经颅彩色编码超声及经颅超声造影观察颅内静脉窦血栓

目的探讨经颅彩色编码超声(TCCS)及经颅超声造影(CE-TCCS)诊断颅内静脉窦血栓(CVST)及大脑大静脉、基底静脉的血流动力学变化的价值。方法选取经DSA和/或MR静脉血管成像(MRV)确诊为颅内横窦和/或直窦血栓的22例患者为CVST组,行TCCS及CE-TCCS;以同期因其他疾病就诊的68例患者为对照组,行TCCS;对比观察2组大脑大静脉、基底静脉及静脉窦的显示率和血流动力学变化。结果 CVST组中,TCCS诊断直窦血栓13例,左侧横窦血栓20例,右侧横窦血栓17例,与DSA和/或MRV结果比较差异有统计学意义(P均0.05);经CE-TCCS判定直窦血栓5例,左侧横窦血栓14例,右侧横窦血栓9例,与DSA和/或MRV结果比较差异均无统计学意义(P均0.05)。CVST组较对照组大脑大静脉、双侧基底静脉显示率及峰值血流速度均增高(P均0.05)。结论 CE-TCCS诊断CVST与DSA和/或MRV相似。TCCS可显示静脉窦血栓形成后的大脑大静脉、基底静脉;静脉流速升高可提示CVST形成可能。     

产后脑静脉窦血栓形成的临床分析与MRI和MRV的诊断价值(附3例报告)

目的:讨论磁共振成像( MRI)和磁共振静脉成像(MRV)对产后脑静脉窦血栓形成的诊断价值;方法:3例临床报告均有MRISE序列平扫及TOF法MRV.急性期(＜1周)脑静脉窦血栓形成1例;亚急性期(1-2周)1例;慢性期(＞2周)1例;结果:3例脑静脉窦血栓均由MRISE序列平扫及TOF法MRV确诊.结论:对于有妊娠和分娩史,不明原因出现颅内压增高、局限性神经症状、突然意识障碍的患者,须行头颅MRI及MRV检查,头颅MRI及MRV对脑静脉窦血栓形成提供早期诊断价值.     

二维时间飞跃法MR静脉成像与三维对比增强成像在评估脑膜瘤侵犯静脉窦中的应用

目的比较二维时间飞跃法MR静脉成像(Two-dimension time of flight MRV,2D TOF-MRV)与三维对比增强MR静脉血管成像(Three-dimension contrast enhancement MRV,3D CE-MRV)在评估静脉窦旁脑膜瘤侵犯静脉窦的部位和程度的显示能力。方法 14例静脉窦旁脑膜瘤患者,行2D TOF-MRV与3D CE-MRV检查,对两组影像数据应用最大密度投影(MIP)与多平面重组(MPR),对静脉窦的改变进行观察比较,并与手术结果或/和DSA影像资料对比。结果 6例病例2D TOF-MRV,3D CE-MRV与DSA、手术资料相一致;3例病例2D TOF-MRV静脉窦信号缺失,管腔缺如,难以作出诊断,3D CE-MRV显示良好,与DSA,手术资料相一致;5例3D CE-MRV与DSA,手术资料一致的病例,2D TOF-MRV显示有一定的误差。结论 3D CE-MRV能同时显示静脉窦与瘤体,明确肿瘤与静脉窦的关系,在评估静脉窦旁脑膜瘤侵犯静脉窦方面比2D TOF-MRV有明显的优势,对手术方案的制定及预防手术并发症有重要的意义。     

硬脑膜静脉窦血栓诊治分析

目的观察经静脉窦机械碎栓、尿激酶局部血管内溶栓治疗颅内静脉窦血栓形成的疗效。方法回顾性分析比较全身肝素化常规治疗方法治疗10例患者,与血管内治疗方法即经静脉窦机械碎栓、尿激酶局部血管内溶栓的方法治疗14例硬脑膜静脉窦血栓患者的治疗效果。结果血管内治疗组平均住院16天,其中11例痊愈（颅内压转正常、无神经功能障碍）,3例好转（颅内压仍高,但较前有降低）;全身肝素化常规治疗组平均住院28天,5例临床症状改善,3例无变化,1例加重后转本院行血管内溶栓,死亡2例。结论经静脉窦机械碎栓、尿激酶局部血管内溶栓治疗颅内静脉窦血栓形成临床疗效确切、安全可靠。     

Galen静脉动脉瘤样畸形血管影像学分类和治疗

Ｇａｌｅｎ静脉动脉瘤样畸形是一种少见的颅内血管畸形，由于位置深在，治疗较为困难。作者收治１１例该类畸形，其中５例为先天性Ｇａｌｅｎ静脉动脉瘤样畸形（ＶＧＡＭ），治疗主要是闭塞瘘口；继发性Ｇａｌｅｎ静脉动脉瘤样扩张（ＶＧＡＤ）５例，其治疗主要是栓塞脑实质或硬膜的畸形血管来达到治愈或改善临床症状；另１例依据ＭＲＩ进行诊断，未作造影及分类。本组有８例行血管内治疗，其中５例治愈，３例临床症状好转；有２例发生自发血栓，未治疗。作者对Ｇａｌｅｎ静脉动脉瘤样畸形的概念、分类及影像学特点，特别是血管内治疗方法和注意事项进行了讨论。     

CTA术前评估颅内窦旁脑膜瘤

目的探讨320层CTA术前评估颅内窦旁脑膜瘤的价值。方法回顾性分析经手术病理证实的36例颅内窦旁脑膜瘤患者的CT资料,所有患者术前均接受320层CTA,扫描后数据后处理方法为MPR、VR、MIP,观察及评估肿瘤与周围血管及静脉窦的关系,并与术中所见比较,分析CTA术前诊断与术中所见是否一致。结果 36例中,肿瘤位于上矢状窦旁25例,下矢状窦旁2例,横窦旁4例,直窦旁5例;CT静脉成像(CTV)示13例静脉窦正常,未受肿瘤侵犯,与术中所见一致;CTV示23例静脉窦不同程度受肿瘤侵犯,其中Ⅰ型6例,Ⅱ型10例,Ⅲ型7例,而术中示22例静脉窦受侵,1例未受侵,CTV与术前诊断符合率为97.22%(35/36)。36例中CTA均可以清楚显示脑膜瘤的供血血管,其中颈外动脉供血26例(脑膜中动脉、颞浅动脉、枕后动脉),颈外、颈内动脉共同供血6例,颈内动脉供血4例,CTA结果与术中所见一致。结论 320层CTA能清楚显示颅内窦旁脑膜瘤与供血动脉及静脉窦的关系,对临床选择最佳手术入路、确定肿瘤切除范围和处理周围血管有重要的意义。     

脑动静脉畸形导致出血的多层螺旋CT血管造影的相关因素分析

目的 探讨多层螺旋CT血管成像(MSCTA)显示脑动静脉畸形(AVM)合并出血的影像学相关因素.方法 通过比较脑AVM出血组和未出血组之间MSCTA所显示的供血动脉、畸形血管团、引流静脉特点.结果 脑出血组与未出血组两组间MSCTA所显示得畸形血管团部位、大小、引流静脉条数、引流静脉是否受损以及有无合并动脉瘤比率差异有统计学意义.结论 MSCTA提示导致AVM的血管压力增高的深部位、小病灶、单支引流静脉或引流静脉狭窄、闭塞以及合并动脉瘤是脑AVM合并出血的密切相关因素.MSCTA为临床治疗提供依据和借鉴.     

脑动静脉畸形导致出血的影像学相关因素分析

目的探讨多层螺旋CT血管成像（MSCTA）显示脑动静脉畸形（AVM）合并出血的影像学相关因素。方法通过比较脑AVM出血组和未出血组之间MSCTA所显示的供血动脉、畸形血管团、引流静脉特点。结果脑出血组与未出血组两组间MSCTA所显示得畸形血管团部位、大小、引流静脉条数、引流静脉是否受损以及有无合并动脉瘤比率差异有统计学意义。结论 MSCTA提示导致AVM的血管压力增高的深部位、小病灶、单支引流静脉或引流静脉狭窄、闭塞以及合并动脉瘤是脑AVM合并出血的密切相关因素。MSCTA为临床治疗提供依据和借鉴。     

经血管内溶栓和支架成形治疗脑静脉窦闭塞

目的：介绍应用静脉窦内直接溶栓和支架成形治疗脑静脉窦闭塞的初步经验。方法：17例患者均经DSA证实为静脉窦内血栓形成。单一部位血栓3例,多发性血栓14例;脑动静脉循环时间均延长至13s以上。所有患者先采用血管内直接溶栓治疗,先在静脉窦内留置微导管5d,同时局部输入尿激酶150万U/d,并口服华法令3-5mg。其中4例经复查造影见静脉窦仍狭窄明显,再置放Smart支架进行窦内成形。结果：17例患者经静脉窦内接触性溶栓、支架成形术后静脉窦完全再通9例,部分再通8例。治疗后7例颅内压恢复正常,8例于术后7d内再次有不同程度的颅内压升高,经扶持抗凝后使颅内压恢复正常,仅2例颅内压高于280mmH2O。术后对患者随访3个月-5年,15例症状持续缓解。结论：对静脉窦血栓采用持续溶栓和支架成形可直接促进脑静脉血液因流,从而降低颅内压。     

低剂量对比剂联合生理盐水在MSCT双期脑血管成像中的应用

目的探讨低剂量对比剂加生理盐水冲洗对MSCT双期脑血管成像图像质量的影响。方法60例受试者平均分为两组：A组：低剂量对比剂＋生理盐水;B组：76ml对比剂。以Test-Bolus确定脑动、静脉期延迟扫描时间,对两组受试者行MSCT双期扫描,比较CT动脉成像（CTA）、CT静脉成像（CTV）图像质量差异。结果Test-Bolus测试血管循环时间组间差异无统计学意义,CTA脑动脉分支显示及静脉干扰评分、动脉最大强化均值、动静脉最大强化差值的组间差异均无统计学意义。CTV脑静脉窦最大强化均值的差异不显著,B组均匀性优于A组（P〈0.001）,深浅静脉最大强化均值大于A组（P=0.02）。静脉显示评分差异无统计学意义。A组静脉窦、深浅静脉与动脉最大强化差值均大于B组（P〈0.001,P〈0.001）,CTV期动脉强化干扰程度低于B组（P〈0.001）。结论低剂量对比剂加生理盐水冲洗不影响脑CT血管图像质量,同时能显著降低CT静脉成像期的动脉干扰,不影响脑静脉清晰显示。     

自体颅骨粉一期修复颅骨缺损的临床应用

目的探讨用自体颅骨骨粉一期修复颅骨缺损的临床应用. 方法 1999年10月～2002年12月,采用自体颅骨骨粉加医用黏合剂原位黏合,对128例重型颅脑损伤、急性颅内血肿、颅骨肿瘤及脑肿瘤并颅骨侵犯开颅术后行一期再植成形术,术后随访3～24个月,通过CT或X线片观察骨质生长情况. 结果一次完成减压及成形术,时间较常规手术延长5～l0分钟,修复颅骨外观正常,无凹陷、突出,术后12个月再植骨与正常颅骨完全融合,类似正常颅骨形态.再植修复成功123例,占96.1%,5例因骨粉量少成形欠佳,但未见脑搏动和缺损综合征,均不需二期修补. 结论自体颅骨骨粉加医用黏合剂一期颅骨再植成形术,能够有效避免传统的二期颅骨缺损修补术和并发症.     

Surgical experience of aged patients with ruptured intracranial aneurysms (author's transl)]

Outcome of 77 cases with ruptured intracranial aneurysms above 60 years of age was reported. 44 cases were treated conservatively and 33 cases surgically. 1. Among conservatively treated group, 10 cases died after initial hemorrhage and 14 cases after second hemorrhage. The mortality rate was 55%. 2. Among surgically treated group, 11 cases died and 4 cases had severe neurological deficits following the direct intracranial operation. The mortality and morbidity rate was 33% and 12% respectively. 3. These results indicate that the direct intracranial operation should be the first choice of treatment to the aged patients also. 4. Intracranial complications occured more frequently than the extracranial one during intra and postoperative course. Among them normal pressure hydrocephalus was the comonnest. 5. Occlusion of the main cerebral artery occured in 5 cases related to operative procedure. Outcome of 4 cases of them was poor. Microsurgical technique should be used in order to prevent these conditions which tend to occur in aged patients.     

Clinical evaluation on glucocorticoid administration in neurosurgical patients (author's transl)

Anterior pituitary function tests (ITT, TRH test and LH-RH test) were performed on 10 patients with intracranial lesions other than hypothalamo-pituitary tumors. These lesions were 8 brain tumors and 2 aneurysms. Relatively high doses of glucocorticoid were administered in pre- and post-operative period to all the cases. Preoperative study showed a slightly low response of GH and FSH in one case and a low TSH response in 2 cases. ACTH, LH and PRL were normal in all the cases. Postoperative study was performed about 10 days after ceasing of glucocorticoid. Postoperative data revealed that anterior pituitary function tests did not show any significant changes after surgeries in all the patients.     

水解微弹簧圈栓塞治疗颅内动脉瘤(附10例报告)

目的 探讨水解微弹簧圈（microplex coilsystem ＆ hydrocoil embolicsystem．MCS ＆ HES）栓塞治疗颅内动脉瘤的疗效。方法 10例颅内动脉瘤患者，均在静脉全麻下股动脉穿刺行全脑血管造影，采用MCS＆HES水解微弹簧圈栓塞治疗。结果 8例患者动脉瘤完全栓塞，90％栓塞2例，其中1例结合Neuroform支架栓塞，1例予球囊辅助。随访1～16个月，部分栓塞的1例复发。结论 水解微弹簧圈栓塞治疗颅内动脉瘤效果确切，手术安全，并发症少，复发率低。     

迟发性外伤性颅内血肿30例分析

目的总结迟发性外伤性颅内血肿(DTICH)的诊治经验。方法患者均头部CT检查,首次检查于伤后1～3 h。正常8例,脑挫裂伤伴血肿9例,硬膜下血肿6例,硬膜外血肿7例,颅内积气5例。复查头部CT发现血肿时间22例于伤后3～6 h,4例于伤后3～7 d,4例伤后7d以后发现。其中脑内血肿22例(额叶10例、颞叶12例),硬膜下血肿6例,硬膜外血肿2例。血肿与受力点关系,直接着力12例,对冲部位18例。迟发性颅内血肿指首次检查(CT扫描)未发现,经过一定时间后复查发现的血肿,或手术、尸检在原无血肿部位发现血肿。其产生的机理尚不清楚。结果 30例中14例有颅骨骨折及硬脑膜中动脉破裂,5例原发血肿,11例迟发性血肿发生在颅骨骨折部位。可能与血肿清除后填塞现象解除及骨折线渗血加速有关。结论对有颅骨骨折的颅内血肿患者,如血肿不在骨折线附近,或骨折线较长,原发血肿位于骨折线的一端,血肿清除后,颅内压仍高或脑膨出者,首先应排除远隔部位骨折线附近迟发血肿的可能。     

Long-term monitoring of intracranial pressure in hydrocephalic children not affected by cerebral tumor

Long-term epidural intracranial pressure (ICP) recordings were performed in 10 hydrocephalic children, not affected by cerebral tumor. The work concerns the identification of A and B Lundberg's waves during normal sleep in the ICP pattern. Plateau-waves of high amplitude and long duration were measured in one patient. A base-line pressure higher than normal was found in the other cases in which waves during sleep were seldom revealed. Five children were monitored by studying the pressure pattern after shunt surgery. The Authors discuss the implication of the rarity of plateau-waves in infancy and the cause of this phenomenon.     

Cerebral metastases in childhood malignancies

Summary Between January 1982 to June 1994, 154 children with non-CNS malignant tumours excluding leukaemias and lymphomas were admitted and treated at the UKMC. Symptomatic (10 cases; 6.5%) and non-symptomatic (2 cases; 1.2%) cranial metastases (calvarial, durai and/or parenchymal) were seen in 12 (7.8%) cases. Among these 12 cases, 7 had intracranial parenchymal metastases (4.5%). Three cases had multiple intracranial parenchymal metastases. Only one case had infratentorial (cerebellar) metastasis. The patients' ages ranged from 1 to 18 years (mean age was 7.3 years). The male female ratio was 52. While six patients' brain metastases diagnosed during subsequent relapses, one patient first presented with brain metastasis. Time elapsed between the diagnosis of the primary disease and intracranial metastasis ranged from 0 to 755 days (mean 327 days). Histopathological diagnoses were confirmed in 4 cases who had craniotomy and tumour removal. Mean survival following the diagnosis of intracranial lesion was 157 days (ranged from 0 to 412 days). Despite the aggressive treatment, including surgery, chemotherapy and radiotherapy, 6 cases died with progression or relapse of the intracranial disease.In conclusion, the incidence of paediatric intracranial parenchymal metastasis is 4.5%. Prognosis is poor and intracranial disease is the primary cause of death.     

一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗体会

目的 探讨一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗方法.方法 回顾性分析13例急性颅内血肿术中继发对侧迟发性颅内血肿患者的临床资料,采用一次开颅清除双侧血肿.结果 术后按Glasgow(COS)评定预后,其中良好4例,中残4例,重残2例,植物生存1例,死亡2例.结论 采用一次开颅治疗一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的效果显著,可以提高患者的生存率和生活质量.     

颅内动脉瘤和颈内动脉海绵窦瘘的微弹簧圈栓塞治疗

采用介入放射学方法对6例颅内动脉瘤和14例颈内动脉海绵窦瘘进行了国产微弹簧圈的栓塞治疗。结果4例脑动脉瘤瘤腔栓塞90％,另2例瘤腔完全充填闭塞。14例CCF有12例栓塞满意,栓塞后一周杂音逐渐消失。2例行2次栓塞。本组结果提示微弹簧圈栓塞是颅内动脉瘤和颈内动脉海绵窦瘘的一个简单有效的方法,对其适应证和并发症的预防应当进一步探讨。     

一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗体会

目的 探讨一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗方法.方法 回顾性分析13例急性颅内血肿术中继发对侧迟发性颅内血肿患者的临床资料,采用一次开颅清除双侧血肿.结果 术后按Glasgow(COS)评定预后,其中良好4例,中残4例,重残2例,植物生存1例,死亡2例.结论 采用一次开颅治疗一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的效果显著,可以提高患者的生存率和生活质量.