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目的:应用放射性核素脑池显像法(Cisternography)对隐性脑脊液漏(cerebrospinal fluid leak CSFL)的部位、程度进行精确的诊断,进一步明确CSFL的发病原因,并选用适当治疗方法加以根治。方法:对6名无明确诱因患有头痛、反复发作性颈强直、低热、电解质紊乱、偶有鼻腔及外耳道液体溢出和长期低颅压的患者,应用腰椎管注入脑池显影剂99mTC-DTPA进行1h、1.5h、6h、24h的脑池显影观察,对脑池内显影剂的循环通路进行严密观察,参照正常人脑池显影形态,分析其脑脊液异常流向。结果:与正常人显像比较6名患者在1.5h-6h左、右、前、后位不同部位扫描显示出CSFL管放射性聚集影。其中鼻漏4例,耳漏1例,耳鼻漏(耳漏经咽鼓管流入鼻腔者)1例,经过确诊后,分别采用保守及手术的方法加以根治。结论:对隐源性CSFL的患者,应用脑池显像法可准确测量其CSFL管部位、明确其发病原因,并指导进一步根治方案的选择。 相似文献
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脑池显像与CT脑池造影对脑脊液鼻漏定位诊断 总被引:3,自引:0,他引:3
目的:探讨核素脑池造影(RNC)和CT脑池造影(CCTC)定位诊断脑脊液鼻漏的价值。。方法:37例脑脊液鼻漏患者,行RNC26例,行CCTC24例,同时行这两种检查13例,均与手术结果进行对照分析。结果 RNC结合鼻棉拭测定,准确定位22/26例(84.6%),定位错误3/26例(11.5%),未能诊断1/26例(3.8%)。CCTC检查,准确定位20/24例(83.3%),定位错误1/24例(4.2%),不能诊断3/24例(12.5%)。同时采用两种方法13例,各有1例漏诊。结论:RNC为一种用于定位或显示脑脊液鼻漏的有效检查手段,结合鼻棉拭的放置,更有利于协助定位。RNC和CCTC诊断脑脊液鼻漏,两者可互为补充。 相似文献
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脑脊液鼻漏是颅脑外伤常见的并发症之一,临床在行修补术之前,部位常不明确,通过脑池造影,螺旋 CT 扫描及图像后处理技术,可准确显示漏道的部位,给临床手术起到指导作用.本文总结6例报告如下. 相似文献
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目的:探讨采用核素脑池显像结合CT或者MR定位漏口后经鼻内镜下修补治疗隐匿性脑脊液鼻漏的临床意义?方法:采用核素对18例隐匿性脑脊液鼻漏患者进行脑池显像,结合CT或者MR明确脑脊液鼻漏的漏口后,在鼻内镜下行手术修补?结果:18例患者鼻道核素均显示阳性,结合CT或者MR确诊后经鼻内镜下修补,全部成功修补,痊愈出院?结论:核素脑池显像可作为诊断隐匿性脑脊液鼻漏的一种灵敏?简便?准确的检查手段,结合CT或者MR可明确定位漏口,在鼻内镜下手术修补脑脊液鼻漏创伤小,封堵准确,成功率高? 相似文献
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外伤性脑脊液漏在头部损伤的病人中发生率为2%~3%。脑脊液漏与颅骨骨折的部位有关,前颅窝底骨折的病人中有25%~50%发生脑脊液漏,大部分国内学者认为外伤性脑脊液漏的治疗应以非手术疗法为主,约50%~80%能自行闭合且效果可靠。但仍有部分病人虽经较长期的保守治疗仍不能自愈或出现迟发性鼻漏,这类病人又易并发颅内感染及低颅压综合征。不能自愈的鼻漏病人需手术治疗,手术治疗成功的关健在于找到痿口的内口及恰当处理痿口。我科对2例外伤性脑脊液鼻漏患者在手术前采用脑池造影CT扫描方法确定痿口的内口,手术修补瘿口效果良好,现介绍如下。 相似文献
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证实^99锝^m体内标记红细胞(^99Tc^m-RBC)显像具有定位诊断肠道出血的临床价值。采用^99Tc^m-RBC法对21例肠道出血患进行血池显像。^99Tc^m-RBC显像具有灵敏、简便、无创伤、定位准确等优点,可用于诊断和定位肠道出血。 相似文献
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随着医学技术的不断发展 ,诊断肝癌的方法日益增多。我院自 1 997年 8月引进 ECT以来共对 64例肝癌患者进行肝静态核素显像和肝血流血池核素显像检查 (以下统简称核素显像 ) ,现回顾分析以探讨它们对诊断肝癌的价值。1 资料与方法1 .1 一般资料 :病例选择时间为 1 997年 8月~2 0 0 0年 1月 ,其中男 48例 ,女 1 6例 ,年龄 1 6~ 2 3岁 ,平均年龄 46.7岁 ;全部病例均做了 B超、 CT、肝核素显像检查 ;全部病例的诊断均以至少两项以上影像技术检查结果一致作为依据 ,并与临床资料和随访结果相符 ,或有手术病理结果证实。其中原发性肝癌 60… 相似文献
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目的 探讨外伤性脑脊液鼻漏的经颅手术治疗效果。方法 回顾性分析24例外伤性脑脊液鼻漏患者临床资料。术前均行三维CT及MRI检查,已确定漏口所在位置,并行手术治疗。明确漏口且外置靠前的20例患者应用硬膜外入路手术;4例术前漏口未能明确或靠后者,采用硬膜下入路手术。对术前未能确定漏口及确定漏口靠后者,采用硬膜下入路将硬膜打开,探查颅底骨折及漏口所在。探及漏口后仔细分离、冲洗,对有脑组织或硬脑膜、蛛网膜疝入者,予以回纳,不能回纳者切除。结果 24例患者经一次手术全部治愈,随访患者21例,平均随访2年,无一例复发,无手术后并发症。结论 在闭合性颅脑损伤患者中,脑脊液漏的发生率为2.0%~20.8%;而在开放性颅脑损伤的患者中,脑脊液漏的发生率为7%~10%,其中80%左右为脑脊液鼻漏。脑脊液鼻漏典型的临床表现为清水样鼻漏,鼻漏的量随漏口的大小及形态不等,也可随体位改变。脑脊液鼻漏诊断的难点并不在于定性,而在于定位寻找脑脊液从何处流出,如何准确地定位漏口的位置是手术成功的关键,因此确定漏口是术前准备中的一项最重要工作,是手术成功关键因素,也消除了阴性探查的机会。外伤性脑脊液鼻漏患者经颅手术修补漏口,手术安全,并发症少,疗效满意。 相似文献
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Pseudo cerebrospinalfluidrhinorrheaisveryrarelyreported In 1994 ,ourhospitaladmittedsuchacase ,andwereportithere CASEREPORTOnMay 2 8,1994 ,a 37 year oldmanwasreadmittedtoourhospitalone yearfollowingtreatmentforheadinjuryandcerebrospinalfluidrhinorrhea Hehadbeensuff… 相似文献
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Pseudo-cerebrospinal fluid rhinorrhea is very rarely reported. In 1994, our hospital admitted such a case, and we report it here.
CASE REPORT
On May 28, 1994, a 37-year-old man was readmitted to our hospital one-year following treatment for head injury and cerebrospinal fluid rhinorrhea. He had been suffering from a recurrence of rhinorrhea for three months at the time of his readmission. One year prior, the patient had been suffering from a recurrence of the rhinorrhea for three meters. He complained of headaches, dizziness and a right rhinorrhea. The fluid was positive for glucose. Skull-base film showed a traverse fracture of the right petrous bone. For three months, conservative treatment of the rhinorrhea continued, then he was first admitted to our hospital. After admission, a right temperal craniotomy was performed. During surgery, a traverse fracture of the petrous bone was found. In addition, the dura matter over the fracture line was torn, and the fibrotic brain tissue with arachnoid protruded into the fracture fissure. The dura adhering to the edge of the fracture fissure was explored and the bared internal carotid artery discovered. The fracture fissure was occluded with free-muscle and fascia lata grafts. Postoperative intravenous antibiotic therapy and cerebrospinal fluid drainage were carried on for 72 hours. Ten days after the operation the patient was discharged without any symptoms. 相似文献
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Spontaneous cerebrospinal fluid (CSF) rhinorrhea is rarely found, especially in patients with brain tumors.Similarly, reports of tentorial meningioma coexisting with acquired Chiari I malformation with hydromyelia are also few. No doubt, one patient with cerebrospinal fluid rhinorrhea, tentorial meningioma and Chiari I malformation with hydromyelia is hardly ever found. We reported one case of this rare condition. 相似文献
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Prevention of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea 总被引:1,自引:0,他引:1
Background Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention.
Methods A total of 167 patients (113 males and 54 males, average age of 34.4 years) with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed. The data collected included etiology, previous history, clinical manifestation, site of bone defect, operative approach, and postoperative complications. Risk factor(s) for postoperative infection were analyzed using the stepwise multiple Logistic regression.
Results Eighteen (10.8%) patients were infected post-operatively. The independent risk factors for infection were the site of defect (RR=0.508, 95% CI 0.306–0.843, P=0.009) and historical meningitis (RR=0.290, 95% CI 0.094–0.893, P=0.031). Patients with multiple defects and saddle floor defects had a higher infection rate. The germiculture was positive in 11 patients, and vancomycin was sensitive to all the pathogenesis. Nine infected patients needed lumbar drainage. Ten patients had hyponatremia, and hydrocephalus occurred in two patients with serious trauma.
Conclusions To prevent the infection, we should pay closer attention to the high-risk patients pre-operation. During the operation, the methods those can improve wound healing, such as using blood-supply materials, reliable fixation, and eliminating dead space are all helpful. Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management.
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背景:颅内感染是神经外科的常见术后并发症。由于脑脊液鼻漏患者颅腔与外界环境连通,该病患者容易发生术后颅内感染。本文的目的是分析与脑脊液鼻漏患者术后颅内感染的相关因素,并提出预防的方法。
方法:回顾性分析由通讯作者手术的167例脑脊液鼻漏患者的情况。其中男性114例,女性53例,平均年龄34.4岁。收集的数据包括病因、既往史、临床情况、漏口位置、手术入路和术后并发症。以多因素逐步逻辑回归的统计学方法分析术后感染的易感因素。
结果:本组中,18例(10.8%)患者发生术后感染。漏口部位(RR=0.508,95%CI 0.306-0.843,P=0.009)和术前感染史(RR=0.290,95%CI 0.094-0.893,P=0.031)是发生术后感染的独立危险因素。多发颅底骨折及鞍底缺损患者术后感染率高。其中11例细菌培养结果阳性,所有病原菌都对万古霉素敏感。9例感染患者需要持续腰穿外引流。感染患者中10例发生低钠血症,2例严重外伤后的患者继发脑积水。
结论:为预防术后感染,术前应对高危患者给予更多的关注。术中所有能促进伤口愈合的方法,如使用带血运的修补材料、可靠的固定、避免死腔形成等,都对预防感染有帮助。术后在高危患者早期行腰穿外引流及使用有效抗生素也是预防感染的方法。 相似文献
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目的:探讨经鼻内窦镜脑脊液鼻漏及脑膜脑膨出手术的有效性。方法:回顾性研究13例脑脊液鼻漏及脑膜脑膨出的诊断及治疗。结果;13例患者中颅底缺损位于筛顶及额隐窝5例,蝶窦4例,筛板4例。13例中脑膜脑膨出4例,其中3例有外伤史,1例为先天性。经鼻内窥镜手术后随访6-27mo,11例(84.6%)无复发。1例术后10d抽取碘纺纱条时复发,另1例碟窦非霍杰金氏淋巴瘤术后3mo化疗时复发。无手术并发症。结论:经鼻内窥镜手术直视下切除脑膜膨出组织,修补漏口,避免开颅,是治疗脑脊液鼻漏及鼻内脑膜脑脑膨出的理想手术方法。 相似文献
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目的探讨脑脊液鼻漏的诊断及手术治疗方法。方法回顾性分析潍坊市人民医院与聊城市人民医院2005—2010年收治的28例脑脊液鼻漏患者资料,其中男性18例,女性10例,年龄18~59岁,平均年龄38岁,病程7d~2年;外伤性脑脊液鼻漏20例,自发性6例,医源性2例。结合生化检查、CT/MRI及鼻内窥镜检查明确诊断,修复材料为鼻中隔黏膜(18例)、颞肌筋膜(8例)、额部带蒂骨膜瓣(2例)。结果28例均在鼻内镜下修补成功,其中1次修补成功26例,2例经再次修补成功,2例术后嗅觉明显减退,1例治疗后好转,1例无效;所有患者无鼻塞及鼻腔干燥等并发症,随访6~36个月未见复发。结论脑脊液鼻漏的准确诊断及修补方式和修补材料的正确选择是手术成功的关键。 相似文献