维生素K依赖因子缺乏致颅内血肿的神经外科治疗

目的进一步探讨新生儿颅内出血外科的治疗和手术方法的选择及其治疗效果。方法对18例维生素K依赖因子缺乏颅内出血患儿临床资料进行回顾性分析。结果1例死亡外所有患儿在儿科诊断和治疗基础上施行微创手术,清除颅内血肿疗效显著,均治愈出院。结论微创手术清除婴儿颅内出血可减轻神经系统后遗症,降低婴儿期颅内出血的病死率。     

维生素K依赖因子缺乏致颅内血肿的神经外科治疗

目的 进一步探讨新生儿颅内出血外科的治疗和手术方法的选择及其治疗效果.方法 对18例维生素K依赖因子缺乏颅内出血患儿临床资料进行回顾性分析.结果 除1例死亡外,所有患儿在儿科诊断和治疗基础上施行微创手术,清除颅内血肿疗效显著,均治愈出院.结论 微创手术清除婴儿颅内出血可减轻神经系统后遗症,降低婴儿期颅内出血的病死率.     

颅内血肿穿刺治疗新生儿维生素K缺乏致颅内出血

目的观察颅内血肿穿刺抽吸治对新生儿维生素K缺乏致颅内出血的疗效。方法对2000年1月至2006年12月收治的2,6例维生素K缺乏致颅内出血的新生儿均行颅内血肿穿刺抽吸治疗，随访3—40个月，平均26个月，依据头颅CT征象及GOS评分标准评估疗效。结果24例术后2周复查头颅CT示颅内出血均消失，4例脑室稍大；2例术后第2天出现枕叶大面积缺血灶。除1例因先天性胆道闭锁放弃治疗外，25例随访24-40个月，按GOS评分，恢复良好23例，轻残1例，重残1例。结论颅内血肿穿刺抽吸对新生儿维生素K缺乏致颅内出血有很好的治疗效果。     

微创手术治疗婴儿晚发型维生素K缺乏致颅内出血

目的探讨微创手术治疗婴儿晚发性维生素K缺乏致颅内出血的疗效. 方法总结分析微创手术治疗25例婴儿晚发性维生素K缺乏致颅内出血的临床资料. 结果25例患儿均治愈,死亡率为0%,21例获得3月～9年随访,其中17例无任何神经系统后遗症,3例智力发育落后,1例癫痫.结论对婴儿维生素K缺乏致颅内血肿采取微创手术是一种非常有效的治疗手段.     

晚发性维生素K缺乏致颅内出血28例临床分析

目的 探讨晚发性维生素K缺乏致颅内出血病因.方法 对28例晚发性维生素K缺乏致颅内出血回顾性分析.结果 单纯母乳喂养25例(89.3%),混合喂养2例(7.1%),人工喂养1例(3.6%),病前腹泻16例(57.1%),合并婴儿肝炎综合征10例(35.7%),应用抗生素5例(17.8%),所有患儿出生后均未预防应用过维生素K制剂(100%).结论 单纯母乳喂养、病前腹泻、合并婴儿肝炎综合征、应用抗生素为常见病因.     

婴幼儿维生素K缺乏致颅内出血

由维生素K缺乏所致的婴儿颅内出血并非少见,作者2000年1月至2004年2月共收治15例患儿,现报告如下。资料与方法1.一般资料:本组共15例均符合迟发性维生素K缺乏症合并颅内出血的诊断标准。其中男     

婴儿晚发型维生素K缺乏致颅内出血28例诊治体验

目的　总结婴儿晚发型维生素K缺乏所致颅内出血的诊治体验。方法　对近 10年收治的 2 8例患儿的临床特点、诊断及治疗进行回顾分析。结果　本组保守治疗 15例 ,手术 13例 ,共治愈 2 1例 ,死亡 7例 ,随访 1～ 8年 ,13例发育正常 ,8例遗有不同程度神经系统后遗症。结论　掌握其临床特点并作出早期诊断 ,根据具体病情选择合适的治疗方法是降低本病病死率及致残率的关键。     

晚发性维生素K缺乏致颅内出血的微创手术治疗

晚发性维生素K缺乏是引起新生儿及婴幼儿颅内出血最常见的病因之一,发病急,病情重,进展快,致残率及病死率高。特别是出血量大者,可迅速引起颅内高压、脑疝而死亡。单纯的保守治疗已日见缺点,即使成功救治,大多也留下脑瘫、脑积水、癫痫等终生后遗症。我科自1997年至今共     

迟发性外伤性颅内血种的临床特点及预后因素

目的 研究迟发性外伤性颅内血种（DTIH）的临床特点及预后因素。方法 回顾性分析了66例DTIH病人的临床资料。结果 DTIH常见于男性中老年减速性损伤,以额颞部最多,常发生于伤后72h;意识障碍进行性加重,逐渐出现局限性神经症状及局限性癫痫是其三个重要症状;低血压为促发因素。原发性脑损伤重,年龄超过60岁,诊断时间超过24h,术前GCS评分小于8分死亡率高。结论 DTIH的临床表现具有其特点,正确认识该病、及时复查CT是早期诊断的关键;原发性脑损伤的程度、年龄、瞳孔变化、确诊时间、术前意识水平是影响其预后的主要因素。     

Extended Pneumocephalus after Drainage of Chronic Subdural Hematoma Associated with Intracranial Hypotension : Case Report with Pathophysiologic Consideration

Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.     

中、老年人外伤性迟发性颅内血肿151例临床分析

目的 探讨中、老年外伤性迟发性颅内血肿(DTICH)临床特点、伴随危险因素及诊疗过程中注意问题。方法 回顾分析15l例中老年DTICH病例的临床和影像学资料。结果DTICH占中老年颅脑损伤病人的77．8％，死亡率为25．2％。结论 对于中老年颅脑损伤患应密切观察病情变化，警惕DTICH的发生，及时作出诊断、治疗。DTICH多出现于颅脑损伤后72h内或清除其它颅内血肿后突然出现，高峰期是伤后24h。     

迟发性硬脑膜外血肿所致的术中急性脑膨出

目的 分析急性颅脑损伤后开颅血肿清除术中急性脑膨出的原因。方法 对发生于近5年内开颅血肿清除术中发生的急性脑膨出患者进行统计,总结其中迟发性硬脑膜外血肿发生情况。结果 5年中发生于颅脑损伤后开颅血肿清除术中的急性脑膨出患者75例,其中迟发性外伤性硬脑膜外血肿25例(25/75),占同期外伤性硬脑膜外血肿的5.1％。死亡6例,死亡率为24％(6/25)。结论 颅脑损伤后减压术中出现原因不明的颅内压增高、脑膨出时,应首先排除迟发性硬脑膜外血肿的可能,以防漏诊,延误治疗。     

微创颅内血肿抽吸引流术对幕上脑出血患者颅内压的影响

目的  观察微创颅内血肿抽吸引流术对幕上脑出血患者颅内压的影响,从而进一步评估该治疗方法的疗效。 方法  选择2013年4月～2014年12月行微创颅内血肿抽吸引流术治疗幕上脑出血患者,观察患者手术前后颅内压变化及早期预后情况。 结果  共入组53例患者,术后14?d/出院Glasgow意识障碍量表（Glasgow Coma Scale,GCS）评分显著高于术前［7（12（9,15） vs 7（5,11）,Z＝-5.057,P＜0.001］,美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分低于术前［14（11,18） vs 19（15,23）,Z＝-4.210,P＜0.001］。终点血肿体积较基线减小［17.2（11.8,25.8）ml vs 67.5（48.2,82.2）ml,Z＝-6.048,P＜0.001］。其中29例患者行颅内压监测,结果显示术后颅内压较术前颅内压降低［14（9.5,21.5）mmHg vs 30（21.5,40）mmHg,Z＝-4.705,P＜0.001］,但颅内压降低率与首次血肿抽吸率之间无相关性（r＝0.162,P＝0.401）。行颅内压监测的患者早期预后良好组与不良组的术前颅内压、术后颅内压、颅内压降低量、颅内压降低率无显著差异。 结论  微创颅内血肿抽吸引流术治疗幕上脑出血有效,可改善早期神经功能预后,减轻血肿占位效应,并显著降低颅内压。术前后颅内压及术中颅内压变化对于脑出血早期预后的影响不明显。     

Unintended Complication of Intracranial Subdural Hematoma after Percutaneous Epidural Neuroplasty

Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN.     

Intracranial Extension of Spinal Subarachnoid Hematoma Causing Severe Cerebral Vasospasm

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.     

Clinical Features of Acute Subdural Hematomas Caused by Ruptured Intracranial Aneurysms

Objective

Spontaneous acute subdural hematomas (aSDH) secondary to ruptured intracranial aneurysms are rarely reported. This report reviews the clinical features, diagnostic modalities, treatments, and outcomes of this unusual and often fatal condition.

Methods

We performed a database search for all cases of intracranial aneurysms treated at our hospital between 2005 and 2010. Patients with ruptured intracranial aneurysms who presented with aSDH on initial computed tomography (CT) were selected for inclusion. The clinical conditions, radiologic findings, treatments, and outcomes were assessed.

Results

A total of 551 patients were treated for ruptured intracranial aneurysms during the review period. We selected 23 patients (4.2%) who presented with spontaneous aSDH on initial CT. Ruptured aneurysms were detected on initial 3D-CT angiography in all cases. All ruptured aneurysms were located in the anterior portion of the circle of Willis. The World Federation of Neurosurgical Societies grade on admission was V in 17 cases (73.9%). Immediate decompressive craniotomy was performed 22 cases (95.7%). Obliteration of the ruptured aneurysm was achieved in all cases. The Glasgow outcome scales for the cases were good recovery in 5 cases (21.7%), moderate disability to vegetative in 7 cases (30.4%), and death in 11 cases (47.8%).

Conclusion

Spontaneous aSDH caused by a ruptured intracranial aneurysm is rare pattern of aneurysmal subarachnoid hemorrhage. For early detection of aneurysm, 3D-CT angiography is useful. Early decompression with obliteration of the aneurysm is recommended. Outcomes were correlated with the clinical grade and CT findings on admission.     

老年人迟发性外伤性颅内血肿预后因素分析

目的探讨影响老年人迟发性外伤性颅内血肿患者预后的因素。方法对1995年4月至2008年10月收治的126例老年人外伤性迟发性颅内血肿患者的临床资料进行回顾性分析。结果老年人外伤性迟发性颅内血肿患者的预后受患者年龄、颅脑损伤的严重程度、治疗方法、原有的慢性疾病、合并症和并发症等多因素的影响。结论对老年人颅脑损伤患者应密切观察病情变化,选择正确的治疗方法及注意原有慢性疾病的处理和各种并发症的防治,是降低病残率和死亡率的关键。     

颅内血肿微创手术及亚低温脑保护的临床研究

目的 探讨颅内血肿微创手术的优越性及围手术期亚低温脑保护的临床效果。方法 对１００例内血肿病人转手术期亚低温脑保护同时予以微创血肿清除术。其中外伤性颅内血肿５３例,高血压性脑内血肿４０例,自发性脑内血肿（脑动静脉畸形或脑动脉瘤）７例。结果术后半年随访内血肿ＡＤＬ１（社会生活能力正常）３７例,ＡＤＬ２（有自理生活能力）２５例,ＡＤＬ３（部分生活处理）２６例,ＡＤＬ４（卧床）７例,ＡＤＬ５（植物生存