脉供血的高级别脑AVM患者的临床资料,其中首发症状表现为头痛4例,意识障碍1例,肢体无力1例,顽固性癫痫1例。Spetzler-Martin分级Ⅳ6例,Ⅴ级1例。所有患者均Onyx-18胶栓塞硬脑膜供血动脉和/或部分高流量的颅内供血动脉、深部供血动脉,栓塞术后48 h内行显微外科手术切除脑AVM,术后1周复查脑血管造影评估手术切除效果。结果 6例患者成功栓塞10支硬脑膜动脉及其对应的畸形团,1例患者仅栓塞供血动脉近端,同时栓塞4例大脑后动脉(其中1例有血流动力学相关性动脉瘤),2例大脑前动脉分支(1例有血流动力学相关性动脉瘤),1例小脑上动脉。所有患者AVM均被完全切除。1例患者肌力较术前下降,2例出现颅内感染。临床随访7例,改良Rank评分0～1分7例,6例血管造影复查AVM未显影。结论 硬脑膜动脉供血的脑AVM以高级别多见,同时兼备脑AVM和硬脑膜动静脉瘘的临床表现,显微外科手术前行介入栓塞治疗能降低手术并发症,提高临床疗效。     

大脑半球内侧面动静脉畸形的手术治疗：附22例报告

在22例大脑半球内侧面动静脉畸形(AVM)手术中,AVM 切除19例,供血动脉结扎3例。术后结果优、良者20例,中等者2例,无重残和死亡。该区AVM的特点是:(1)位置隐蔽、深在;(2)供血动脉主要来自大脑后动脉(PCA)或大脑前动脉(ACA),常累及脉络膜前、后动脉;(3)引流静脉常有深、浅二组;(4)畸形从切线方向显露,手术切除困难。我们对其临床特点,解剖结构,手术入路与技术进行简要探讨。     

脑动静脉畸形的多普勒超声研究

本文报道经颅多普勒超声(TCD)研究29例脑动静脉畸形(AVM)的血流动力学改变,50％小型AVM供血动脉的流速正常,50％小型AVM和大中型AVM供血动脉的流速均增快;中型AVM同侧颅外颈内动脉(PICA)流速增快,大型AVM双侧PICA流速均增快。AVM切除后供血动脉流速均减慢、脉动指数(PI)增大,其中中型AVM同侧PICA流速减慢,大型AVM双侧PI-CA流速均减慢且双侧颅内非AVM供血动脉的舒张末期流速减慢和PI增大。3例大型AVM手术中或手术后发生脑血流过度灌注现象。     

NBCA和ONYX栓塞治疗不同类型脑动静脉畸形的对比研究

目的对比分析NBCA和ONYX两种液态栓塞系统对不同类型脑动静脉畸形（AVM）的栓塞率，对NBCA和ONYX的有效性作出评价。方法选取1998年1月至2005年6月经过NBCA和ONYX栓塞治疗的50例脑AVM病人，NBCA组30例，ONYX组20例。男32例，女18例，平均33．5岁。对两组间不同大小、供血动脉类型、供血动脉支数脑AVM的栓塞率对比分析。全部数据采用秩和检验，应用SAS 6．12统计软件分析。结果对中型、皮质多支供血和浅部引流的脑AVM，ONYX的栓塞率高于NBCA。两者对小型、单支供血的脑AVM均有较高的栓塞率。结论对中型、皮质动脉多支供血的脑AVM，ONYX栓塞率比NBCA高。对大型和混合供血的脑AVM，NBCA与ONYX两者的栓塞率并无统计学意义。对于小型脑AVM，两种栓塞剂均有着较好的栓塞率。穿支供血的脑AVM不适合经动脉行血管内栓塞。对于体积较大的伴有广泛供血和位于功能区的AVM，可以分次栓塞，并结合手术和立体定向放射治疗。     

脑动脉畸形合并动脉瘤的分类、发生率和出血风险

脑动静脉畸形(AVM)合并动脉瘤已有广泛文献报导,但其分类方法仍未完善。作者根据AVM与动脉瘤的解剖和病理生理学关系提出一种新的分类方法。并回顾了1987年～1997年间632例AVM病人,以确定合并动脉瘤的发生率和出血率及AVM的治疗对动脉瘤自然病程的影响。 作者将AVM合并的动脉瘤分为三型:①巢内型:动脉瘤位于AVM灶内,血管造影早期即充盈;②供血动脉有关型——动脉瘤位于AVM供血动脉上。可细分为近端血流有关型(指动脉瘤位于颈内动脉床突上段,Willis动脉环,大脑中动脉到其主要分叉部,大脑前动脉到前交通动脉或椎基底干)与远端血流有关型     

Onyx胶治疗脑动静脉畸形相关动脉瘤二例及文献复习

目的 探讨Onyx胶治疗动静脉畸形(AVM)相关的供血动脉蒂动脉瘤中的应用价值.方法 结合文献复习,回顾性分析2例大脑后动脉远端AVM相关的大型供血动脉蒂动脉瘤病例资料.结果 根据病变血管构筑特征及临床特点,对1例病人采用Onyx胶结合弹簧圈的方法进行栓塞,而对另1例病人则采用单纯利用Onyx胶进行栓塞.结果 提示Onyx胶结合弹簧圈的方法能降低术中动脉瘤破裂的风险,并能达到致密栓塞.结论 Onyx胶结合弹簧圈的方法有助于治疗动静脉畸形(AVM)相关的大型供血动脉蒂动脉瘤.     

脑内动静脉畸形自行消退一例报告

脑动静脉畸形(AVM)在神经外科非属少见,但其自行消退病例却极为罕见,现将我院发现1例报告如下: 冯× 男,33岁。1971年4月20日突然头痛、意识不清,伴有左侧肢体偏瘫,当时诊断为蛛网膜下腔出血,给予降颅压、止血等治疗。2天后患者清醒,病情逐渐完全恢复。于6月7日行右颈内动脉造影,提示为右额叶AVM,供血动脉为大脑前动脉之胼周动脉及大脑中动脉之额顶升支,引流静脉粗大,引向上矢状窦。因不同意手术出院。1979年患者再次出现头     

Eyebrow incision with supraorbital trephination for endoscopic corpus callosotomy: a feasibility study

Objective We describe a novel technique for the partial bisection of the corpus callosum in order to increase the minimally invasiveness of this procedure.Methods Brow incisions with midline trephinations were performed in six adult cadavers. An endoscope was next introduced and used to transect approximately the anterior two-thirds of the corpus callosum.Results No complications such as injury to the superior sagittal sinus or anterior cerebral artery were encountered in any of our cadaveric specimens. The corpus callosum was easily transected in each specimen.Conclusion As a feasibility study, we believe this technique could provide a less invasive mechanism for patients who require corpus callosotomy and will minimize much of the morbidity associated with the traditional methods of sectioning the corpus callosum.     

以失用为主要表现的胼胝体梗死

目的探讨胼胝体梗死的临床表现、病因及鉴别诊断特点。方法对2005年7月收治的1例53岁男性胼胝体梗死患者的临床表现、影像学特点、病因机制及其治疗过程进行回顾分析。结果临床主要表现为发作性黑蒙、言语不利,既往有高血压、糖尿病、脑梗死、吸烟、饮酒史,体格检查以失用为主要表现。头部MRI检查可见左侧脑室旁、胼胝体梗死,右侧基底节、脑桥陈旧性腔隙性梗死;脑血管造影检查显示为多发性血管狭窄,其中以左侧大脑中动脉、右侧颈内动脉及基底动脉最为严重。经颈内动脉内膜剥离术及颈内动脉支架植入术治疗,临床症状缓解。结论失用可以是胼胝体梗死的主要表现,其病因是在脑动脉粥样硬化基础上的血流动力学改变,患者预后良好。     

Crossed aphasia following an infarction in the right corpus callosum

A 68-year-old right-handed woman with no history of brain damage or familial left-handedness was admitted to our hospital due to the acute onset of speech difficulty; her speech was nonfluent. Literal and phonological paraphasias, agrammatism and paragrammatism were observed. Brain MRI revealed an acute infarction in the right anterior cerebral artery territory, involving the right corpus callosum. Moreover, cerebral blood flow was decreased not only in the area of the right corpus callosum but also in the left fronto-temporal lobe, suggesting crossed diaschisis. This is a rare case of crossed aphasia following an infarction in the right corpus callosum.     

胼胝体动静脉畸形的血管内治疗的疗效分析

目的探讨胼胝体动静脉畸形的临床、影像学特点及血管内治疗的临床疗效。方法回顾性分析2017年12月至2020年12月接受血管内治疗的6例胼胝体动静脉畸形的临床资料。结果6例均有脑室出血,伴蛛网膜下腔出血2例,伴胼胝体血肿3例。Spetzler-Martin分级Ⅰ级1例,Ⅱ 级3例,Ⅲ级2例。1例仅由胼周动脉供血,5例合并存在胼周动脉及大脑后动脉分支供血;6例均向大脑内静脉的深部引流,其中1例合并存在上矢状窦引流。术后即刻造影显示大部分栓塞3例,完全栓塞3例。围手术期未发生颅内出血,1例出现拔管困难而体内留管,1例因脑积水行脑室-腹腔分流,2例术后出现短时记忆下降。DSA随访71~292 d,平均（178.3±76.15）d;1例畸形复发,行立体定向放疗;1例畸形团少量残留,复查造影显示畸形团无进展;其余4例畸形团均消失。出院后半年,6例改良Rankin量表评分0~1分。结论胼胝体动静脉畸形临床少见,但出血风险较高,因此需要积极干预。由于胼胝体的特殊解剖位置,血管内治疗具有良好的适应证。术前充分评估并选择合适的栓塞方案是一种非常安全和有效的治疗手段。     

经胼胝体-穹隆间入路的显微解剖学研究

目的为经胼胝体-穹隆间入路的临床应用提供显微解剖学资料,以利于术中重要血管、神经结构的辨认和保护。方法模拟经胼胝体-穹隆间入路,对15例国人成人头颅湿标本进行显微解剖,详细观察与本入路相关的重要解剖结构,并进行测量和拍照。结果在胼胝体中部两侧纵纹之间的沟槽内有一标志中线的细小动脉;以分别位于大脑半球内侧面中央沟上端之前5cm和7cm的两点(P5/P7)为参照,得到的相关测量值的均数如下:(1)P5/P7至扣带沟的距离分别为29.26mm、30.43mm;(2)胼胝体下缘和穹隆间的距离分别为7.53mm、9.88mm;(3)胼胝体的高度分别为7.18mm、7.78mm;(4)前连合和室间孔的距离为5.04mm。结论经胼胝体入路应限定在P5-室间孔和P7-室间孔两连线之间的范围内;胼胝体中部两侧纵纹之间沟槽内的小动脉可作为切开胼胝体的标记;熟悉上述数据资料有助于术中保护运动区、胼胝体膝、穹隆连合、前连合。     

Pure alexia caused by separate lesions of the splenium and optic radiation

Pure alexia is severe difficulty in reading and understanding written language but with normal oral language and writing abilities. We report a patient with pure alexia caused by two different infarct lesions in the left lateral thalamus and the left splenium of the corpus callosum. A 56-year-old right-handed man was admitted to hospital with right homonymous hemianopia associated with pure alexia. He could write kana characters but not kanji. His cranial magnetic resonance imaging revealed two different infarct lesions in the left optic radiation and the left splenium of the corpus callosum. Magnetic resonance angiography showed mild stenosis at the origin of the right vertebral artery and stenosis of the left distal posterior cerebral artery. The mechanism of developing pure alexia can be simply explained by disconnection. We assumed that agraphia of kanji was caused by the effect of ischemia and edema following transient obstruction in branches from the distal posterior cerebral artery.     

A case of agenesis of the corpus callosum accompanied by a ruptured azygos anterior cerebral artery aneurysm and lipoma--a case report

A 53-year-old woman suffered from sudden onset of severe headache on February 28 in 1982. She was admitted to our hospital soon after onset. On admission, she had a severe headache and nausea, and her consciousness was drowsy. CT scan showed a marked subarachnoid hemorrhage with intracerebral and intraventricular hematoma, a separation of the lateral ventricles with enlargement of posterior horns, and deformity of anterior horn. By these findings, the patient was diagnosed as an agenesis of the corpus callosum with subarachnoid hemorrhage. Left carotid arteriogram revealed an azygos anterior cerebral artery and an aneurysm at the terminal portion of this artery. Surgery was performed on the 24 th day after subarachnoid hemorrhage. Operative finding revealed a little finger's head-sized tumor was situated over the right frontobasal artery. An azygos anterior cerebral artery aneurysm was clipped and tumor was removed. Pathological diagnosis of the tumor was a lipoma. Namely, she had an agenesis of the corpus callosum, an azygos anterior cerebral artery, an aneurysm and a lipoma. There are some reports in which an agenesis of the corpus callosum is accompanied with a lipoma and an azygos anterior cerebral artery is accompanied with an aneurysm. But a case of agenesis of the corpus callosum with an azygos anterior cerebral artery was rarely reported. So this rare case with these anomalies was reported and pathogenesis about the development of 4 anomalies was also discussed.     

Alexia without agraphia associated with spleniogeniculate infarction

Pure alexia, following an infarction in the distribution of the left posterior cerebral artery, is attributed to damage of the left occipital lobe and the splenium of the corpus callosum. We describe a case of pure alexia in a 57-year-old woman with infarction of the left lateral geniculate body and the splenium of the corpus callosum, a variation on this classic disconnection syndrome.     

Meta-analysis of corpus callosum size in schizophrenia.

Studies with MRI have shown differences in corpus callosum size between schizophrenic patients and controls. Most have found that the corpus callosum is smaller in schizophrenic patients, but in only a minority was this finding statistically significant, perhaps due to small sample sizes. Therefore a meta-analysis of 11 published studies of corpus callosum morphology in schizophrenia was conducted to ascertain whether there was a significant difference in corpus callosum size between schizophrenic patients and normal controls. These studies combined comprised 313 patients and 281 controls. Measures of corpus callosum midsagittal area, length, and corpus callosum area:brain area ratio were used in the meta-analysis. There was overall a statistically significant reduction in corpus callosum area in schizophrenic patients compared with controls (P < 0.02). Differences between patients and controls in measures of corpus callosum: brain area and corpus callosum length were not statistically significant. Age and corpus callosum area were related in both patients and controls. The influences on the corpus callosum of overall alterations of brain size, sex, handedness, and psychiatric illness in general remains to be determined.