高血压性基底核区脑出血的显微外科治疗进展

高血压性基底核区脑出血在内、外科治疗及手术方法的选择上仍存在许多争议。本文结合国内外的最新相关研究,从手术目的、手术适应证、手术禁忌证、手术时机及手术方法等方面,综合分析高血压性基底核区脑出血的显微外科治疗,为高血压性基底核区脑出血的外科治疗提供方式及方法。     

大面积脑梗死的临床治疗进展

大面积脑梗死通常是指颈内动脉主干、大脑中动脉主干或皮层支的完全性卒中.目前的治疗方法包括内科、外科、康复、物理治疗等,其中最主要的是内科和外科治疗.内科治疗主要包括脱水降颅压、脑保护、基因及生物工程等治疗.外科治疗以单纯的去骨瓣减压手术为主,但是对手术指征仍存在很大的争议.     

周围性眩晕外科治疗的现状及进展

眩晕是临床常见的主诉之一,分为中枢性眩晕以及周围性眩晕,其中前庭周围性眩晕占71%,是主要病因。周围性眩晕的治疗方法主要包括内科治疗、康复治疗和外科治疗,其中,外科治疗是眩晕疾病重要的治疗方法之一。本文就较为常见的周围性眩晕梅尼埃病及良性阵发性位置性眩晕的外科治疗进展做一综述,以期增进对眩晕疾病外科治疗的认识,促进眩晕疾病外科治疗的发展。     

脑积水分类和治疗现况及进展

脑积水分类复杂,争议较多,目前尚无统一标准,近年出现的新分类方法指导着脑积水的研究及治疗,以往脑积水治疗主要以脑室-腹腔分流术(Ventriculo-peritoneal shunt,V-P shunt)为主,但其并发症多且发生率高,为此可调压分流管、腹腔穿刺系统、导航及内镜等新技术在脑积水外科治疗中广泛应用,提高了脑积水手术疗效、减少了相关并发症的发生,明显改善了脑积水患者的预后,本文对目前脑积水的分类,外科治疗的现况以及新技术新方法在外科治疗中的应用情况进行综述。     

加速康复外科在全膝置换患者康复治疗中的应用

背景：加速康复外科是一种新的外科模式,已成功应用于普外科、胸心外科等领域,但在骨科领域尚未推广应用。 目的：评价加速康复外科理念指导下膝关节置换患者围手术期康复治疗的效果。 方法：选择45例骨性关节炎行全膝关节表面置换的患者作为实验组,进行加速康复外科理念指导下的置换前后康复治疗,选择30例按传统方法进行置换前后康复治疗的膝关节表面置换患者作为对照。 结果与结论：两组患者比较,实验组置换后并发症发生率明显下降,平均住院日及住院费用减少,置换后随访时HSS评分高。提示加速康复外科理念在全膝关节置换患者围手术期康复治疗中的应用加速了患者的康复速度,提高了治疗效果。     

小脑梗死患者外科治疗预示因素分析

目的探讨小脑梗死患者外科治疗的预示因素,以减少严重危及生命事件的发生。方法对2007年12月-2015年12月河北医科大学第二医院收治的小脑梗死患者进行分析,对比保守治疗患者与外科干预患者的临床特点及影像学征象。结果对比内科保守治疗和外科干预治疗的小脑梗死患者共169例,发现持续性头痛(P=0.004,OR=56.145)、进展性意识障碍(P=0.002,OR=72.555)、头颅CT或MRI显示大面积小脑梗死(P=0.001,OR=25.041)、脑干症状(P=0.014,OR=9.467)和梗阻性脑积水(P=0.017,OR=9.782)等因素预示应及时考虑外科干预治疗。结论小脑梗死患者当出现持续性头痛、进展性意识障碍等临床表现进行性加重以及影像学显示占位效应和进展性水肿等特征时,应考虑积极的外科干预治疗。     

矢状窦旁脑膜瘤的外科治疗(附34例报告)

目的探讨矢状窦旁脑膜瘤的外科治疗。方法回顾性分析34例矢状窦旁脑膜瘤的临床资料,采用显微手术及γ—刀放疗等外科治疗。结果25例全切除,9例次全切除术后行γ-刀放疗．恢复良好．术后复查无复发。结论显微手术切除程度可达SimpsonⅠ～Ⅱ级．次全切除术后辅以放射外科治疗,可有效抑制残余肿瘤生长。     

综合应用定位技术和外科方法治疗顽固性癫痫

目的：研究顽固性癫痫的致痫灶精确定位和外科治疗方法。方法：对185例顽固性癫痫患综合应用三维痫灶精确定位诊疗计划系统及影像学检查进行术前、术中致痫灶三维精确定位，采用癫痫外科综合治疗方案（手术治疗、介入放射治疗、定向放射治疗等）毁损致痫灶、阻断致痫网，以治疗顽固性癫痫。结果：术中64导皮层电极及8导深部电极检测证实该定位系统定位准确可靠。必要的影像学检查有助于痫灶定性定位诊断及治疗方案设计。随访疗效评估显效率达到87．0％，总有效率达到94．6％，术后神经功能保持良好，无明显后遗症。结论：综合应用三维痫灶精确定位诊疗计划系统和影像学检查对痫灶进行定位以及采取癫痫外科综合治疗方式是治疗顽固性癫痫的较好方法。     

老年人高血压脑出血外科治疗的特点：附83例报告

本文分析了８３例老年人高血压脑出血外科治疗的特点。讨论了老年人高血压脑出血、丘脑出血、脑室出血外科治疗的方法。对血肿腔－脑室置管引流及尿激酶灌注的治疗作了分析。     

颅底外科概况

颅底外科是近10年来发展最快的一种新兴治疗手段。它融合神经外科、耳外科、口腔科、肿瘤科、神经放射科、整形外科等于一体,形成了一整套诊断与治疗技术。本文就颅底外科的概念、侵犯颅底的常见肿瘤、诊断问题、动力设备、手术显微镜及特殊器械、麻醉要求、手术入路等作一简介。     

Spinal cord lesions after diagnostic and therapeutic procedures

This paper is dealing with spinal cord lesions following diagnostic and therapeutic procedures according to the literature and some personal observations. It becomes quite clear what prices have to be payed using modern methods. There are not only surgical procedures involved. Spinal cord lesions following medical activities cannot be judged as malpractice in any case. Some of these accidents can be avoided by strong indications and sophisticated performance of any procedure.     

Latex allergy in neurosurgical practice

The possibility of latex allergy and the implications of the potential life-threatening allergic reactions among patients (for example those with spina bifida), health care professionals, and latex industry workers are discussed. Latex allergy is becoming increasingly widespread in medical and surgical practice. Although early reports of latex allergy date from 1927, only over the last decade has more attention been paid to this condition. This is due to an increasing number of reported cases of adverse reactions to latex, varying in severity from mild to fatal. Latex allergy has become a major problem in children with spina bifida, who need to undergo many major aggressive diagnostic and therapeutic procedures. Risk groups have been identified and include patients having multiple surgical procedures, such as those with spina bifida. In this review we aim to emphasise some aspects of the current management of surgical patients with latex allergy. Received: 1 March 1999     

Treatment of Dystonia

Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual’s quality of life.     

Surgical Complications of Epilepsy Surgery Procedures : Experience of 179 Procedures in a Single Institute

Objective

There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon''s point of view and compare our results with other previous reports.

Methods

A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications.

Results

The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself.

Conclusion

Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.     

Peripheral nerve tumours--diagnostic and therapeutical basics

In this review of international literature, we have described recent opinions on diagnostics and therapy of peripheral nerve tumours. We have emphasised the use of differential diagnostics on certain stages of therapeutic procedures. The importance of proper surgical technique choice and its influence on final results have been especially underlined. Other important factors influencing final therapeutical results have also been considered and discussed.     

儿童脑积水脑室腹腔分流术100例预后分析

目的 通过分析接受脑室腹腔分流手术(VPS)的儿童脑积水患者的预后情况,探讨预后相关因素及其治疗措施.方法 本研究共包括100例2006年至2010年接受VPS的儿童脑积水患者(3个月至15岁).术后3个月至5年进行初次随访,对患者的人口学特征、临床表现、外科措施等资料进行分析.结果 头颅增大、头痛、步态不稳为术前三大主要症状,分流术后87.5%患者头痛改善,头颅缩小者35.2%.在前三年随访中全部患者(各种程度)的脑室缩小率超过80%,脑室增大者1%～2%.随访期内患者自评或监护人针对患者症状评价的改善率为35.2%～87.5%,平均69%.分流术后各种并发症发生率为44%,死亡率为3%.结论 分流手术的疗效需进行长期观察,CT或MRI显示脑室缩小是分流术后效果良好的直接证据,但不是唯一证据.在评价分流手术最终预后时不能忽略症状和体征的改善.     

Establishment of a modified surgical safety checklist for the neurosurgical patient: Initial experience in 400 cases

IntroductionAdverse events during diagnostic and therapeutic procedures and medical errors associated with them are an important source of patient morbidity. In an attempt to reduce these, the WHO has proposed a series of measures applicable to medical and surgical patients. Within these last ones is the surgical safety checklist (SSC), a brief questionnaire that does not increase healthcare costs, is accessible to all surgical centres and can be adapted to each specific environment.ObjectivesTo evaluate the effectiveness of establishing a modified WHO SSC on the safety and quality of care of the neurosurgical patient in a third-level university hospital.Material and methodsThe SSC was applied to a series of 400 scheduled surgeries between May 2009 and May 2010. During the initial 6 months, 183 surgical procedures were performed (group 1). All adverse events detected in this period were studied with a root-cause analysis methodology (RCA) and, according to its results, corrective measures were introduced. After that, 217 procedures were performed (group 2).ResultsWe recorded 51 events in 44 surgeries (11%). We were able to correct 88.23% of them before surgery was initiated, avoiding any consequence in the normal management of the case. In Group 1, incidents were noted in 15.3% of the procedures. The RCA suggested that 37.8% of the events had a human cause, followed by problems related to material resources and equipment in 29.7%, and organisational reasons in 21.6%. Incidence of events was reduced in group 2 to 7.4% (P=.01). Corrective measures prevented the appearance of perioperative events in 1 out of 13 procedures.ConclusionsThe SSC is an effective tool for improving safety in neurosurgical patients, which can be established in surgical departments of any hospital without increasing healthcare costs or operative time.     

Surgical management of head trauma

In addition to its inability to predict pressure elevation accurately, head CTs done serially even at 12-hour intervals, cannot adequately portray the dynamic, sometimes rapid evolution (usually growth) of a traumatic hematoma. These limitations aside, CT scanning provides adequate imaging for rational surgical treatment of head injury. Whether for monitoring, diagnostic, or therapeutic purposes, cranial procedures for traumatic pathology are guided by CT.     

两种不同入路手术治疗海绵窦区肿瘤

目的探讨海绵窦区肿瘤切除的手术入路,以提高手术全切率,降低残障率.方法对14例海绵窦内肿瘤行硬膜下入路切除5例,行硬膜外入路切除9例,比较两种入路的方法及疗效.结果行硬膜下入路者中全切除2例,大部切除3例;术后出现新的神经功能障碍4例.行硬膜外入路者中全切除5例,次全切除3例,大部切除1例;术后出现新的脑神经功能障碍3例,其中1例完全恢复.结论针对不同类型的肿瘤及生长特性,选择适当的手术入路和显微神经外科技术,可有效提高全切率,降低残障率.     

Epilepsy, surgery, and the elderly

Treatment of elderly patients with epilepsy may present unique challenges to physicians. Co-morbid conditions and drugs to treat such conditions are common in elderly patients, possibly complicating epilepsy therapies that are dependent on drugs alone. For this reason, surgical intervention may be an attractive option for elderly patients with epilepsy, particularly for medically intractable patients with key disease features, such as lateralization and precisely localized epileptic foci. Curative procedures, including lobectomy and lesionectomy, are most likely to lead to seizure freedom, but not all patients are candidates for such procedures. When a curative surgical procedure is not an option, palliative procedures, including vagus nerve stimulation and deep brain stimulation, may be viable options. Vagus nerve stimulation has been reported to reduce seizure rates and improve quality of life in elderly patients with epilepsy. Currently, widespread therapeutic application of deep brain stimulation is limited by risks, costs, and pending studies.