经菱形窝手术切除脑干海绵状血管瘤的护理

脑干海绵状血管瘤(cavernous malformation,CM)为先天性脑血管异常,是-种少见病,在-般人群中患病率为0.4%～0.9%,占颅内血管畸形的5%～13~([1]).CM由于部位深在,位于生命中枢,周围邻近有重要神经核团的脑桥和延髓,因此手术风险较大([2]).随着神经外科显微手术技术的提高,以及神经电生理术中监测的应用,手术切除病灶的报道逐渐增多.2005年3月至2009年1月,我院经菱形窝实施CM手术共11例,取得了良好的效果,现报道如下.     

脑干血管母细胞瘤的显微外科治疗(附15例报告)

目的:探讨脑干血管母细胞瘤的诊断及显微外科手术方式、技巧与效果。方法:回顾性分析15例脑干血管母细胞瘤患者的影像学资料、手术方式、治疗效果。结果:根据肿瘤在MRI上的表现可分为囊肿型和实体型:囊肿型4例,实体型11例。15例患者病灶均于显微镜下全切,无手术死亡,术后病理学检查证实为血管母细胞瘤。8例患者术后神经功能障碍得到改善,4例症状加重,3例术后1周左右死亡,死亡原因均为脑干功能障碍。结论:MRI对脑干血管母细胞瘤的定位、定性诊断具有重要意义,对手术方式的选择具有重要参考价值。采用显微外科技术切除脑干血管母细胞瘤是提高治疗效果的有效方法。     

脊髓髓内肿瘤22例外科治疗策略

目的探讨髓内肿瘤的手术治疗方法与疗效。方法回顾性分析22例髓内肿瘤手术治疗的临床与随访治疗,并进行文献复习。结果肿瘤完全切除12例(室管膜瘤10例,星形细胞瘤和血管网织细胞瘤各1例);次全切除7例(星形细胞瘤、皮样囊肿和多形性胶质母细胞瘤各2例,累及延髓下部室管膜瘤1例);部分切除3例(脂肪瘤2例和多形性胶质母细胞瘤1例)。术后近期疗效:治愈10例,稳定、好转7例,加重2例,死亡3例。结论根据肿瘤部位、性质、体积、电生理监测结果制定个体化治疗方案,具有较好的治疗效果,应积极开展髓内肿瘤的早期显微外科治疗。     

小脑延髓裂入路在扩展型四脑室肿瘤显微手术中的应用

对11例扩展型四脑室瘤患者采用经小脑延髓裂入路进行显微手术治疗,其中2例术中采用神经内镜辅助手术,并对肿瘤切除和显露程度进行评价。10例肿瘤获全切除,1例累及脑干的肿瘤近全切除,所有病变均获得满意显露,无新增神经系统功能障碍。对扩展型四脑室肿瘤采用经小脑延髓裂显微手术进行治疗,可满意显露病变,辅助应用神经内镜可帮助提高肿瘤切除率。     

应用术中神经电生理监测的幕下肿瘤切除术中顺式阿曲库铵用量的临床观察

<正>随着影像学、显微技术及神经电生理的发展,神经外科正从大体神经外科、显微神经外科、微创神经外科进入以病变切除最大化、功能损伤最小化、手术效果最佳化的精准神经外科阶段[1,2],术中神经电生理监测(Intraoperative Neuromonitoring IONM)在幕下肿瘤切除术中主要用于保护颅神经及脑干神经功能活动的完整性[3,4]。依据日常麻醉工作经验及相关指南,肌肉松弛药对神经电生理监测的运动     

经后正中小脑延髓裂入路切除儿童第四脑室肿瘤

[目的]了解经后正中小脑延髓裂入路手术切除儿童四脑室肿瘤的临床疗效及并发症.[方法]采用枕下后正中切口小脑延髓裂入路显微切除儿童第四脑室肿瘤12例.[结果]手术肿瘤全切除10例,近全切除2例.病理检查髓母细胞瘤10例,室管膜瘤2例,未能全切原因是1例因周围已种植转移未能全切,1例因与四脑室底粘连严重.术后核性面瘫(Ho...     

神经电生理监测下脑干肿瘤的显微外科治疗

目的：探讨神经电生理监测对脑干手术的指导意义,总结实施体会和改进方向。方法：回顾分析了既往2年内,在电生理监测下完成手术的48例脑干肿瘤病例资料。在总结手术疗效的同时,就影像资料对临床判断的指导作用,手术指征的把握,电生理指标的选择和意义等进行了讨论。结果：运用听觉脑干诱发电位、体感诱发电位、运动诱发电位等手段,为手术提供了强有力的支持。48例患者中,27例全切,15例大部切除,6例部分切除;术后无1例昏迷,一例因脑室炎死亡;神经机能较术前相仿或改善者31例,症候加重或出现新的废损17例（治疗随访,12例明显恢复,达到术前神经机能水平）。结论：在手术入路日趋成熟的今天,多参数神经电生理监测对于提高手术疗效、减少功能废损,具有重要意义。它为术中选择切人的安全区或探知神经通路的完整性提供了有力支撑,但对于特定神经机能评判仍存在不确定性,需要进一步研究。     

延髓髓内血管母细胞瘤切除后并发症的护理

我科自2001年4月—2005年6月共收治7例延髓髓内血管母细胞瘤病人,均给予手术切除,经围手术期护理,病人康复。现将护理报告如下。1临床资料本组7例,男4例,女3例,年龄12岁～54岁。病人自出现症状至住院时间为1个月～13个月,平均3.4个月。7例中4例有家族史,伴有多囊肾/多囊胰3例,伴有眼底血管瘤1例。本组病例均行CT及MRI检查确诊。术前伴严重后组脑神经麻痹2例,术后并发呼吸抑制1例,消化道出血2例,肺炎及呼吸道感染1例,伴吞咽困难1例,均有发热。7例肿瘤均行显微手术切除,并经病理证实为血管母细胞瘤。住院14d～40d,平均20d。术后1例出现呼吸…     

延髓肿瘤的临床分析

目的探讨延髓肿瘤的治疗策略,以达到最佳预后。方法回顾分析2007年1月-2010年12月19例延髓肿瘤患者的临床资料,其中18例经外科手术治疗和病理证实,1例通过影像学确诊。结果 12例血管网状细胞瘤中,11例手术全切,1例手术次全切;2例室管膜瘤均手术全切;2例海绵状血管瘤分别手术全切及伽马刀治疗;3例胶质瘤均手术部分切除。18例手术治疗患者术后神经功能障碍明显好转者13例,无明显变化者3例,2例因术后严重并发症死亡;1例伽马刀治疗患者症状好转。术后随访6～48个月,平均24个月。11例恢复工作,4例生活可自理,2例因肿瘤复发死亡。结论术前通过MRI检查、术中神经电生理监测及熟练的显微外科技术是外科治疗优势,伽马刀治疗延髓较小肿瘤有着损伤小的优点,因此制定合理的治疗策略有利于提高患者生存质量。     

延髓髓内血管母细胞瘤切除后并发症的护理

我科自2001年4月-2005年6月共收治7例延髓髓内血管母细胞瘤病人，均给予手术切除，经围手术期护理，病人康复。现将护理报告如下。 1 临床资料 本组7例，男4例，女3例，年龄12岁～54岁。病人白出现症状至住院时间为1个月～13个月，平均3．4个月。7例中4例有家族史，伴有多囊肾／多囊胰3例，伴有眼底血管瘤1例。本组病例均行CT及MRI检查确诊。术前伴严重后组脑神经麻痹2例，术后并发呼吸抑制1例，消化道出血2例，肺炎及呼吸道感染1例，伴吞咽困难1例，均有发热。7例肿瘤均行显微手术切除，并经病理证实为血管母细胞瘤。     

The use of evoked potentials in intraoperative neurophysiologic monitoring

Although not universally adopted, the growing body of literature provides strong evidence of the clinical utility of IOM in a variety of cerebrovascular surgical and endovascular procedures. The Therapeutics and Technology Subcommittee of the American Academy of Neurology and Fisher et al concluded that the following are useful and noninvestigational: 1. EEG, compressed spectral array, and SSEP in CEA and brain surgeries that potentially compromise cerebral blood flow, 2. BAEP and cranial nerve monitoring in surgeries performed in the region of the brainstem or inner ear, 3. SSEP monitoring performed for surgical procedures potentially involving ischemia or mechanical trauma of the spinal cord. They also came to the conclusion that although promising, motor EPs and visual EPs are still investigational. Further investigation, especially in the area of outcomes research and cost-effectiveness, is required before IOM can become standard practice.     

14例脑干海绵状血管瘤的显微手术治疗

目的探讨脑干海绵状血管瘤显微手术治疗的适应证及预后。方法对14例行显微手术治疗的脑干海绵状血管瘤患者的临床资料及手术效果进行分析总结。结果9例全切,4例次全切,其中1例于术后第3天再出血而死亡,另1例大部分切除。术后早期神经功能障碍改善6例,同术前5例,加重3例。随访6～38个月,仍有2例患者未恢复至术前状态。肿瘤未全切的4患者中有2例行放射治疗,肿瘤体积未见明确增大。肿瘤全切的9例患者生存良好,未见确切复发,亦无再次出血。结论对有手术指征的脑干海绵状血管瘤,积极行显微手术治疗效果良好。     

脑干肿瘤的显微手术治疗

目的探讨脑干肿瘤的外科治疗方法及其注意事项。方法48例脑干肿瘤依据MRI选择不同入路行显微手术治疗,术后给予呼吸、循环功能的对症处理。结果肿瘤全切除25例,次全切除10例,大部切除8例,部分切除5例;术后并发呼吸功能障碍10例,循环功能障碍4例,咳嗽反射减弱和上消化道出血各5例,肌力减弱9例;术后随访35例,神经系统功能明显好转29例。结论术前MRI检查和一定的手术技巧是脑干肿瘤手术治疗取得良好效果的关键,术后监护和并发症的处理可增加手术安全性。     

高血压脑干出血显微手术治疗

目的：探讨高血压脑干出血的显微外科治疗的手术指征、手术技巧、效果和预后。方法：回顾性分析21例高血压脑干出血患者的临床资料、手术方式、治疗效果及随访资料。结果：21例患者均于显微镜下清除血肿,无手术死亡,术中运用神经电生理监测。11例患者术后神经功能障碍得到改善,5例症状加重持续昏迷。5例术后死亡,术后随访6～18个月,9例生活基本能够自理,7例长期卧床。结论：采用显微外科技术治疗高血压脑干出血,效果良好。     

脑干血管母细胞瘤的手术治疗效果研究

目的探讨脑干血管母细胞瘤的手术治疗效果。方法脑干血管母细胞瘤患者共12例,均行显微外科手术切除。结果本组患者均恢复正常工作生活,随访未见肿瘤复发。结论通过充分的术前影像学评估,细致的显微外科手术操作及围手术期严密监护治疗,脑干血管母细胞瘤手术治疗效果良好。     

Maisonneuve injury with no fibula fracture: A case report

BACKGROUNDAnkle syndesmosis injury is difficult to diagnose accurately at the initial visit. Missed diagnosis or improper treatment can lead to chronic complications. Complete syndesmosis injury with a concomitant rupture of the interosseous membrane (IOM) is more unstable and severe. The relationship between this type of injury and Maisonneuve injury, in which the syndesmosis is also injured, has not been discussed in the literature previously.CASE SUMMARYA 16-year-old patient sustained left medial malleolar fracture, and the associated inferior tibiofibular syndesmotic instability was overlooked. After open reduction and internal fixation of the medial malleolar fracture, inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging. Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws. Twelve weeks later, the screws were removed. At the 6-mo follow-up, the patient gained full range of motion of the ankle.CONCLUSIONComplete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury. Open reduction and internal fixation could obtain good outcomes.     

Auditory-evoked potentials during coma: Do they improve our prediction of awakening in comatose patients?

Objective

The mismatch negativity (MMN), an auditory event-related potential, has been identified as a good indicator of recovery of consciousness during coma. We explored the predictive value of the MMN and other auditory-evoked potentials including brainstem and middle-latency potentials for predicting awakening in comatose patients after cardiac arrest or cardiogenic shock.

Materials and Methods

Auditory brainstem, middle-latency (Pa wave), and event-related potentials (N100 and MMN waves) were recorded in 17 comatose patients and 9 surgical patients matched by age and coronary artery disease. Comatose patients were followed up daily to determine recovery of consciousness and classified as awakened and nonawakened.

Results

Among the auditory-evoked potentials, the presence or absence of MMN best discriminated between patients who awakened or those who did not. Mismatch negativity was present during coma in all patients who awakened (7/7) and in 2 of those (2/10) who did not awaken. In patients who awakened and in whom MMN was detected, 3 of those awakened between 2 and 3 days and 4 between 9 and 21 days after evoked potential examination. All awakened patients had intact N100 waves and identifiable brainstem and middle-latency waves. In nonawakened patients, N100 and Pa waves were detected in 5 cases (50%) and brainstem waves in 9 (90%).

Conclusions

The MMN is a good predictor of awakening in comatose patients after cardiac arrest and cardiogenic shock and can be measured days before awakening encouraging ongoing life support.     

Persistent hiccup after surgical resection of a brainstem arteriovenous malformation: a case successfully treated with gabapentin during rehabilitation. Case report

Persistent hiccup rarely occurs during rehabilitation, but its management can prove to be very difficult, particularly in presence of associated dysphagia, requiring longer hospitalization and higher risk of severe clinical complications. We present a case of persistent hiccup after surgical resection of a brainstem arteriovenous malformation successfully treated with gabapentin during rehabilitation.