颅骨缺损修补术后癫痫5例报告

继发性癫痫是颅脑损伤后严重并发症之一,为临床常见病、多发病,其进展缓慢,病程较长,严重影响社会生产力。国内外对于继发性癫痫的治疗研究颇多,但有关颅骨修补术后致痫因素方面的报道较少。我院2004年8月至2010年5月行颅骨缺损修补术后发生癫痫5例,现总结报道如下。     

颅骨缺损修补术后并发恶性脑水肿1例

<正>1临床资料1.1患者资料患者:男,24岁,因车祸后右侧肢体活动不灵伴言语障碍3月余入院,头核磁示:左侧额颞顶颅骨局部缺损,脑组织外膨;左侧额颞叶、岛叶、基底节区缺血,部分呈亚急性期表现;伴左侧颈内动脉颅内段闭塞;鼻窦炎。并于2016年06月29日行去骨瓣减压术,术后患者清醒,遗留右侧肢体运动障碍及言语障碍,后行系统康复物理治疗近2月,病情好转。遂于2016年11月14日于全麻下行颅骨缺损修补术,术     

外伤性颅骨缺损后自体颅骨修补384例报告

作者1991年1月～2004年12月对384例脑外伤患者行成形骨瓣开颅后，将骨瓣包埋于左下腹壁皮下，2～3个月后择期行自体颅骨骨瓣修补颅骨缺损，效果满意，现报告如下。     

外伤性颅骨缺损后自体颅骨修补384例报告

作者1991年1月~2004年12月对384例脑外伤患者行成形骨瓣开颅后,将骨瓣包埋于左下腹壁皮下,2~3个月后择期行自体颅骨骨瓣修补颅骨缺损,效果满意,现报告如下。1临床资料本组男239例,女145例,年龄17~65岁,平均41.2岁。颅骨缺损部位:额颞顶部242例、颞顶79例、额部39例、枕部24例,颅骨缺损范围约为5.0 cm×7.0 cm~10 cm×14 cm。手术方法:将术中取下的减压颅骨骨瓣先浸泡于无菌生理盐水中,待手术完毕后,常规消毒下腹部,将骨瓣凸面向上,包埋于左下腹皮下。骨瓣如有骨折且大骨片离断者将其重叠,包埋于腹壁皮下,粉碎性骨折小骨片未离断者整复后用生…     

颅骨修补术后常见并发症分析

目的探讨颅骨修补术后头皮下积液、癫痫和自发性脑出血发生的相关因素。方法回顾分析2009年11月~2013年6月本院颅骨修补术后患者211例,均采用二维钛合金网板修补材料。术后常规护理治疗,对出现相关并发症按诊疗常规积极处理。统计术后术侧头皮下积液、癫痫和自发性脑出血的发生情况,对可能的相关因素,包括性别、年龄、原发病因、颅骨缺损部位、发病至修补术时间、术前并发脑积水情况以及术中硬膜破损情况进行分析。结果患者三种并发症总发生率为4.7%(10/211)。术后出现术侧头皮下积液4例,癫痫发作5例,自发性脑出血1例。头皮下积液与术前存在脑积水(χ~2=4.804,P=0.028)及术中硬膜破损(χ~2=7.510,P=0.006)相关。癫痫发作及自发性脑出血与以上因素不相关(P0.05)。结论术中严密修补破损硬膜,术后及时处理脑积水,可以减少术后头皮下积液的发生。     

颅骨修补术后32年并发硬膜外血肿1例

<正>1临床资料患者女性,51岁,因右侧头部胀痛1周于2014年5月8日入院。患者1979年10月19日因开放性颅脑损伤行开颅手术。1980年12月行颅骨缺损修补术(修补材料为有机玻璃)。2012年11月体检行头颅CT扫描发现右颞顶枕部硬膜外血肿(血肿量约40ml),未行治疗。2012年12月及2013年2月两次复查头颅CT扫描,均显示颅内血肿未增多。2014年5月1日无明显诱因出现右侧头部胀痛,并扪及右颞顶枕部头皮肿胀。5月4日到我院就诊,     

外伤性颅骨缺损后修补术100例

外伤性颅骨缺损是颅脑外伤后一种常见并发症。我科自1997年10月至2004年11月共收治100例外伤性颅骨缺损病例行颅骨修补术,现分析报道如下。1临床资料1.1一般资料本组100例,男64例,女36例,年龄13～65岁,平均30.2岁。住院时间10～20d,平均12d。颅骨缺损部位:额颞顶部72例,颞顶部25...     

颅骨缺损修补术184例分析

2000年1月至2005年12月我科收治了因颅骨缺损而施行颅骨修补术的病例184例,现就颅骨修补的适应证、修补材料、对神经功能的影响以及术后并发症等问题,结合献进行分析。     

颅骨缺损修补术67例临床分析

目的探讨可塑形钛网修补颅骨缺损的效果及对患者神经功能的恢复改善情况。方法对本科2007年1月至2011年10月收治的67例颅骨缺损患者,均用三维钛网进行了颅骨修补,术后常规预防感染、止血治疗,负压引流管根据引流情况于24～48h内拔除。结果 64例颅骨缺损头颅外观正常修复,7例出现皮瓣下积液,3例大骨瓣缺损外观塑形稍差。结论三维钛网硬度大,容易塑形,使用钛网行颅骨缺损手术,手术操作简便,创伤小,只要修补时机选择适当,对患者的神经功能恢复和预后的改善是有帮助的。     

颅骨缺损修补术63例临床分析

颅骨缺损修补术是神经外科常见的手术。本科2004年8月至2010年5月对63例颅骨缺损患者进行了颅骨修补术。现对63例患者资料作一回顾性分析,报告如下。     

Facial pain in a case of cranial dystonia: a case report

A 76-year-old man had shown sustained excruciating facial pain in the maxillary region for more than 30 years. Since he was suffering from blepharospasm, facial electromyography was performed and revealed a perioral dystonia. This possible cause of facial pain might have been overlooked had dystonia not been considered and electromyographical studies performed. Repeated intramuscular perioral injections of botulinum toxin brought about complete pain relief. This case shows that involuntary activity of facial muscles can cause a severe chronic pain syndrome. Possible mechanisms include irritation of ascending trigeminal fibers, muscle ischemia due to compression of blood vessels, or release of pain-producing substances.     

Persistent fibrinogen deficiency after snake bite: A case report

BACKGROUNDVenom-induced consumption coagulopathy (VICC) is characterized by coagulation dysfunction accompanied by decreased coagulation factor activity and fibrinogen (FBG) concentrations. We report a patient with VICC caused by snake bite who manifested persistent FBG deficiency without abnormal coagulation factor activity. This information may be helpful in diagnosing and treating VICC.CASE SUMMARYA 49-year-old man who had been bitten by a snake 13 h previously was admitted to the Emergency Department of our hospital with visible swelling of a finger and a bleeding puncture site. The provisional diagnosis was VICC, this being made based on persistent bleeding from the puncture site and subcutaneous hemorrhage. Laboratory evidence of coagulation abnormalities, including fibrinolysis, and findings on thromboelastography confirmed VICC. He had persistent afibrinogenemia requiring intravenous infusions of cryoprecipitate and fresh frozen plasma, together with continuous large doses of human FBG. After this treatment, the patient’s right upper limb swelling improved significantly and his subcutaneous hemorrhage resolved. All of his abnormal laboratory findings returned to normal by day 25. During 6 months’ of follow-up, the patient had no further hemorrhagic events.CONCLUSIONHemorrhagic snake venom can result in coagulation dysfunction characterized by persistent FBG deficiency without abnormal coagulation factor activity.     

Laparoscopic repair of complete intrathoracic stomach with iron deficiency anemia: A case report

BACKGROUND Giant paraesophageal hiatal hernias(HH)are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch(either synthetic or biologic)is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoracic stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.     

颅骨缺损修补对病人精神心理的影响

Localcranialdeficiencyiscommonafteroperationsoncranialtraumaortumors．Intheearlystageofdisease，itplaysactiveef－fect．Butinrehabilitationstageitcouldcauseseriousofpathologi－calandphysiologicalchanges，andaffectthebodyandmindnega－tively．１Subjectsandmethods１．１Subjects２６patientswithcranialdeficiencyreceivedfromJanuary１９９１toSeptember２００１wereallmales，agedfrom１８to５１yearsold．Decompressionbyboneflapresectionwasperformedbe－causeofintracranialhematomaaftercerebralcontusionandl…     

后颅窝胶样囊肿1例报告

患者女，49岁。两年前无明确诱因出现后枕部胀痛，呈间断性发作，每次持续约半分钟，头低位时加重。近一年疼痛加重，用力后疼痛加剧，且发作频繁。半年前出现走路不稳，下肢无力。3个月前开始头晕并呕吐，呕吐物为胃内容物。外院CT平扫示肿块呈高密度，边缘清楚。     

Thoracoabdominal aneurysm repair: a case report

Aneurysms that extend from the descending thoracic aorta into the abdomen, which can also involve the visceral segments of the upper abdominal aorta, are traditionally classified as thoracoabdominal. Thoracoabdominal aortic aneurysm reconstruction is very complex vascular surgery associated with high postoperative morbidity and mortality and related postoperative complications. In addition to the surgical complexity associated with repair of these aneurysms, the temporary interruption of blood flow distal to the clamp introduces multiple considerations for the anesthetic practitioner to consider for the reduction of potential complications. This case report involves an 80-year-old female presenting for elective repair of a type IV thoracoabdominal aortic aneurysm, with utilization of standard invasive hemodynamic monitoring and cerebrospinal perfusion pressure monitoring as a neuroprotective measure. Hemodynamic stability was maintained via vasoactive agents, as well as compensatory vascular repletion guided by invasive monitoring. A definitive anesthetic plan based on thorough preoperative assessment, insistent intraoperative management techniques to minimize potential complications, and postoperative management of this patient allowed for successful vascular reconstruction, resulting in a positive patient outcome.     

Knot impingement after arthroscopic rotator cuff repair mimicking infection: A case report

BACKGROUNDKnot impingement as a complication after arthroscopic rotator cuff repair (ARCR) has been suggested as a cause of persistent pain with limited motion. We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion, which was confused with infection.CASE SUMMARYA 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room. Passive range of motion could not be evaluated due to the patient’s severe pain. The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder. An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder, and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging. Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils. The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed. Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials. The patient’s symptoms subsided immediately after the surgical procedure. CONCLUSIONAlthough the incidence of knot impingement is rare, the possibility of knot impingement after ARCR should be a consideration.