脑立体定向多靶点毁损术治疗精神分裂症

目的探讨脑立体定向多靶点毁损术治疗精神分裂症的疗效。方法对精神分裂症患者行双侧扣带回、内囊前肢及杏仁核毁损术,并随访观察疗效。结果本组无围手术期死亡病例发生,术后发生并发症如下:①毁损灶出血8例,标准嗜睡和偏瘫,术后2周均吸收。②膀胱功能障碍,表现为尿失禁,其中1周内42例尿失禁症状自动消失,4例1个月内症状消失。③偏瘫8例,术后CT,MRI证实为基底节缺血性改变,扩张血管治疗后均恢复正常。术后随访1年,有效为43.5%,显效为42.5%,无效为14%。随访二年,有效为35.0%,显效为43.8%,无效为21.2%。结论脑立体定向多靶点毁损术治疗精神分裂症有一定的临床治疗效果,术后需适当服药及心理治疗。     

精神病脑立体定向毁损术麻醉选择的看法

贵刊1991年第7卷第2期中发表了两篇关于精神病的脑立体定向手术的麻醉处理的报道(黑龙江省神经精神病院、解放军254医院),对精神病人的处理均选用静脉全麻。对此我们有不同的体会。我院自1987年,开展锥体外系疾病脑立体定向靶点毁损术,兹将78例的经验体会介绍如下,与同道们商榷。 78例中,男62,女16。年龄8～13岁3例,16～49岁75例。其中慢性精神分裂症47例,强迫症7例,脑发育迟滞伴精神障碍10例,癫痫伴精神障碍7例,混合性     

立体定向多靶点手术治疗情感性精神障碍

目的探讨螺旋CT引导下同期双侧多靶点手术治疗情感性精神障碍的疗效和安全性。方法采用螺旋CT定位,对182例情感性精神障碍患者,采用同期双侧多靶点射频热凝手术治疗。按全国精神外科协作组于1990年制定的评定方法进行疗效评定。结果182例患者术后2周随访：显著改善86例,改善81例,无效15例,加重0例,有效率91．76％;166例术后随访6～54个月：恢复38例,显著改善59例,改善52例,无效17例,加重0例,有效率89．76％;术后除早期一过性并发症外,远期并发症发生率小于1％。结论螺旋CT引导同期双侧多靶点手术治疗情感性精神障碍疗效显著,安全性高。     

脑立体定向射频毁损手术的麻醉

脑立体定向射频毁损手术治疗震颤麻痹等锥体外系疾病是近年来国内开展比较多的手术，创伤小、恢复快，对一些药物难以控制的患者确有一定疗效。现将我院111例手术麻醉小结如下。 资料与方法 一般资料本组111例，男74例，女37例，年龄3～79岁,均因震颤麻痹、扭转痉挛或痉挛性斜颈、慢性进行性舞蹈病入院。术前合并高血压病22例，冠心病19例,糖尿病8例。     

立体定向杏仁核与海马联合毁损治疗颞叶内侧型癫痫

目的 探讨立体定向杏仁核、海马联合毁损治疗颞叶内侧型癫痫(MTLE)的方法。方法患者头部安装Leksell立体定向框架,使其平行于颞角长轴。针对23例一侧MTLE患者,应用核磁共振(MRI)扫描定位、深部电极杏仁核及海马脑电监测和射频毁损技术,局部麻醉下分别经旁正中额、枕入路完成立体定向杏仁核和海马毁损术。结果射频毁损前23例患者深部电极均记录到杏仁核和海马区域棘波或多棘波,术后痫样放电消失。术后1～2周复查MRI显示与毁损部位相一致的广泛凝固性坏死,周围有水肿带。术后随访8～32个月,癫痫发作完全控制者43．48％(10／23例),总有效率(发作减少≥50％)91．30％(21／23)。结论立体定向杏仁核、海马联合毁损治疗MTLE是一种安全有效的微创治疗方法,值得临床推广和应用。     

脑立体定向术治疗难治性精神分裂症患者的观察与护理

目的探讨脑立体定向杏仁核毁损术(下称脑立体定向术)治疗难治性精神分裂症的围术期护理。方法对采用脑立体定向术治疗的72例难治性精神分裂症患者进行观察及护理，评价疗效。结果优5例，显进28例．进步35例。无效4例。患者妄想、冲动伤人、毁物等症状改善明显。术后并发颅内出血1例，脑水肿3例，脑脊液漏2例，均在细心观察和精心护理下1～2周内恢复。结论脑立体定向术是目前治疗难治性精神分裂症效果较好且创伤小的手术。手术后有效的观察护理是预防并发症、提高疗效的关键。     

脑立体定向术治疗难治性精神分裂症患者的观察与护理

目的探讨脑立体定向杏仁核毁损术(下称脑立体定向术)治疗难治性精神分裂症的围术期护理。方法对采用脑立体定向术治疗的72例难治性精神分裂症患者进行观察及护理,评价疗效。结果优5例,显进28例,进步35例,无效4例。患者妄想、冲动伤人、毁物等症状改善明显。术后并发颅内出血1例,脑水肿3例,脑脊液漏2例,均在细心观察和精心护理下1~2周内恢复。结论脑立体定向术是目前治疗难治性精神分裂症效果较好且创伤小的手术,手术后有效的观察护理是预防并发症、提高疗效的关键。     

小柴胡汤联合多靶点疗法治疗难治性肾病综合征临床研究

目的：探讨小柴胡汤联合多靶点疗法治疗难治性肾病综合征（RNS）的临床疗效及安全性.方法：将134例RNS患者随机分为对照组及观察组,对照组给予多靶点疗法,即小剂量尿激酶、贝那普利、缬沙坦、霉酚酸酯及激素等,观察组在此基础上联合小柴胡汤,并随证加减,疗程结束后比较两组的疗效及生化指标.结果：对照组脱落10例,观察组9例,共115例完成研究,对照组总有效率68.4%,观察组84.5%,两组临床疗效比较差异有统计学意义（P〈0.05）.治疗后两组及同组治疗前后总胆固醇、白蛋白、24 h尿蛋白水平比较,差异有统计学意义（P〈0.05）,而Ccr水平两组治疗后及同组治疗前后比较,差异无统计学意义（P＞0.05）.对照组不良反应发生率为23.8%,观察组9.8%,观察组不良反应发生率低于对照组（P〈0.05）.结论：小柴胡汤联合多靶点疗法治疗RNS,能够提高疗效,并可降低不良反应的发生.     

精神病立体定向细胞刀手术麻醉

精神病已是一种常见病,而且发病率较高,以精神分裂症而言,国内流行病学调查统计约占总人口的2‰～4‰,若加上其他种类的精神病,病人数量更大。精神病治疗以往基本上采用以内科药物治疗为主的综合治疗,近年来由于引进了立体定向微电极导向的细胞刀技术,精神病的外科治疗已取得了较好的效果。但由于是精神病病人,手术对麻醉有特殊要求。我院2001年以来共对1070例精神病人实施立体定向细胞刀手术。现就麻醉处理报告如下。     

脑立体定向手术治疗深部脑脓肿

脑立体定向手术治疗深部脑脓肿祁宜志，郑立高１９８８～１９９３年以来，我科采用立体定向手术治疗深部脑脓肿１０例，疗效满意。现将治疗方法及结果报道如下。１．一般资料：本组１０例中，男３例，女７例；年龄９～２０岁，平均１６岁。单发６例，多发４例。共１７个脓...     

Intractable lung abscess successfully treated with cavernostomy and free omental plombage using microvascular surgery

A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity. Finally, the abscess was filled with a free greater omentum flap, accompanied by microvascular anastomosis. In this way, the intractable lung abscess was successfully cured. Conventionally, surgical treatment, particularly cavernostomy, has been applied only to limited cases when dealing with a lung abscess. Our experience with the present case suggests that surgical treatment, including cavernostomy as one option, should also be considered when dealing with lung abscesses resisting medical treatment and causing compromised respiratory function. To enable maximum utilization of the greater omental flap, which is available in only a limited amount, it seems useful to prepare and graft a free omental flap making use of microvascular surgery.     

An encounter with stereotactic brain surgery

A historical account of the "medieval" period of stereotactic brain surgery characterizes it as a time of instrument development, choosing of treatment targets, and close rapport between patients and neurological surgeons. Pioneers had frequent contact with the next tier of investigators. Brain function and instrumentation became better understood, leading to the more recent exponential advancements in the field.     

Comparison of actual pallidotomy lesion location with expected stereotactic location

Accuracy of pallidotomy lesion placement was assessed by comparing actual lesion locations with expected pallidotomy lesion locations based on stereotaxy. Actual and expected lesions were compared in anteroposterior, dorsoventral and lateral axes. In 22 pallidotomies, actual lesion locations were determined using axial MR images. Expected lesion locations were calculated using a starting point derived from preoperative computerized tomography, displacements from the starting point based on microelectrode-driven electrophysiological refinement, and the trajectory angle of the lesioning tract relative to the anterior-posterior commissural plane. On average, actual lesion locations were found 2.91 +/- 2.23 mm posterior, 3.22 +/- 2.49 mm ventral, and 0.05 +/- 1.80 mm lateral compared to the expected lesion location. Discrepancies between the actual lesion and expected lesion locations may be mostly accounted for by posterior and ventral lesion spread from the exposed electrode tip, in-plane and volume averaging effects associated with MR images, and possible brain shifting during surgery. However, despite the remaining small differences between actual and expected lesion location, good clinical outcome of reduced dyskinesias and 'off' time along with UPDRS-based improvement in mentation, motor and activity of daily living measures was observed.     

Experience in 300 cases of CT-directed stereotactic surgery for lesion biopsy and aspiration of haematoma

Despite advances in imaging of the brain, an accurate diagnosis of brain lesions requires tissue sampling and histological verification. A series of CT-directed procedures has been performed in 300 patients with deep sited, multiple, diffuse, extensive, small or inflammatory lesions, brain stem haematomas and tumours presenting with epilepsy. A positive diagnosis was obtained in 271 cases (92.8%), no diagnosis in 21 cases (7.2%). Therapeutic results were also obtained in eight cases (2.7%) of brain stem haematoma aspiration. Complications occurred in 14 cases (4.7%) including one death (0.3%). Because of the importance of an accurate diagnosis in order to avoid inappropriate therapy, together with the relative safety of the technique, CT-directed stereotactic biopsy should be considered in all patients harbouring deep seated, multiple, diffuse, small or inflammatory brain lesions.     

Resection of brain metastases previously treated with stereotactic radiosurgery

OBJECT: To date, no report has been published on outcomes of patients undergoing resection for brain metastases who were previously treated with stereotactic radiosurgery (SRS). Consequently, the authors reviewed their institutional experience with this clinical scenario to assess the efficacy of surgical intervention. METHODS: Sixty-one patients (each harboring three or fewer brain lesions), who were treated at a single institution between June 1993 and August 2002 were identified. Patient charts and their neuroimaging and pathological reports were retrospectively reviewed to determine overall survival rates, surgical complications, and recurrence rates. A univariate analysis revealed that patient preoperative recursive partitioning analysis (RPA) classification, primary disease status, preoperative Karnofsky Performance Scale score, type of focal treatment undergone for nonindex lesions, and major postoperative surgical complications were factors that significantly affected survival (p < or = 0.05). In contrast, only the RPA class and focal (conventional surgery or SRS) treatment of nonindex lesions significantly (or nearly significantly) affected survival in the multivariate analysis. Major neurological complications occurred in only 2% of patients. The median time to distant recurrence after resection was 8.4 months; that to local recurrence was not reached. The overall median survival time was 11.1 months, with 25% of patients surviving 2 or more years. Conventional surgery facilitated tapering of steroid administration. Conclusions. The complication, morbidity, survival, and recurrence rates are consistent with those seen after conventional surgery for recurrent brain metastases. Our results indicate that in selected patients with a favorable RPA class in whom nonindex lesions are treated with focal modalities, surgery can provide long-term control of SRS-treated lesions and positively affect overall survival.     

The flow-cytometric analysis of nasopharyngeal carcinoma treated with stereotactic radiosurgery

Stereotactic radiosurgery has been used in the treatment of nasopharyngeal carcinoma. To analyze the effect of radiosurgery on the flow cytometry DNA index and progression of cells through the cycles, 4 recurrent nasopharyngeal carcinoma cases were treated with stereotactic radiosurgery. The distribution of cells through the cycles was measured by flow cytometry at various times thereafter. The 50% isodose curve was placed at the tumor margin and the margin dose was 20 Gy. Biopsy of the nasopharynx was performed before and 1, 3, and 6 months after treatment. The specimens were then subjected to flow-cytometric analysis. The percentage of cells in the S phase was 27.6 +/- 1.0, 14.6 +/- 0.8, 12.1 +/- 1.6 and 11.3 +/- 1.3%; the proliferating index was 39.1 +/- 1.4, 17.0 +/- 0.9, and 14.3 +/- 1.2 and 14.1 +/- 1.5%, and the DNA index was 1.5 +/- 0.1, 1.6 +/- 0.2, 1.7 +/- 0.1 and 1.9 +/- 0.1 before and 1, 3, and 6 months after treatment, respectively. It is suggested that the percentage of cells in the S phase and the proliferating index decreased to normal after treatment with stereotactic radiosurgery. This study explores the preliminary radiobiological effect of stereotactic radiosurgery on the DNA content and the distribution of cells through the cycles in nasopharyngeal carcinoma.     

Prospective feasibility study of outpatient stereotactic brain lesion biopsy

OBJECTIVE: To assess the safety and feasibility of performing computed tomography-guided stereotactic brain lesion biopsy as an outpatient day-surgery procedure. METHODS: In late 1996, a prospective trial of outpatient stereotactic biopsies was initiated. The protocol consists of preadmission education of the patient, computed tomography-guided biopsy with local anesthesia (using a Brown-Roberts-Wells or Cosman-Roberts-Wells frame), postoperative observation in the postanesthetic care unit for 2 hours and in the day surgery unit for 2 hours, and then discharge home 4 hours after the procedure. RESULTS: Seventy-six patients constituted the intent-to-treat group, of whom two were not discharged on the same day (97.4% success rate). The two patients underwent inpatient admission because one required intravenous antibiotic treatment of a brain abscess and the other had a hard lesion in the brainstem that precluded biopsy needle penetration; admission for further investigation of the lesion was elected. Two patients experienced complications (2.6%), i.e., one small area of intraventricular hemorrhage that produced only a mild headache and one case of mild worsening of preexisting leg weakness, with negative computed tomographic results. CONCLUSION: Discharging patients home after 4 hours of observation after stereotactic biopsies seems to be a safe, well-tolerated practice. In this series, there was no major morbidity and no patient was disadvantaged by participating in this protocol. This approach would be expected to result in health care resource and cost savings, with a potential increase in patient satisfaction because of shorter hospital stays.     

Intractable malleolar bursitis treated with lateral calcaneal artery adipofascial flap.

Infections of the malleolar bursa, which is an adventitious bursa, rarely progress to intractable infectious bursitis. We present two cases of intractable malleolar bursitis. We performed successful transplantation of the lateral calcaneal artery adipofascial flap that resulted in healing of the bursitis. We discuss classification of bursae, treatments for bursitis and characteristics of the lateral calcaneal artery adipofascial flap.