内窥镜辅助下侧颅底手术

目的观察内窥镜辅助下侧颅底手术的疗效及并发症。方法在内窥镜辅助下采用迷路进路及乙状窦后进路行听神经瘤手术11例，颅中窝进路及颅中窝、乳突联合进路行岩尖胆脂瘤手术5例。结果听神经瘤全切除9例，2例残留部分包膜；术中内窥镜下探查面神经均完整，其中9例术后无面瘫表现，2例术后出现轻度周围性面瘫；术中内窥镜下探查蜗神经均完整，2例术后听力与术前比较保持不变，9例出现不同程度听力下降。其中，中度感音神经性耳聋1例，中重度2例，重度3例，极重度3例。岩尖胆脂瘤患者均行病变全切除，3例术前面瘫患者经术中减压，术后9个月内均恢复。2例术后出现中重度传导性耳聋，其余患者术后听力无明显改变。结论侧颅底手术中使用内窥镜可提高血管、神经保全率及病变全切率，但也有其不足，仅能作为显微镜手术的辅助使用。     

岩尖胆脂瘤2例的诊断与治疗

目的探讨岩尖胆脂瘤的临床特征、手术进路和方法,以提高手术疗效,减少并发症。方法总结了2例岩尖胆脂瘤的回顾性资料。结果 2例均有重度耳聋、眩晕、面瘫及慢性中耳炎病史,颞骨CT扫描作出诊断,耳内镜辅助下经迷路-耳蜗径路全部切除岩尖胆脂瘤。2例术后均无脑脊液漏和感染,无眩晕或平衡失调。结论认为颞骨CT扫描及MRI对临床诊断及手术径路的选择有重要作用。手术清除病灶为本病治疗的惟一措施,耳内镜辅助下经迷路-耳蜗径路为彻底清除胆脂瘤、处理面神经及脑脊液漏提供了最直接的通道。     

神经内镜辅助显微外科治疗颅底胆脂瘤

目的探讨神经内镜在颅底胆脂瘤显微手术治疗中的应用价值。方法神经内镜辅助显微手术治疗颅底胆脂瘤20例,其中经乙状窦后入路10例,颞下经小脑幕入路6例,改良翼点颞下入路3例,颞枕开颅幕上下联合入路1例。结果显微镜下手术后应用神经内镜观察,20例均有肿瘤残留。全切15例,次全切5例。术后无并发症11例。新增动眼神经麻痹3例,展神经麻痹1例,后组颅神经麻痹2例,轻面瘫3例,肢体轻偏瘫2例,短暂失语1例,无菌性脑膜炎1例。15例患者随访3~36个月,均恢复正常生活。结论根据胆脂瘤的主体部位及其生长方式选择适合的手术入路,是手术成功的关键。术中应用神经内镜辅助有助于减少手术创伤,提高肿瘤切除率。     

神经内镜辅助显微外科治疗颅底胆脂瘤

目的探讨神经内镜在颅底胆脂瘤显微手术治疗中的应用价值。方法神经内镜辅助显微手术治疗颅底胆脂瘤20例，其中经乙状窦后入路10例，颞下经小脑幕入路6例，改良翼点颞下入路3例，颞枕开颅幕上下联合入路1例。结果显微镜下手术后应用神经内镜观察，20例均有肿瘤残留。全切15例，次全切5例。术后无并发症11例。新增动眼神经麻痹3例。展神经麻痹1例，后组颅神经麻痹2例，轻面瘫3例，肢体轻偏瘫2例，短暂失语1例，无菌性脑膜炎1例。15例患者随访3～36个月。均恢复正常生活。结论根据胆脂瘤的主体部位及其生长方式选择适合的手术入路，是手术成功的关键。术中应用神经内镜辅助有助于减少手术创伤，提高肿瘤切除率。     

神经电生理监测、术中B超应用下听神经瘤的显微手术配合

目的探讨显微手术切除听神经瘤中应用神经电生理监测、术中B超的手术配合要点及意义。方法回顾研究我院近5年来显微手术治疗听神经瘤患者40例,其中28患者在术中行神经电生理监测以及应用术中B超检查（监测组）;其余12例为非监测组。手术中熟练有效的护理配合保障手术的顺利进行。结果 40例患者跟踪随访3个月～4年,未监测组肿瘤全切8例,4例患者行肿瘤近全切;神经电生理监测＋B超组（下简称监测组）肿瘤全切26例,2例患者行肿瘤近全切。未监测组7例术后患者面瘫恢复或好转,4例无明显变化,加重1例;听力恢复或好转1例,10例无变化,加重1例。监测组术后患者面瘫恢复或好转24例,1例无明显变化,加重3例;听力恢复或好转12例,16例无明显变化,加重0例。监测组与非监测组在肿瘤切除率、面/听神经功能改善方面比较,P均〈0.05。结论听神经瘤显微手术治疗中,充分的术前准备,协调的护理配合,加上神经电生理监测、B超应用可较好地保护面、听神经的功能,提高全切率,对保障手术的顺利进行,提高手术效果有积极的意义。     

听神经瘤手术30例治疗体会

目的总结30例听神经瘤手术切除治疗提高肿瘤全切除率预防并发症。方法选取30例听神经瘤采用乙状窦后入路治疗方法资料进行分析。结果本组30例患者均采用手术治疗,25例术后康复良好并痊愈出院,4例好转后自动出院,1例死亡。面神经的保存率超过90%~95%。结论颅中窝或经迷路后入路手术更有利于保留听力功能;但当肿瘤已生长至桥小脑角,采取经乙状窦后入路可能更合适。     

观察儿童胆脂瘤型中耳炎临床手术治疗效果

目的：探讨儿童胆脂瘤型中耳炎的临床手术治疗效果。方法选取我院2005年3月至2011年3月间进行手术治疗的胆脂瘤型中耳炎患者65例,其中后天性胆脂瘤62例,先天性胆脂瘤3例。广泛病变需采用开放式乳突凿开术有50例,鼓室胆脂瘤患者需采用完璧式乳突凿开术有13例,因中耳腔病变需采用鼓室探查术有2例。结果经过手术治疗后,听力提高者有43例,保持原有听力者14,听力下降者8例。其中有4例因病变复发,需进行二次手术。结论儿童胆脂瘤型中耳炎的侵袭性较强,为使治疗效果有所提高,必须强化术前分析和手术操作,并加强术后随诊。     

显微血管减压术治疗面肌痉挛并发症的预防及治疗探讨

目的 探讨显微血管减压术治疗面肌痉挛手术并发症的预防及治疗方法.方法 对57例显微血管减压术治疗的面肌痉挛患者进行回顾性分析.结果 57例中发生并发症12例,其中颅神经损伤9例(面瘫6例、听力下降3例),脑脊液漏1例.口唇疱疹2例.结论 术中对责任血管的正确判断、娴熟的显微操作和实时的术中监测是减少并发症的有效手段.面瘫、脑脊液漏及口唇疱疹等并发症规范治疗,预后良好,听神经损伤难以恢复,预防为主.     

显微血管减压术治疗面肌痉挛并发症的预防及治疗探讨

目的 探讨显微血管减压术治疗面肌痉挛手术并发症的预防及治疗方法.方法 对57例显微血管减压术治疗的面肌痉挛患者进行回顾性分析.结果 57例中发生并发症12例,其中颅神经损伤9例(面瘫6例、听力下降3例),脑脊液漏1例.口唇疱疹2例.结论 术中对责任血管的正确判断、娴熟的显微操作和实时的术中监测是减少并发症的有效手段.面瘫、脑脊液漏及口唇疱疹等并发症规范治疗,预后良好,听神经损伤难以恢复,预防为主.     

显微血管减压术治疗面肌痉挛并发症的预防及治疗探讨

目的 探讨显微血管减压术治疗面肌痉挛手术并发症的预防及治疗方法.方法 对57例显微血管减压术治疗的面肌痉挛患者进行回顾性分析.结果 57例中发生并发症12例,其中颅神经损伤9例(面瘫6例、听力下降3例),脑脊液漏1例.口唇疱疹2例.结论 术中对责任血管的正确判断、娴熟的显微操作和实时的术中监测是减少并发症的有效手段.面瘫、脑脊液漏及口唇疱疹等并发症规范治疗,预后良好,听神经损伤难以恢复,预防为主.     

颅底肿瘤的显微外科治疗

目的提高对颅底肿瘤治疗的认识。方法回顾分析显微外科手术治疗颅底肿瘤56例的临床特点和总结手术体会。结果56例颅底肿瘤中,手术全切除46例,次全切除4例,大部切除6例。术前颅神经功能损伤35例46条,术后恢复23条（50%）,好转8例（17.4%）,症状无改善9条（19.6%）,加重6条（13.0%）,出现新的颅神经症状者5例。结论术前精确的诊断对手术及预后非常重要。手术入路主要取决于肿瘤的位置、延伸及大小。显微外科手术是减少术后并发症、获得良好预后的关键。     

枕下-乙状窦后显微手术切除听神经瘤48例

为探讨听神经瘤手术切除经验,提高肿瘤全切率和面、听神经保留率,本研究回顾性分析枕下－乙状窦后入路４８例听神经瘤显微手术,并对手术要点、肿瘤大小与肿瘤全切率和面、听神经保留率之间的关系进行了讨论。如果１３例小于２ｃｍ的肿瘤 全切,１８例２￣４ｃｍ的肿瘤,全切１６例,１７例大于４ｃｍ的肿瘤,仅１０例全切。肿瘤全切除率８１．３％,面神经保留率７７．１％,功能恢复率６６．７％,术前有听力者听神经保留率５２     

手术治疗85例慢性化脓性中耳炎的临床效果分析

目的 探讨手术治疗慢性化脓性中耳炎的临床效果.方法 选取85例(91耳)慢性化脓性中耳炎患者作为研究对象,根据患者情况选择开放式或闭合式或改良式乳突根治术;术后随访6个月,纯音听力语言频率气导听阈,统计患者并发症情况.结果 术后6个月纯音测听语言频率气导听阈均较治疗前有明显改善,差异有统计学意义(P＜0.05),其中,62例(64耳)听力提高,占70.3％,20例(24耳)听力无改善,占26.4％,3例(3耳)听力下降,占8.3％;术后＜1个月,出现2例创口感染,1例面瘫,4例眩晕;术后＜6个月,4耳鼓膜再穿孔(4.4％).结论 对骨疡型、胆脂瘤型及单纯型经药物保守治疗无效的慢性中耳炎患者,根据其病变部位及咽鼓管功能情况,选择合适的手术方法治疗,可快速清除中耳病变,阻止其引发严重的颅内、外并发症,还可有效改善患者听力.     

面神经微血管减压术后并发症分析及治疗

目的：探讨面肌痉挛微血管减压术（MVD）后并发症的原因、预防措施及预后。方法：对笔者所在医院2009年3月-2011年3月行MVD治疗的54例面肌痉挛患者进行1年以上的随访,观察相关并发症的发生、发展及转归情况。结果：12例（22．2％）术后出现不同程度面瘫,其中3例为迟发性面瘫,5例（9．3%）出现轻度听力下降,2例（3．7％）出现耳鸣,1例（1．9%）颅内感染,3例（5．6％）出现皮下积液,1例（1．9％）复视,本组无脑脊液漏及死亡病例,随访1-3年,面瘫及听力下降者全部恢复,1例复视于术后2周自愈,1例仍有耳鸣并出现进展性听力下降。结论：面瘫、耳鸣、听力下降及皮下积液是MVD主要症状,面瘫、耳呜、听力下降及皮下积液多可以恢复或部分恢复,耳聋为远期并发症,术中注意操作技巧,术后给予适当的治疗可有效预防并发症发生。     

Méningite à Streptococcus salivarius avec bactériémie révélant un cholestéatome de l'apex petreux

Streptococcus salivarius meningitis are uncommon and often iatrogenic. We describe the case of a patient with community-acquired Streptococcus salivarius meningitis that revealed petrous apex cholesteatoma. A 50-years old patient was hospitalized because of severe headache, fever (39 °C), vomiting, and confusion. Cerebrospinal fluid (CSF) showed 2044 cells/mm³ with 91% neutrophils, Gram positive cocci, protein level > 2.5 g/L, glucose level 2.5 mmol/L (glycemia 7.1 mmol/L). Two blood cultures and CSF culture were positive with Streptococcus salivarius. Evolution was good with amoxicillin treatment. The patient had rhinorrhea and chronic otitis. Cholesteatoma was revealed in a scanner, and was opered. Community-acquired Streptococcus salivarius meningitis are unfrequent, and can reveal ENT pathology like cholesteatoma.     

Recurrent purulent bacterial meningoencephalitis

During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET) is recommended, because it is useful not only in the functional evaluation of the cerebral tissue after the injury, but also in assessing the dynamics of pathologic changes.     

Sequelae of epidemic meningococcal meningitis in Africa

Audiological and other long-term neurological sequelae were determined in 157 cases and their controls matched for age, sex and village 6 to 12 months after an epidemic of group A meningococcal meningitis in rural West Africa. 19 cases (12.1%) and 3 controls (1.9%) had moderate or severe neurological sequelae of any type (P less than 0.001); 6 cases (3.9%) and no controls had severe or profound sensorineural hearing loss (P = 0.03). There was no difference in conductive hearing loss between cases and controls. Other cranial nerve sequelae (except visual defects) and generalized neurological and motor and co-ordination sequelae were also significantly increased in cases. Sensorineural hearing loss and other cranial nerve sequelae occurred significantly more frequently in males than in females, and co-ordination sequelae more frequently in cases aged 10 years or more than in younger cases. Sensorineural hearing loss and loss of visual acuity were found significantly more frequently in cases whose treatment was delayed for 4 d or more, compared with those who received treatment sooner.     

Guillain-Barre syndrome in children. Report of 39 cases

The authors report a retrospective study of 39 cases of Guillain-Barré syndrome in children. Including 23 boys and 16 girls. The mean age was 4 years (14 months to 10 years). A history of infection preceded the polyradiculoneuritis in 75% of cases. The mean duration of extensive phase and of the maximum paralysis was 10 days. A severe respiratory involvement was observed in 9 children and cranial nerve paralysis in 8 children. An early raised cerebrospinal fluid protein concentration was found in 95%. Electrodiagnostic studies, performed in 37 patients, showed nerve conduction velocity slowing in all cases. 28 children (73%) recovered clinically, 8 patients (20%) had residual deficits and 3 patients (7%) died.