三房心伴右肺静脉畸形引流1例

三房心伴右肺静脉畸形引流１例王庆安，盖东和，刘明林，鲁子仁，徐元平，燕书能病儿女，６岁。出生４个月时体检发现心脏杂音。现活动后心慌、气短，无发绀。查体：胸骨左缘第２肋间可闻及３／Ⅵ级吹风样收缩期杂音。Ｐ２亢进。心电图：窦性心律，电轴右偏，右室肥厚。超...     

后路寰枕固定融合治疗外伤性寰枕脱位1例报告

<正>外伤性寰枕脱位(occipitoatlantal dislocation,OAD)是由于严重的寰枕部韧带损伤所致。由于同时造成颈、延髓交界区的损伤,伤后生存者较为少见,约占颈脊髓损伤患     

右位心心脏移植1例

目前世界范围内已报道的右位心心脏移植术罕见，均为小儿复杂先天性心脏病者。2005年11月，我们施行1例右位心心脏移植，现报道如下。     

镜面右位心合并复合畸形一例

患者女,11岁。3岁时出现活动后心悸、气促、轻度紫绀。查体心尖搏动位于右锁骨中线第5肋间外侧7.5 cm,胸骨右缘外侧第3、4肋间可见2.0 cm×3.0 cm搏动区,心尖部及胸骨右缘可触及震颤,叩诊心界向右侧扩大,心尖部及胸骨右缘第2肋间可闻及4/6级收缩期喷射性杂音,向颈背部传导,P2消失。超声心动图提示:镜面右位心、右心室双出口、双向上腔静脉、肺动脉口重度狭窄、室间隔缺损(V SD)、房间隔缺损(A SD);16层CT血管成像(CTA)检查示:镜面右位心、双上腔静脉、V SD、A SD、右心室双出口、右心室流出道狭窄和肺动脉发育良好;胸部X线片示:右位…     

枕颈后外侧入路齿状突切除治疗寰枕部畸形

目的:探索治疗寰枕部畸形的新的手术入路.方法:采用经枕颈后外侧入路齿状突切除治疗寰枕部畸形4例,一期达到前方、侧方及后方的减压并后路植骨枕颈融合,术后Holo背心头环外固定.结果:本组病例获效满意,无病情加重,无手术死亡及术后感染,术后随访10个月～5年6个月,感觉恢复接近正常,四肢肌力明显增加,肌张力降低,能自己行走.结论:经枕颈后外侧入路行齿状突切除术野清楚、操作简单、减压充分,经枕颈后外侧入路是治疗寰枕部畸形较为理想的手术入路.     

枕颈后外侧人路齿状突切除治疗寰枕部畸形

目的：探索治疗寰枕部畸形的新的手术入路。方法：采用经枕颈后外侧入路齿状突切除治疗寰枕部畸形4例，一期达到前方、侧方及后方的减压并后路植骨枕颈融合，术后Holo背心头环外固定。结果：本组病例获效满意，无病情加重，无手术死亡及术后感染，术后随访10个月～5年6个月，感觉恢复接近正常，四肢肌力明显增加，肌张力降低，能自己行走。结论：经枕颈后外侧入路行齿状突切除术野清楚、操作简单、减压充分，经枕颈后外侧入路是治疗寰枕部畸形较为理想的手术入路。     

右位心刀刺伤1例

右位心刀刺伤１例齐海，鲁巍，木沙由夫我们成功抢救１例右位心刀刺伤病人。病人男，２９岁。１９９１年７月左胸刀刺伤后１．５小时求治。查体：病人神清、苍白、多汗，颈静脉怒张。血压９／６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）。左胸横形伤口约１５ｃｍ，深度呈梯状，...     

复杂寰枕畸形颅底凹陷症的手术疗效分析

[目的]探讨经口咽入路寰齿松解齿状突复位脊髓减压后路固定颈枕融合治疗复杂寰枕畸形颅底凹陷症.[方法]A组病例26例均在颅骨牵引下行口咽入路寰齿间隙松解齿状突复位后路固定枕颈植骨融合术.B组病例25例均在本院神经外科行后路后颅窝减压术.[结果]A组26例术后10d内临床症状较术前改善,2例改善不明显.1例术中发现脑脊液漏并伴有发热.1例因肺部感染死亡.B组25例术后10d内临床症状较术前有不同程度改善,但在术后12～24个月随访中有22例出现术前症状复发,其中17例恢复到术前水平,5例加重.[结论]经口咽入路寰齿松解齿状突复位脊髓减压后路固定颈枕植骨融合对治疗复杂寰枕畸形颅底凹陷症是一种有效方法.     

枕寰区神经鞘膜瘤1例报告

患者 ,女 ,5 5岁 ,农民 ,枕顶、颈后及右肩不适 3年 ;四肢无力 3月 ,加重半月伴颜面潮红、大汗、呼吸困难、小便不畅3天。 3年前无名原因枕后酸软不适 ,逐渐头顶、枕后、颈项及右肩疼痛、上肢疼痛无力。 1年前颈段 CT示 C5- 6 椎间盘膨出 ,多次以牵引、针灸等治疗无好转 ,3月前上述重状加重 ,并出现左上肢麻木、无力及双下肢乏软。行头颅 CT无阳性发现 ,又以“颈椎病”保守治疗无效。近半月来 ,头顶枕后颈肩及四肢症状加重、行走困难 ,小便受阻 ,呼吸不适 ,拟“脊髓型”颈椎病住院。查体 :扌背入病房 ,痛苦面容 ,头面大汗 ,面部潮红 ,呼吸…     

Angular craniometry in craniocervical junction malformation

The craniometric linear dimensions of the posterior fossa have been relatively well studied, but angular craniometry has been poorly studied and may reveal differences in the several types of craniocervical junction malformation. The objectives of this study were to evaluate craniometric angles compared with normal subjects and elucidate the main angular differences among the types of craniocervical junction malformation and the correlation between craniocervical and cervical angles. Angular craniometries were studied using primary cranial angles (basal and Boogard’s) and secondary craniocervical angles (clivus canal and cervical spine lordosis). Patients with basilar invagination had significantly wider basal angles, sharper clivus canal angles, larger Boogard’s angles, and greater cervical lordosis than the Chiari malformation and control groups. The Chiari malformation group does not show significant differences when compared with normal controls. Platybasia occurred only in basilar invagination and is suggested to be more prevalent in type II than in type I. Platybasic patients have a more acute clivus canal angle and show greater cervical lordosis than non-platybasics. The Chiari group does not show significant differences when compared with the control, but the basilar invagination groups had craniometric variables significantly different from normal controls. Hyperlordosis observed in the basilar inavagination group was associated with craniocervical kyphosis conditioned by acute clivus canal angles.     

Arachnoid cyst of the craniocervical junction: case report.

OBJECTIVE AND IMPORTANCE: An arachnoid cyst at the craniocervical junction presenting with obstructive hydrocephalus as a result of blockage of the outflow of the fourth ventricle is described. This is a very rare anatomic site, with only five other cases described in the literature. CLINICAL PRESENTATION: A 37-year-old woman presented with a 9-month history of severe neck pain, persistent vomiting, visual disturbances, and numbness of the nose, cheek, and lips. She had severe bilateral papilledema on ophthalmoscopy. Magnetic resonance imaging revealed a midline cystic lesion extending down to C2. INTERVENTION: The patient underwent posterior fossa craniectomy and excision of the arachnoid cyst. She made a full recovery and was asymptomatic at follow-up examination. CONCLUSION: The symptomatology of these rare craniocervical arachnoid cysts and their development are discussed.     

Perimedullary arteriovenous fistula at the craniocervical junction - case report -

Perimedullary arteriovenous fistulas (AVFs) at the craniocervical junction are uncommon, and are often fed by the anterior spinal artery, with only a few cases fed by the intradural vertebral artery (VA). A 55-year-old man presented with a case of perimedullary AVF fed by the VA at the craniocervical junction manifesting as subarachnoid hemorrhage. Left vertebral angiography demonstrated an AVF supplied by branches from the VA. Three-dimensional computed tomography angiography (3D-CTA) revealed that the feeding arteries originated from the VA at the intradural position. Two feeding arteries were coagulated and dissected, followed by coagulation of a small feeder. The draining veins became discolored and shrank. 3D-CTA performed 2 months after the operation revealed disappearance of the AVF. Open surgery was successfully performed for the almost perimedullary AVF at the craniocervical junction, and is considered to be preferable for the treatment of this disease.     

Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx

Summary Background. A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD). Methods. Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent. Findings. In normal subjects, the mean CSF velocities were 2.4 ± 0.2 cm/s (PP), 2.8 ± 0.3 cm/s (AC), and 2.4 ± 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001). Conclusions. In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx’s size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.     

Tuberculosis of the craniocervical junction: two case reports

Summary We report on two children with tuberculosis of the craniocervical junction. Atlantoaxial instability was evident in both patients due to the destruction of the dens and the atlantoaxial ligaments. In addition, one child had tuberculosis involving the anterior arch of the atlas and the anterior rim of the foramen magnum. Despite anti-tuberculosis treatment and immobilization, atlantoaxial instability was evident on flexion/extension views. Successful fusion of C1 and C2 was performed in both patients.     

Arteriovenous malformation at the cervicomedullary junction: A case report with magnetic resonance imaging

A rare case of arteriovenous malformation at the cervicomedullary junction is reported. A 72-year-old man developed symptoms of total transection of the upper cervical cord without evidence of subarachnoid hemorrhage. The arteriovenous malformation had an intramedullary nidus with an aneurysmal dilatation at the C-1 level. This lesion was diagnosed by magnetic resonance imaging and confirmed at autopsy. The neurological symptoms may have been due to compression of the spinal cord by the intramedullary lesion, followed by degeneration and necrosis. The usefulness of magnetic resonance imaging in the neuroradiological diagnosis is particularly emphasized.