The third ventricle in hydrocephalus due to basal cistern block

One hundred and two cases of hydrocephalus due to basal cistern block were studied by ventriculography and encephalography. The third ventricle shows anterior displacement and there are varying degrees of impression upon the infundibular recess produced by a dilated inter-peduncular cistern. The block in the basal cisterns may occur at any level between the exit foramina of the fourth ventricle and the level of the tentorium. Loculation of cerebrospinal fluid in a basal cistern is seen with moderate frequency. —The cerebrospinal fluid protein levels in basal cistern block, which were usually moderately or markedly elevated, did not distinguish these cases from those with aqueduct stenosis. Nearly 20 per cent of the basal cistern block cases also had aqueduct stenosis. — The aetiology of the block in the basal cisterns is usually either haemorrhage (due to anoxia or trauma) or infection. Either of these causes the formation of obstructive adhesions in the subarachnoid space.     

Transtentorial herniation of the fourth ventricle

Transtentorial herniation (TTH) of the fourth ventricle is the result of a progressive enlargement of an isolated fourth ventricle which herniates through the tentorial incisure into the middle cranial fossa. The characteristic CT-MR and neurosonographic findings are described.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

Spectrum of hearts with one underdeveloped and one dominant ventricle

Summary Hearts with one underdeveloped and one dominant ventricle form a spectrum of anomalies extending from the heart with two clearly adequate chambers to those with a true single ventricle. An angiographic concept of grouping such hearts is presented. 129 patients with unequal ventricles underwent catheterization and cineangiography between 1974 and 1983. The age at first catheterization ranged from one day to 24 years (mean 3.9 years). Male-female ratio was 2:1. Five groups of hearts (with their relative frequencies in the spectrum) were established: (1) dominant left ventricle (53%); (2) dominant right ventricle (20%), each with normally related chambers; (3) dominant left ventricle (20%); (4) dominant right ventricle (3%), each with ventricular inversion; (5) true single ventricle (5%). The incidence of atrial anatomy, venous return, intracardiac connections and associated lesions within each group was assessed. From the standpoint of deranged physiology as well as surgical implications there are more similarities than differences among these hearts. The fact that one ventricle will not generate an adequate stroke volume after repair is overwhelmingly more important than most other considerations. For the diagnostic and surgical approach, we believe that the system offers many advantages.     

心室双入口的外科治疗

目的 总结分析阜外心血管病医院近10年心室双入口外科治疗的经验。方法 选择1996～2005年阜外心血管病医院手术治疗的137例心室双入口患儿。其中左心室型84例，右心室型39例，未定型14例。分别行手术163例次：主要包括全腔静脉肺动脉吻合术47例，Fontan手术2例。双向Glenn术80例，体肺分流术13例，肺动脉环缩窄9例。有22例患儿行47例次手术，其中Ⅰ期减状手术，Ⅱ期行全腔静脉肺动脉吻合术15例。结果 术后早期死亡11例，病死率8．0％。并发症15例，发生率10．9％。存活126例均顺利出院，动脉血氧饱和度由术前平均69．2％上升至91．9％，症状缓解，心功能改善。结论 心室双入口心内畸形复杂，很难行解剖矫治手术。应根据肺血管病理生理情况，选择合适的姑息手术或生理性矫治手术，把握手术时机。妥善矫治心脏畸形和良好的围术期处理是提高心室双入口外科治疗效果的关键。     

新生儿单心室伴永存动脉干1例

1 病史患儿,男,6 d,因“少吃、少动2 d,呻吟1 d”入院。母亲系G1P1,患儿胎龄38 6周,于2005年8月30日剖宫产分娩,Apgar评分1 min内8-9分,5 min内10分,脐带绕颈1 周,羊水、胎盘无异常,无窒息抢救史,出生体重3 100 g。母亲在孕早期曾有病毒感染,口服阿莫西林胶囊1-2粒。父母非近亲婚配,无家族遗传性疾病史。入院查体:反应     

Atrioventricular septal defect: Quantitative anatomy of the right ventricle

Summary In 19 human fetal and newborn hearts with atrioventricular septal defect (AVSD), not associated with other anomalies, the two ventricles were studied morphometrically. A total of 17 different parameters were studied: nine in the right ventricle and eight in the left. In the right ventricle we analyzed ventricular wall thickness, length of right ventricular inflow and outflow tracts, and volume of right ventricular inflow and outflow tracts. The data for these parameters were compared with the patterns of normality published previously, and the volumetric data were compared with patterns of normality published previously by us. The ventricular inflow tract was shorter than the outflow tract, the difference being especially significant in the left ventricle. The length of the diaphragmatic wall of the heart in both the right and left ventricle was equal to the sum of the length of the inflow tract and the thickness of the ventricular wall at the apex.     

Atrioventricular septal defect: Quantitative anatomy of the left ventricle

A morphometric study was performed in 18 human hearts with atrioventricular septal defect not associated with other anomalies; 16 hearts had common atrioventricular orifices, and 2 presented separate right and left atrioventricular orifices. A total of eight parameters were analyzed, characterizing ventricular wall thickness, length and circumference of the inflow and outflow tracts, and circumference of the left orifice and aortic orifice. The data were compared with previously published patterns of normality. In addition, the volume of the aortic outflow tract was calculated. The inflow tract was shorter than the outflow tract, and the length of the diaphragmatic wall was equal to the sum of the lengths of the inflow tract and ventricular wall thickness at the level of the apex     

小脑延髓裂入路手术切除儿童第四脑室肿瘤

目的探讨经小脑延髓裂入路（ transcerebeliomedullochoroidal fissure, TCMCF）手术切除儿童第四脑室肿瘤的临床疗效。方法2004年11月至2010年11月,河南省开封市陇海（脑科）医院神经外科采用枕下正中切口,经小脑延髓裂入路,应用显微外科技术对20例第四脑室肿瘤患儿进行手术治疗。结果20例中,手术完全切除17例,次全切除3例;术后病理检查提示髓母细胞瘤12例,室管膜瘤6例,脉络丛乳头状瘤1例,星形细胞瘤1例。结论经小脑延髓裂入路,不需切开小脑蚓部,可避免损伤正常小脑组织,暴露范围广,有助于彻底切除第四脑室肿瘤,提高手术疗效。     

经小脑延髓裂入路显微手术治疗儿童第四脑室肿瘤

目的 探讨经小脑延髓裂(CMF)人路显微手术治疗儿童第四脑室肿瘤的方法,提高手术治疗效果.方法 对17例2～14岁原发第四脑室肿瘤患儿,采用枕下正中切口、横窦下颅骨开窗骨瓣成形及经小脑延髓裂入路显微切除肿瘤,其中广泛型CMF切开12例,外侧壁型切开3例,外侧隐窝切开2例;硬脑膜严密缝合或修补,骨瓣复位并固定.结果 肿瘤全切除15例,次全切除2例,病理结果髓母细胞瘤9例,室管膜瘤5例,星形细胞瘤3例,无围手术期死亡发生.术后15例患儿症状体征均明显改善或消失,无新发共济失调、震颤、肌张力降低及脑积水、小脑缄默综合征等并发症.复发2例,均为髓母细胞瘤,2年后死亡1例.结论 经小脑延髓裂人路能较好地显露儿童第四脑室肿瘤,可减少因切开小脑蚓部和向侧方牵拉损伤小脑所导致的并发症发生.     

Left ventricle dimensions in preterm infants during the first month of life

This study was designed to evaluate left ventricle dimensions in preterm infants during the first month of life, in order to define reference values and their correlation with gestational age, birth weight, gender and baseline. Thirty-five infants, gestational age 25–29 (mean 27.9 ± 1.4) weeks, birth weight 750–1249 (mean 965 ± 206) g, were measured using echocardiography on days 3, 7, 14, 21 and 28 of life. The following dimensions were measured: end-systolic and end-diastolic interventricular septum thickness, end-systolic and end-diastolic left ventricle posterior wall thickness, end-diastolic and end-systolic left ventricle diameter. A progressive and significant increase of all the left ventricle measurements was observed during the first month of life. Left ventricle dimensions at the first scan (Day 3) correlated with birth weight but not with gestational age and gender. The degree of the increase observed during the first month of life was inversely related to the baseline, suggesting that the smaller the left ventricle is at birth, the higher is its postnatal increase toward dimensions similar to those of term infants. Our study gives reference data about left ventricle dimensions of preterm infants during the first month of life and is helpful when making a diagnosis of left ventricular hypertrophy in these subjects. Received: 23 March 2000 / Accepted: 11 October 2000     

功能性单心室的外科治疗及近期疗效

目的 总结功能性单心室的外科治疗经验.方法 回顾性分析我科2003年12月至2010年7月59例功能性单心室患儿,对其手术时机,手术方式及手术效果进行分析,并用Logistic回归分析Glenn手术的高危因素.结果 死亡8例(病死率13.56%),其中4例为Glenn术后死于低心排和多器官功能衰竭,2例为Banding术后死于低心排,1例为TCPC术后死于多器官功能衰竭,1例为B-T分流术后死于低心排.Glenn术后的主要并发症为上腔静脉梗阻综合症和低心排,Fontan术后的主要并发症是房性心律失常和胸腔积液.Logistic回归分析得出房室瓣反流是Glenn术后患儿死亡的高危因素.结论 功能性单心室心内畸形复杂,需根据肺血流的情况及早进行姑息手术,选择合适的术式.改良Fontan是进行生理矫正的理想术式,保留肺动脉前向血流的Glenn手术是保证患儿顺利进行Fontan术的有效方法,但需根据肺动脉狭窄的程度进行处理,避免上腔静脉综合症的发生.

Abstract：

Objective To retrospectively analyze the outcome of surgical treatment of patients with functional single ventricle. Methods Betveen December 2003 and July 2010, 59 patients with functional single ventricle underwent corrective surgeries, and were followed up at this center. Their median age was 3. 0 months old at pulmonary artery band surgery (PAB), 13. 5 months at bidirectional Glenn procedure (BDG), and 11 years old at Fontan operation. The variables of the anatomical lesions with single ventricle physiology, combined abnormalities, age at surgery, and type of the surgical procedure were retrospectively analyzed. Logistic regression analysis was also performed to determine the risk factors associated with Glenn. Results Duration of mechanical ventilation was 30. 4 ± 19. 7 hours. Length of stay in ICU was 4. 3 ± 1.6 days. Length of hospital stay was 34. 8 ± 15. 9 d.SpC2 increased from 75 ± 6. 97% to 88 ± 6. 28% after operation. Exercise tolerance was also improved remarkably. Eight deaths were noted after surgery (13. 56%). The leading complications after Glenn surgery were superior vena cava syndrome and low cardiac output syndrome. Complications after Fontan surgery were atrial tachycardia and pleural effusions. Logistic regression analysis suggested atrioventricular valve regurgitation was an important risk factor for the death of the patients had Glenn surgery. Conclusions The clinical outcome of surgical treatment of patients with functional single ventricle is satisfied. The surgical strategy should be made according to anatomic abnormality of the functional single ventricle and pulmonary circulation. Modified Fontan operations can become an alternative therapy for patients who are not suitable for double ventricle correction. Glenn with antegrade pulmonary blood flow may be a temporary palliation prior to Fontan surgery, but the pulmonary blood flow should be controlled to avoid the occurrence of superior vena cava syndrome.     

按STS-EACTS数据库分类的右室双出口手术方法和结果分析

目的 上海儿童医学中心心胸外科数据库采用STS-EACTS数据库颁布的右室双出口（DORV）命名和分类方案后（以下简称为“新方案”），报道该中心外科治疗DORV的新进展。方法 2000年5月-2006年5月302例DORV患儿接受手术治疗，根据“新方案”将研究对象分4组，A组：79例，DORV为VSD型；B组：133例，DORV为四联症型；C组：34例，DORV为TGA型；D组：56例，DORV为VSD远离大动脉型。分析“新方案”与DORV手术方法和手术病死率的相关性。结果 总病死率7．9％（24／302）。A组和B组的病死率分别为1．3％（1／79）和4．5％（6／133），低于C组（23．5％，8／34）和D组（16．1％，9／56），DORV的新分类方案与住院病死率和手术方法选择有显著的相关性。结论 “新方案”有利于数据库对临床资料的搜集和整理，根据“新方案”选择优化的手术方法，可以提高DORV外科疗效。     

神经生长因子脑室内注射对脑积水幼鼠的行为改变的影响

目的 研究神经生长因子脑室内注射对脑积水幼鼠的行为改变的影响。方法 雄性Wistar 1月龄大鼠30只,全部采用枕大池注射白陶土的方法制备交通性脑积水的模型,1个月后行MRI证实。模型制备后将脑积水幼鼠随机分成3组,每组10只,实验组脑室内注入神经生长因子(NGF)0.3 ml(1000 U,连续3 d),安慰组脑室内注入生理盐水0.3ml（连续3 d）,对照组不做任何处理。2周后对3组幼鼠分别进行Morris水迷宫和旷场分析进行研究,实验后处死脑积水幼鼠,常规HE染色及免疫组织化学检测海马区结构变化及GFAP与S-100β的表达。结果 安慰组和对照组脑积水幼鼠游泳所用时间(108.1±31.2,110.2±28.7)及错误次数(4.8±1.4,4.7±1.5)均多于实验组(82.1±21.3,3.3±1.3),空间认知能力及新环境适应性低于实验组。各组脑积水幼鼠海马区均有GFAP的阳性表达,实验组122.53±13.50与安慰组224.68±8.65及对照组256.80±10.22间差异有统计学意义。各组脑积水幼鼠海马区均可见S-100β阳性细胞存在,安慰组及对照组海马区可见大量阳性细胞染色,与实验组比较差异有显著统计学意义。结论 安慰组和对照组脑积水幼鼠学习记忆能力、空间认知能力及兴奋性均低于实验组,表明神经生长因子脑室内注射对脑积水后脑损伤有一定的脑保护作用。     

Assessment of variables affecting flow propagation velocity of the left ventricle in healthy children

BACKGROUND: The purpose of the present study was to establish the normal values of flow propagation velocity (FPV) in healthy children and examine the variables that affect FPV in clinical situations. METHODS: Two hundred and thirty- five healthy children and adolescents were assessed (aged 0-22.6 years, mean age 7.4 +/- 5.4 years; male, n = 142; female, n = 93). FPV was obtained from an apical four-chamber view and determined as the slope of aliasing velocity of early diastolic transmitral flow on the color M-mode using Aloka SSD-5500 with 5.0 MHz transducer. Aliasing velocity was set at 50-70% of the peak transmitral flow velocity. Peak transmitral flow velocities in early diastole (E) and during atrial contraction (A), and the ratio of early to late peak velocity (E/A) were obtained. Tei index was also measured for analysis of general left ventricular performance. Left ventricular mass index (LVMI) was obtained from conventional echo measurement. E, E/A, Tei index and LVMI were compared with FPV in healthy subjects. RESULTS: FPV obtained from all subjects ranged from 23.7 to 96.0 cm/s (61.3 +/- 13.6 cm/s). Normal value of FPV was less dependent on age, body size, heart rate and left ventricular dimension. In contrast, although there was no significant correlation between FPV and ejection fraction, statistically significant correlation was found between FPV, LVMI (P = 0.0008) and Tei index (P = 0.025). CONCLUSIONS: FPV is independent of age, body size and heart rate and is useful to assess left ventricular relaxation in children.     

Pulmonary vascular changes associated with hypoplastic left ventricle syndrome

Summary The lungs of ten newborn infants who died of hypoplastic left ventricle syndrome were studied by a morphometric technique that (1) determined the percentage wall thickness of injected pulmonary arteries, (2) determined the ratio between the number of alveoli per high-power field and the number of corresponding arteries, and (3) examined in detail the extension of medial smooth muscle to the vessels at the periphery of the acinus. The findings in the lung were related to the gross cardiac morphological changes and to echocardiographic and hemodynamic findings. The echocardiograms of eight neonates demonstrated small left ventricles. The aortic root was hypoplastic in seven and the left atrium was small in three of the eight. Pulmonary artery hypertension and elevation of the left atrial pressure were present in all infants in whom measurements were obtained. The mean percentage wall thickness of all vessels was greater in afflicted infants than in normal age-matched control subjects. There was a normal ratio between the number of alveoli per high-power field and the number of corresponding arteries, and all infants had extension of muscle to the peripheral vessels at the alveolar duct and alveolar wall levels. The pulmonary vascular abnormalities observed in the neonate with hypoplastic left ventricle syndrome may represent persistence of fetal vascular abnormalities associated with the abnormal fetal circulatory hemodynamics resulting from the malformation. These abnormalities may influence the success of surgery proposed for hypoplastic left ventricle syndrome. Supported in part by a grant from the Michigan Heart Association This material was presented in part to the American College of Cardiology Annual Scientific Session, March 1979     

Unguarded tricuspid orifice with two-chambered right ventricle

Summary Catheterization and anatomical data are presented of an infant with cyanosis due to a most unusual variant of unguarded tricuspid valve orifice in association with a two-chambered right ventricle. The inlet portion of the right ventricle ended blindly and was completely separated from the outlet portion by a muscular wall. The outlet chamber, which supported the pulmonary trunk, received its blood from the left ventricle through an outlet foramen. The condition is considered to be related to imperforate Ebstein's anomaly.