儿童脊髓内肿瘤的显微外科治疗

目的总结儿童髓内肿瘤的病理特点、显微手术和治疗效果，并进行探讨。方法81例儿童脊髓内肿瘤均经手术切除和病理证实，对手术治疗的效果进行回顾性分析。结果儿童髓内肿瘤以星形细胞瘤24例（29．6％）、室管膜瘤13例（16．0％）和表皮样囊肿11例（13．6％）为多见，不同的病理类型的肿瘤，切除率不同。放疗用于高度恶性的肿瘤。椎板复位术可以有效地减少脊柱畸形的发生率。结论大多数的髓内肿瘤组织学上为低级别星形细胞瘤（Ⅰ～Ⅱ级）、室管膜瘤和胚胎残余组织肿瘤，积极手术切除能够获得满意的疗效。     

儿童颅内动静脉畸形的显微外科治疗

目的 总结显微手术治疗31例儿童颅内动静脉畸形的经验体会,探讨其治疗方案和手术注意事项.方法 我院自2003年6月～2007年6月对31例儿童颅内动静脉畸形的临床资料、治疗过程以及诊治结果进行回顾性分析.31例中有25例以脑内出血起病,5例以癫痫为主要表现,1例表现为轻度头痛.按照Spetzler-Martin分级,Ⅰ级2例,Ⅱ级12例,Ⅲ级10例,Ⅳ级5例,Ⅴ级2例.单纯手术治疗24例,栓塞后手术7例.结果 31例动静脉畸形团均全切除.6例治疗后出现一过性神经功能缺损或轻度新增神经功能缺损,1例患儿遗留偏瘫.无死亡病例.结论 显微手术切除术可以相对安全有效地治疗儿童颅内动静脉畸形,对于大型或位于功能区的颅内动静脉畸形(AVM),术前栓塞有助于提高疗效.     

儿童脑脓肿32例诊治体会

目的　探讨儿童脑脓肿的临床诊断和治疗情况。方法　对 32例根据临床症状和辅助检查确诊为脑脓肿的患儿进行分析 ,观察内外科治疗效果。结果　 32例儿童脑脓肿中具有典型三联征者仅 8例 (2 5 % ) ,全身感染表现者 14例 (43.8% ) ,头痛者 15例 (46 .9% ) ,神经系统定位体征者 14例 (43.8% ) ,癫痫样发作者 12例(37.5 % )。CT确诊者 2 8例 (87.5 % ) ,4例作MRI确诊。保守治疗 2 1例 ,脓肿消失 13例 ,缩小 6例 ,总有效率90 .5 %。外科治疗 13例 ,单纯穿刺抽脓术 8例 ,脓肿消失 5例 ,缩小 3例 ,脓肿切除术 5例 ,死亡 1例。结论　儿童脑脓肿临床症状多不典型 ,头颅CT扫描对确诊极具重要意义 ,保守治疗是本病的主要疗法 ,其次是单纯穿刺抽脓术。     

儿童脑脓肿的研究进展

近年来随着诊断及治疗措施的改进,脑脓肿的病死率已有明显下降。本文阐述了儿童脑脓肿的病因、发病机制、微生物学、诊断及治疗学等方面的新进展。     

儿童脑脓肿37例临床特征和治疗随访

目的 阐明儿童脑脓肿临床特征,探讨脑脓肿的治疗方法。方法 对３７例经ＣＴ和ＭＲＩ确诊为脑逐月中的患儿临床特征进行分析,对疗效进行观察,对其中２３例进行病后３个月～５年的随访。结果 ３７例患儿中未查到原发感染灶的２９例（７８％）,以癫痫为首发症状者２０例（５４％）,头痛者１８例（４９％）,发热者１３例（３５％）,３０例经保守治疗１１例治愈,１２例好转,总有效率７７％;７例采取外科治疗,１例治愈,３例     

儿童脑脓肿46例临床分析

脑脓肿是儿童期颅内严重化脓性感染之一,病死率极高,其主要原因是不易早期诊断和准确定位,以致延误治疗时机。我院自1969～1989年收治小儿脑脓肿46例,现分析报告如下。     

儿童脑脓肿43例临床分析

目的通过对43例儿童脑脓肿病例的分析,进一步认识该病的临床特点。方法回顾上海第二医科大学附属新华医院小儿神经内科1994—2006年就诊的43例儿童脑脓肿的临床表现、致病因素、实验室检查、影像学表现和治疗结果,进行分析。结果临床表现:发热26例(60.5%)、抽搐22例(51.2%)、头痛18例(41.9%)、呕吐15例(34.9%)。先天性心脏病是儿童脑脓肿最常见的致病因素(22例,51.2%),其次为原因不明(12例,27.9%)。有影像资料的共40例,其中合并有先天性心脏病的20例。儿童脑脓肿发生部位以额叶、顶叶较为多见,额叶为20例(50%)、顶叶为15例(37.5%);在非先天性心脏病的脑脓肿患儿以单个脓肿多见为15例(75.0%),而先天性心脏病的脑脓肿患儿中则以多发性脓肿多见为12例(60.0%)。结论儿童脑脓肿的临床表现具有多样性,影像学检查对于脑脓肿的诊断有重要意义。     

应用神经内镜治疗儿童多房脑脓肿

目的：神经内镜技术在最近20年取得了重大进步并得到了广泛应用,而儿童多房脑脓肿目前仍是神经外科的急症之一,死亡率和致残率较高。该文通过总结应用神经内镜治疗儿童多房脑脓肿的临床经验,探讨神经内镜技术在手术治疗儿童多房脑脓肿中的作用。方法：2002年1月至2007年6月,该研究应用神经内镜治疗了16例多房脑脓肿的患儿。结果：该组16例患儿术后颅高压症状均缓解, 术后复查头颅CT/MRI示脓肿腔消失,仅存脓肿壁。随访到的14例患儿随访时间为6个月至5年,13例脓肿壁均消失,术后脓肿复发1例。结论：用神经内镜治疗儿童多房脑脓肿具有安全、高效、并发症少的优势。［中国当代儿科杂志,2009,11（1）：41-43］     

Brain abscess in children

Objectives: Brain abscess is a serious life-threatening complication of several diseases. The objective of this study was to look at the clinical profile of patients, predisposing conditions, microbiology and outcome of children suffering from brain abscess.Methods: Thirty children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was 5.6±4.4 years.Results: The duration of illness at the time of admission was 17.6±24.6 days. Typically patients presented with fever, vomiting, headache and seizures. The predisposing conditions found were cyanotic congenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%), and no underlying cause was found in 5 (17%) children. The most common microbe in children with cyanotic congenital heart disease was of theStreptococcus milleri group (52%). Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6 children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5.Conclusion: Brain abscess is a serious infection with poor outcome if diagnosed late. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosis should be low, particularly in children with a predisposing condition like cyanotic congenital heart disease.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

Diagnosis and treatment of hepatic amebic abscess in children

From 1 January 1976 to 31 December 1985, 11 children under the age of 12 years (range 11 months to 11 years) were treated for hepatic amebic abscess at the UCLA-affiliated hospitals with no mortality. There were 7 girls and 4 boys, and all were of Mexican or Mexican-American descent. In only 3 instances (27%) was the correct diagnosis considered on admission. In 3 patients the diagnosis was made when symptoms persisted following a negative laparotomy for appendicitis, but all 3 made a complete recovery on medical therapy. A delay in diagnosis in 2 other patients contributed to intrahospital rupture of the abscess and resultant urgent surgical drainage. In the remaining 6 patients, amebicidal therapy alone proved effective and no surgery was required. The complex of fever, abdominal pain, anemia, leukocytosis, and elevated erythrocyte sedimentation rate in a child without a definite diagnosis should prompt the clinician to entertain an early diagnosis of amebic liver abscess and to begin immediate therapy with a safe and efficacious drug.     

Renal abscess in children

As in adults, renal abscess in children mimicks a tumoral syndrome. Renal abscess, although infrequent, should however be kept in mind because it is important to make an early diagnosis. The reason is simply that the treatment of the two conditions is so different. Furthermore, an early accurate diagnosis avoids unnecessary investigations, such as arteriography, as well as unnecessary surgery. Four cases are reported in which the diagnosis of abscess was obtained by correlating both clinical and radiological findings. In only one case was arteriography performed and this was after treatment and it was normal.For an early diagnosis intravenous urography is of paramount importance. It shows a tumoral radiological pattern; in the context of clinical signs of suppuration (high fever, high leucocyte count and variably a urinary tract infection). The radiological findings suggest the diagnosis of abscess. On treatment the rapid regression and disappearance of the various clinical, laboratory, and radiological findings confirms the diagnosis of renal abscess.     

儿童癫痫的手术治疗

目的 总结分析儿童期顽固性癫痫手术治疗效果和经验。方法 回顾性分析2001年7月～2002年11月在我科接受手术治疗的25例14岁以下的顽固性癫痫病例，统计患儿的发病、检查及手术治疗情况，手术方式的选择应依据患儿术前脑电图与术中脑电图的定位情况而进行。结果 本组25例患儿，年龄3～14岁，病程平均5．3年，影像学异常9例，占36．0％(9／25)，智商明确缺陷12例，占48．0％(12／25)，以强直一痉挛性发作为主16例，占64．0％(16／25)。病灶位于额叶10例，占40．0％(10／25)，颞叶6例，占24．0％(6／25)，额颞叶5例，占20．0％(5／25)，顶叶和枕叶各2例，占8.0％(2／25)。手术行病灶切除及前颢叶切除11例，占44．0％(11／25)，选择性海马一杏仁核切除4例，占16．0％(4／25)，胼胝体切开15例，占60.0％(15／25)，单纯多处软膜下横切2例，占8，0％(2／25)。术后出现一过性对侧轻瘫4例，一过性语言不利2例。术后疗效满意23例占92.0％(23／25)，显著改善1例占4.0％(1／25)，良好1例占4．0％(1／25)。结论 合理的选择手术方式，对儿童期顽固性癫痫手术治疗，手术效果良好，非常安全。     

Brain abscess: a complication of esophageal dilatations

In this article, we report two new cases of brain abscess in patients under treatment for esophageal stricture secondary to caustic ingestion. This supports Rontal's hypothesis that the pressure from esophageal dilatation may result in microscopic perforation and/or bacteremia and that high-dose steroid treatment facilitates bacterial seeding by impeding the formation of protective scar tissue. This serious complication should be kept in mind when long-term treatment by repeated esophageal dilatations is planned. Offprint requests to: A. Bautista-Casanovas     

儿童先天性心脏病并发脑脓肿的诊治

目的 探讨先天性心脏病并发脑脓肿的诊断及治疗方法。方法 回顾10年19例先天性心脏病并发脑脓肿患儿，分析其诊断、治疗特点及预后，并行文献资料分析。结果 19例患儿，年龄3～16岁，平均7．4岁，男7例，女12例，病史3d～38个月，平均13个月。法洛四联症13例，肺动脉瓣狭窄合并房间隔缺损(或卵圆孔未闭)3例，室间隔缺损1例，室间隔缺损并肺动脉狭窄2例。16例CT及增强CT扫描确诊，3例MRI扫描确诊。CT动态扫描行疗效评估。抗生素保守治疗7例，治愈3例；外科手术治疗12例，治愈11例，手术方式为脓腔穿刺引流。随访时间9～48个月。结论 先天性心脏病并发脑脓肿预后凶险，CT是诊断其最佳方法，早期穿刺引流是首选治疗手段。     

Brain abscess in children – epidemiology,predisposing factors and management in the modern medicine era

Aims: Brain abscess is rare in children. Predisposing factors are found in almost 85% of cases. Overall, 25% of brain abscesses develop in children, mostly in the 4–7 years age group. Our study aimed to characterize children with brain abscesses treated in our hospital, identify risk factors, pathogens and short‐term outcome. Methods: A retrospective cohort of 20 years period, (1989–2009) included 27children (0–18 years). Medical records were analysed for age, gender, presenting symptoms and signs, predisposing factors, laboratory tests, imaging, microbiology results, treatment and outcome. Results: Of all the children, 63% (17/27) were male patients; mean age was 7.9 years and 52% were referred from other hospitals. Predisposing factors were identified in 81%, congenital heart disease and otitis were rare and sinusitis was found in 22% of the children. Main symptoms and signs included headaches, fever, neurological signs convulsions, (41%, 81%, 78% and 41% respectively). In 30% of cases, cultures were sterile. All patients were operated in addition to antibiotic treatment. Outcome was good with low mortality rate (3.7%). Conclusions: Manifestations of brain abscess may be subtle. A high index of suspicion and early imaging are warranted, different predisposing factors may reflect early intervention for congenital heart diseases. Mortality is rare in the modern medicine era.