成人脊髓纵裂的疗效分析

目的：分析成人脊髓纵裂患者的手术治疗效果。方法：对13例行手术治疗的成人脊髓纵裂患者进行回顾性分析。结果：通过手术后观察和6个月～5年的随访发现,手术的总有效率可达87％,尤其是疼痛为主诉的患者恢复最为明显,术后恢复似乎与术前病程无关。结论：双管型脊髓纵裂患者一旦确诊,无手术禁忌症就应尽早手术。只要手术操作细致,大多患者症状可缓解,不会出现明显的神经并发症。     

脊髓纵裂合并脊髓栓系综合征的治疗

目的：分析双管型脊髓纵裂患者脊髓栓系综合征的手术治疗效果。方法：对34例行手术治疗的双管型脊髓纵裂TCS患者进行回顾性分析。结果：通过手术后观察和3个月～5年的随访发现,手术的总有效率可达91％,尤其是疼痛为主诉的患者恢复最为明显,术后恢复似乎与术前病程无关。结论：双管型脊髓纵裂合并TCS的患者一旦确诊,无手术禁忌症就应尽早手术。只要手术操作细致,大多患者症状可缓解,不会出现明显的神经并发症。     

脊髓纵裂分型治疗的疗效分析

目的：探讨脊髓纵裂分型治疗效果。方法：对1978年5月至2005年1月我院收治的有完整资料的121例单管型及双管型脊髓纵裂手术及非手术治疗的病例进行回顾性分析。结果：双管型脊髓纵裂通过手术后观察和6个月～15年的随访发现,手术的总有效率可达86％,尤其是疼痛为主诉的患者恢复最为明显;单管型脊髓纵裂手术前后无明显变化。结论：双管型脊髓纵裂脊髓损害重,且呈进行性加重,精细的手术治疗可以使大多数患者症状缓解,终止神经进行性损伤,确诊后应尽早手术;单管型脊髓纵裂脊髓损害轻,不需手术探查。     

脊髓纵裂患者脊髓栓系综合征的手术疗效分析

目的分忻双管型脊髓纵裂患者脊髓栓系综合征的手术疗效。方法对34例行手术治疗的双管型脊髓纵裂TCS患者进行回顾性分析。结果通过手术后观察和3个月～5年的随访发现．手术的总有率可达91％，尤其是疼痛为主诉的患者恢复最为明显，术后恢复似乎与术前病程无关。结论双管型脊髓纵裂合并TCS的患者一旦确诊．无手术禁忌证就应尽早手术。只要手术操作细致，大多患者症状可缓解．不会出现明显的神经并发症。     

脊髓纵裂手术治疗的疗效

[目的]探讨脊髓纵裂手术治疗效果.[方法]对1978年5月～2006年1月收治的有完整资料的121例单管型及双管型脊髓纵裂手术及非手术治疗的病例进行回顾性分析,并通过临床神经功能评分及胫后神经皮层体感诱发电位(PTNCSEP)P40波峰监测,评价其手术治疗的疗效.[结果]双管型脊髓纵裂通过手术后观察和6个月～15年(平均2年6个月)的随访发现,临床神经功能评分及PrNCSEP术后有明显改变,尤其是疼痛为主诉的患者恢复最为明显,手术的总有效率可达86%;单管型脊髓纵裂手术前后无明显变化.[结论]双管型脊髓纵裂脊髓损害重,且呈进行性加重,精细的手术治疗可以使大多数患者症状缓解,终止神经进行性损伤,确诊后应尽早手术;单管型脊髓纵裂脊髓损害轻,不需手术探查.     

儿童与成人脊髓纵裂的对比分析

目的比较儿童与成人脊髓纵裂的临床特征、治疗和预后的异同。方法对110例儿童和29例成人脊髓纵裂患者的临床表现、影像学和手术疗效进行回顾分析。结果相对成人而言,儿童脊髓纵裂下肢运动障碍,脊柱侧弯、腰背部皮肤特征性的改变等症状、体征较多见;外科治疗对于下肢无力、步态异常、疼痛和感觉障碍效果较好,对于大小便功能障碍效果不理想。而成人以疼痛、下肢无力等症状较多见,外科治疗对于疼痛、下肢无力疗效明显,对大小便功能障碍效果较儿童更差。结论儿童和成人脊髓纵裂在临床特征、预后等方面均有差别,在确定治疗方案时应有所区别。     

脊髓纵裂分型治疗的疗效分析

目的探讨脊髓纵裂分型治疗的疗效。方法对1978年5月至2006年11月收洽的有完整资料的121例单管型及双管型脊髓纵裂患者的病历资料进行回顾性分析，并通过临床神经功能评分及胫后神经皮层体感诱发电位（FTNCSEP）P40波峰监测，评价其手术及非手术治疗的疗效。结果所有患者均得到随访，随访时间6个月～15年，平均2年6个月。96例双管型患者中手术治疗86例，术后观察和随访发现24例痊愈、22例有明显改善、28例有一定改善、12例无明确效果，临床神经功能评分及PTNCSEP术后有明显改变，尤其是以疼痛为主诉的患者恢复最为明显，手术总有效率为86％；10例双管型患者未行手术治疗，随访发现临床症状无明显改善且有加重趋势。单管型患者25例，手术治疗16例，术前、术后临床神经功能评分及胛NCSEP无明显变化；未手术治疗的9例，随访时上述指标亦无明显变化。结论双管型脊髓纵裂患者脊髓损害重且呈进行性加重，精细的手术治疗可以使大多数患者症状得到缓解，终止神经进行性损伤，确诊后应尽早手术。单管型脊髓纵裂患者脊髓损害轻，无须手术探查。     

脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸

目的:探讨脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸的安全性和有效性。方法:回顾性分析2007年6月~2013年6月在我院采用脊柱截骨手术治疗的23例合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸患者。其中男6例,女17例;手术时年龄16.9±3.4岁(10~23岁)。腰骶部疼痛8例,其中5例仅表现为腰骶部疼痛,神经功能损害18例。术前冠状位Cobb角95.4°±25.2°(65°~156°)。Ⅰ型脊髓纵裂9例,Ⅱ型脊髓纵裂14例。脊髓圆锥位置均在L3水平以下。对合并Ⅰ型脊髓纵裂伴脊髓拴系的患者,采用骨性纵隔切除、一期脊柱截骨矫形;合并Ⅱ型脊髓纵裂伴脊髓拴系的患者单纯行一期脊柱截骨矫形(未处理纤维纵隔)。其中行全脊椎截骨13例,经椎弓根截骨10例。术前、术后3个月和末次随访时分别测量患者侧凸Cobb角,并按脊柱裂神经功能评分(SBNS)分级评估神经功能恢复情况。结果:手术时间571.1±136.5min(310~835min);术中失血量4888.3±2482.3ml(500~9600ml)。随访38.9±18.3个月(24~79个月)。术后冠状面Cobb角33.7°±15.9°(3°~73°),较术前明显改善(P0.05),矫正率平均为(62.3±14.1)%;末次随访时冠状面Cobb角37.4°±17.2°(5°~82°),矫正率平均为(58.1±14.7)%,较术后平均丢失4.2°±2.3°,与术后比较无明显矫形丢失(P0.05),但与术前相比有明显改善(P0.05)。末次随访时,18例患者神经损害症状获得不同程度改善,其中13例术前SBNS神经功能分级为Ⅱ级者术后恢复至Ⅰ级;2例Ⅲ级恢复至Ⅱ级;另外3例神经损害评分提高,SBNS分级维持不变,脊柱侧凸畸形及局部疼痛明显好转。围手术期出现并发症5例,其中2例术后出现单侧下肢肌力下降,1例术后2周下肢肌力恢复至4级,另1例于术后3个月恢复至术前水平,术后2年随访肌力基本恢复正常;术中发现胸膜破裂1例,术后脑脊液漏1例、泌尿系感染1例。所有病例术后无伤口感染、假关节形成、内固定松动/断裂及永久性神经损害并发症。结论:脊柱截骨术治疗合并脊髓纵裂伴脊髓拴系综合征的先天性脊柱侧凸患者安全有效,且对神经功能恢复有促进作用。     

稳定性脊髓纵裂的治疗

目的研究稳定性脊髓纵裂的临床特征、手术疗效以指导诊断和治疗.方法报告18例稳定性脊髓纵裂诊治情况.根据手术所见、影像学和手术疗效分析其致病机制及治疗要点.结果稳定性脊髓纵裂患者临床症状是脊髓发育不良的结果,11例患者手术后神经功能障碍无改善,非手术7例患者长期随访神经功能障碍无进展.结论稳定性脊髓纵裂患者无需手术,应长期随访观察.     

成人脊髓纵裂的诊断与治疗

目的：通过对20例成人型脊髓纵裂的分析,提供成人型脊髓纵裂的诊断与治疗方法。方法：回顾性研究成人型脊髓纵裂的病史、临床表现、影像学检查、手术疗效。结果：成人型脊髓纵裂是由于脊髓的过屈牵拉,导致间隔撞击裂口下端脊髓,引起发病,常有损伤病史。其主要症状为疼痛,无矫形外科综合征,其症状较儿童型轻,手术可显著改善症状。结论：成人型脊髓纵裂的症状及手术疗效与儿童型脊髓纵裂有明显区别,早诊断早治疗有良好疗效。     

成人脊髓栓系综合征的诊治

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床特征以指导诊断和治疗。方法报告１８例成人ＴＣＳ的诊治情况。患者均经ＭＲＩ证实并行手术松解;根据手术所见和影像学分析其致病机理及手术要点。结果栓系原因分别为椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月至５年随访,其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ;术中应避免损伤圆锥和马尾神经;病程过长及再栓系是疗效不佳的主要原因     

The adult diplomyelia syndrome

Diplomyelia is an uncommon variant of diastematomyelia in which the spinal cord remains divided caudal to the diastematomyelia spur. Presented here are three adults who presented with a sign-and-symptom complex that is likely to occur only when such an anatomic aberration is found. Each patient complained of pain and paresis in one leg. Neurologic examination demonstrated dysfunction of not only both long tracts but also lower motor modalities in the symptomatic leg and no abnormalities in the opposite leg. These findings, therefore, would strongly suggest that each leg was supplied by one of the split spinal cords, with only one cord being compromised. When planning surgical intervention on these patients, one must be aware that removal of the central spur alone may not resolve the problem because the spur, unlike that in diastematomyelia, does not tether the split spinal cords.     

How well do neurosurgeons care for trauma patients? A survey of the membership of the American Association for the Surgery of Trauma

OBJECTIVE: To quantify the trauma community's perceptions about neurosurgeons' involvement in trauma. METHODS: Mail survey of the membership of the American Association for the Surgery of Trauma. RESULTS: The response rate was 33.6% (280 of 833 mailings). Eighty-four percent of respondents practiced in an academic setting, and 51% reported that neurosurgery residents were available in their hospitals at night and on weekends. Approximately 60% reported that neurosurgeons were in charge of the care of adults with isolated head injuries (HIs) who had been operated on. A similar percentage thought that neurosurgeons should be in charge of such patients' care. Only 31.5% indicated that neurosurgeons were in charge if no operation had been performed (P < 0.001 versus patients who had been operated on), but 42.1% thought that neurosurgeons should be in charge of patients who had not been operated on (P < 0.001 versus neurosurgeons who actually were in charge of such patients). The same question was asked with regard to adults with both HIs and systemic injuries and with regard to children with HIs with and without systemic injuries. In general, the actuality of a leadership role for neurosurgeons depended on whether a craniotomy had been performed, and it was believed that more neurosurgeons should be in charge than actually were in charge of patients with HIs. Reluctance to insert intracranial pressure monitors was the most commonly reported problem (44.8% of respondents) with regard to neurosurgeons' care of patients with HIs. All problems were reported to be significantly more common when in-house neurosurgery residents were not available. More than 40% of respondents indicated that non-neurosurgeons should be allowed to insert intracranial pressure monitors, and 14% thought that non-neurosurgeons should be allowed to perform trauma craniotomies. These opinions were strongly associated with the reporting of problems in neurosurgeons' performance in these areas (P < 0.001 and P = 0.001, respectively). CONCLUSION: Neurosurgeons frequently yield responsibility for managing patients with HIs to other specialists, but more frequent leadership of neurosurgeons in this area would be welcome. Reported problems with neurosurgical care of trauma patients may be related to a lack of immediate availability of neurosurgeons, such as the absence of in-house neurosurgery residents at night. Failure of neurosurgeons to address perceived deficiencies in their care of trauma patients may lead to serious erosion of the central role of neurosurgeons in managing patients with HIs.     

Invasion of the cavernous sinus by medial sphenoid meningioma —“Radical” surgery and recurrence

Summary We have reviewed the cases of 57 patients with medial sphenoid meningioma who were operated on in our department during the period 1976 to 1988. The patients were grouped according to location, and their pertinent clinical features are presented. Given the frequency of invasion of the cavernous sinus by such tumours, the following question must be considered in each individual case: the potential benefit of the most radical surgery possible, to minimize the recurrence rate, must be weighed against the cost to the patient in diminished quality of life of iatrogenic neurological impairment. We currently advocate the following strategy: radical removal of tumour tissue lying within the cavernous sinus is unwarranted for the first operation if it would entail iatrogenic neurological damage. Only if subsequent follow-up reveals either fast growth of this tissue, or neurological signs and symptoms attributable to it, do we then attempt uncompromising radicality at a second operation.     

成人脊髓栓系综合征的诊治

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床诊断和治疗。方法回顾性报告１８例成人脊髓栓系综合征的临床资料。所有患者均经ＭＲＩ证实并行手术松解;根据手术所见和影像学分析其致病机理及手术要点。结果脊髓或圆锥的栓系原因各不相同,包括椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月～５年随访,其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ。术中应避免损伤圆锥和马尾神经。病程过长及再栓系是疗效不佳的主要原因。     

Adult presentation of spinal dysraphism and tandem diastematomyelia.

BACKGROUND CONTEXT: Diastematomyelia is a split-cord malformation often accompanied by other cord or column anomalies. PURPOSE: To report on an adult patient with diastematomyelia and discuss the embryological basis and related developmental sequelae of this split-cord malformation. STUDY DESIGN: Case report. METHODS: A summary of the management of a 54-year-old woman with recent clinical symptomatology related to an undiagnosed split-cord malformation is presented with accompanying literature review. RESULTS: A rare adult presentation of diastematomyelia with accompanying intradural extramedullary epidermoid tumor was repaired with resection of the soft-tissue mass and excision of the fibro-osseous septum. CONCLUSION: Initial presentation of diastematomyelia is rarely seen in adults; accompanying pathology includes scoliosis, tethered cord, and intradural tumors. Effective treatment involves identification of the primary pathology.