桥小脑角区占位性病变的MRI鉴别诊断

Objective： To explore the value of magnetic resonance imaging （MRI） in diagnosis of occupying lesions in cerebellopontine angle area. Methods： MRI records of 78 patients with pathologically confirmed occupied lesions in cerebellopontine angle area were analyzed. Results： Of the 78 cases, 48 （61.5%） were unilateral acoustic neuroma, 5 （6.4%） were bilateral acoustic neuroma, 12 （15.4%） were meningioma, 4 （5.1%） were trigeminal neuroma, 3 （3.8%） were lipoma, 2 （2.6%） were melanoma, and 1 （1.3%） was medulloblastoma. According to the anatomic site, tumor lesion character, and MRI signal, the majority of cerebellopontine angle area tumors were diagnosed accurately. Conclusion： MRI plays an important role in diagnosis of occupying lesions in cerebellopontine angle area.     

桥小脑角区占位性病变的MRI诊断--附78例分析

背景与目的:桥小脑角区肿瘤具有来源多及种类多的特点,给诊断带来了许多困难,本文探讨桥小脑区占位性病变的M RI诊断。方法:收集我院经病理证实的桥小脑区占位性病变78例,分析其M RI特征。结果:78例患者中,单侧听神经瘤48例(61.5%),双侧听神经瘤5例(6.4%),脑膜瘤12例(15.4%),三叉神经瘤4例(5.1%),血管母细胞瘤3例(3.8%),脂肪瘤3例(3.8%),黑色素瘤2例(2.6%),髓母细胞瘤1例(1.3%)。根据解剖部位、肿瘤病变特征和M RI信号特点,能对大多数桥小脑区肿瘤进行定性诊断。结论:M RI在桥小脑角区占位性病变的诊断中具有重要作用。     

肾占位性病变的CT定性诊断(英文)

目的分析肾占位性病变的 CT 表现,探讨 CT 对该类疾病的定性诊断价值。方法对手术/病例证实的28例肾占位性病变进行回顾性分析,所有病例均行平扫和增强扫描。结果肾恶性肿瘤21例(75%),其中肾癌(RCC)16例,CT 表现为肾实质内形态不规则的低密度软组织肿块,增强后不强化或轻度强化;肾盂癌2例,CT 表现为肾盂内软组织肿块影,增强后不强化或轻度强化。肾母细胞瘤(Wilms 瘤)3例,CT 表现为较大不规则的分叶肿块,增强后不强化;肾良性肿瘤3例(11%),均为肾血管平滑肌脂肪瘤(ALL),两例 CT 表现为多种不同成分的混杂密度肿块,一例表现为均匀等密度肿块,增强后软组织部分强化,而脂肪成分不强化。其它4例(14%),3例肾囊肿,CT 表现为典型的边界清楚的囊性病灶,增强后未见强化;1例肾脓肿,CT 表现为实质性与囊性混杂密度的肿块,增强后实质性部分有轻度强化,囊性部分不强化。结论 CT 平扫及增强扫描,以及诊断过程中密切结合病史,对肾占位性病变有重要的鉴别诊断价值。     

后颅凹肿瘤术后发热的原因及治疗

目的：总结并分析后颅凹肿瘤术后发热的治疗经验。方法：收集并分析西北医院2001年9月至2010年7月后颅凹肿瘤开颅术后发热23例病例的临床资料。结果：20例患者预后良好,痊愈出院。2例死亡,1例放弃治疗出院。结论：后颅凹肿瘤术后发热是常见并发症,处理棘手,根据不同情况采取针对性治疗可取得满意效果。     

后颅凹肿瘤术后发热的原因及治疗

目的:总结并分析后颅凹肿瘤术后发热的治疗经验。方法:收集并分析西北医院2001年9月至2010年7月后颅凹肿瘤开颅术后发热23例病例的临床资料。结果:20例患者预后良好,痊愈出院。2例死亡,1例放弃治疗出院。结论:后颅凹肿瘤术后发热是常见并发症,处理棘手,根据不同情况采取针对性治疗可取得满意效果。     

后腹腔镜肾上腺占位性病变切除术130例

背景与目的：较开放手术,腹腔镜肾上腺占位性病变切除术具有微创与视野清晰的优点。该研究拟探讨后腹腔镜肾上腺占位性病变切除的临床价值。方法：回顾性收集2007年1月—2012年12月在复旦大学附属肿瘤医院行后腹腔镜肾上腺占位性病变切除术的患者共130例,比较患者临床病理特征、并发症情况及短期预后。结果：在130例患者中,男性63例,女性67例,平均年龄50岁。病理类型：肾上腺皮质腺瘤68例,嗜铬细胞瘤15例,髓样脂肪瘤13例,囊肿10例,节细胞神经瘤7例,转移性癌5例,肾上腺皮质增生4例,神经鞘瘤3例,淋巴管瘤2例,肾上腺血肿1例,肾上腺皮质癌1例,肾上腺血管肉瘤1例,副脾脏1例(其中1例患者同时有嗜铬细胞瘤和节细胞神经瘤)。肿瘤最大直径为0.5~9.0 cm,平均为3.48 cm,平均术中出血量为62.73 mL,平均术后住院时间为7 d。其中3例患者转为开放手术,另有5例患者发生术后并发症,其中发热2例,食物过敏1例,药物过敏1例,低血钾1例。结论：后腹腔镜肾上腺占位性病变切除术具有创伤小、安全性高,患者术后恢复快的优点,有利于在有条件的中心开展。     

能谱CT虚拟平扫代替常规平扫应用于肺部占位性病变诊疗中的可行性

目的通过定量分析肺部肿块虚拟平扫(VNC)与常规平扫(TNC)图像,探讨能谱CT VNC在肺部占位性病变诊疗应用上的可行性。方法选取Philips IQon spectral能谱CT检查的肺部占位性病变患者30例,利用工作站后处理功能,获得VNC图像。采用CT值、噪声、SNR及CNR等客观评价指标测量比较VNC与TNC的图像质量。采用五分法主观评价VNC、TNC的图像质量。采用配对t检验和秩和检验比较2组图像的客观评价指标,绘制Bland-Altman plot散点图以分析CT值的一致性,使用Kappa检验评价主观评分间的一致性。结果VNC图像的客观评价指标CT值、噪声及CNR与TNC图像比较,无统计学差异(P>0.05);VNC图像SNR高于TNC图像SNR(P<0.05)。VNC、TNC图像的主观评分分别为4.08分、4.03分;Kappa值分别为0.733、0.753,主观评分一致性较强。结论在肺部占位性病变中,基于双层光谱探测器CT系统增强扫描获得的VNC图像替代TNC图像具有一定的可行性。     

超声内镜在腹膜后占位性病变诊断中的应用

目的评价超声内镜(endoscopic ultrasonography)在腹膜后占位性病变定性诊断中的应用价值。方法回顾性分析26例因腹膜后占位病变在本院行超声内镜介导下细针穿刺抽吸活检术(endoscopic ultrasonography guided fine needle aspiration,EUS-FNA)患者的病理诊断情况。结果 26例患者中24例有明确病理结果,组织学诊断率为92.3%。本组患者均未发生出血、感染、腹腔内脏器损伤等并发症。病理诊断为良性肿瘤8例,占33.3%;恶性16例,占66.7%。2例因取材较少无明确病理学诊断,8例患者避免了手术治疗。结论对于腹膜后占位的定性诊断,EUS-FNA具有并发症少、诊断率高的优点,值得临床推广。     

CT引导下经皮肺穿刺活检在肺部外周占位性病变中的诊断价值分析

目的 探讨CT引导下经皮肺穿刺活检(CT-GPLB)在肺部外周占位性病变中的诊断价值.方法 55例肺部外周占位性病变患者均行CT-GPLB,观察诊断准确率、敏感性、特异性、阳性预测值、阴性预测值、误诊率、漏诊率及经皮肺活检并发症发生情况.结果 55例肺部外周占位性病变患者经CT-GPLB诊断准确率为94.55%(52/55),敏感性为97.67%(42/43),特异性为83.33%(10/12),阳性预测值为95.45%(42/44),阴性预测值为90.91%(10/11),误诊率为16.67%(2/12),漏诊率为2.33%(1/43),并发症发生率为10.91%(6/55).结论 CT-GPLB在肺部外周占位性病变中具有较高诊断及鉴别诊断价值,且并发症发生率低.     

第四脑室髓母细胞瘤术后颅外转移1例报告

颅内肿瘤颅外转移临床上少见,作者遇到第四脑室髓母细胞瘤术后颅外转移一例,现报告如下:     

后颅窝病变疑难病例6例报告

背景与目的：后颅窝占位病变的术前诊断有时并不容易。本文报告我们日常临床丁作中遇到的后颅窝病变中诊断困难的病例并分析其特点。方法：统计哈尔滨医科大学第一临床学院神经外科2004年4月至2006年4月的后颅窝病变手术病例，选择6例诊断困难的病例，分析总结发病方式、临床症状和体征、辅助检查、手术所见和组织学检查。结果：6例病例中，其中3例术前诊断为前庭神经鞘瘤，术后证实为脑膜瘤。1例术前诊断为脑梗塞，术后证实为畸胎瘤。1例术前诊断为脑膜瘤，术后证实为畸胎瘤。1例术前诊断为脑膜瘤，术后证实为黑色素瘤。结论：（1）桥小脑角区脑膜瘤和前庭神经鞘瘤容易混淆。（2）先天性良性肿瘤畸胎瘤容易误诊为其他脑肿瘤或脑梗塞。（3）一些罕见的肿瘤容易误诊，如黑色素瘤。     

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBIECTIVE To analyze and discuss about the clinical characteristics,pathological types,surgical modalities and techniques,and postoperative complications in children with tumor of posterior cranial fossa.METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa,admitted and treated in our hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment.Fiftyeight were male and 44 cases were female.The age ranged from 9months to 14 years old,with an average of 6.1±0.5 of age.Cranial CT or MRI examination was conducted before and after the surgery on all patients.RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia.Postoperative pathological diagnoses showed:46 cases of medulloblastoma,43cases of astrocytoma,11 cases of ependymoma(including 1 case of degenerative ependymoma),1 case of dermoid cvst,and 1 case of teratoma.In this group of the patients,radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large Section was performed on 3 cases.There were no deaths from surgery reported.Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions,while 11 cases showed either no improvement or more severely affected afterward.For 6 cases,postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery.Sixty-three patients gained follow-up for 3 to 60 months in duration.Thirty-nine patients regained normal life and were able to learn well,while there were 7 patients who could not live normally on their own.During the follow-up period,there were 17 cases of recurrence and 7 cases of death.In 23 cases of medulloblastoma in children with age of 3 Years old or above,2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord.Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of C:armustine.CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa,right followed by ependymoma,and dermoid cysts and teratomas were rare.Early correct diagnosis,proper selection of appropriate surgical modality and the surgical margin,proper treatment of postoperative complications,and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with turrtor of posterior cranial fossa.     

Neonatal Posterior Fossa Haemorrhage: A Difficult Ultrasound Diagnosis

Four newborn neonates with a historyof birth trauma and significant neurological signs were examined with both ultrasound and computed tomography (CT) performed within hours of each other. Ultrasound was inadequate in initial assessment, as it missed or underestimated posterior fossa haemorrhage, particularly where this was extraparenchymal or vermian. CT is the examination of choice in these patients.     

经前颅凹颅内外联合入路额、筛窦泛眶切除术

本文报告两例经前正中额部骨瓣颅内外联合入路施行泛眶切除术。术中先切开掀起额骨骨瓣,显露前颅凹底,处理硬脑膜和大脑额叶的受侵部分,然后显露切断鼻根和颌骨额突,最后切断筛骨两侧和后部以及额骨的眶部,包括受肿瘤侵犯的眶内容物一并整块切除。本手术符合肿瘤外科原则、显露清楚,可直视下探查和处理颅底和颅内的受侵组织,对挽救部分较晚期鼻腔、额、筛窦恶性肿瘤患者有一定应用价值,但也有创伤大、毁容严重、危险性较大等缺点。术中应防止损伤上矢状窦,仔细修补硬脑膜,术前术后应重视预防感染。     

肾占位性病变的CT定性诊断

目的分析肾占位性病变的CT表现,探讨CT对该类疾病的定性诊断价值。方法对手术/病例证实的28例肾占位性病变进行回顾性分析,所有病例均行平扫和增强扫描。结果肾恶性肿瘤21例(75%),其中肾癌(RCC)16例,CT表现为肾实质内形态不规则的低密度软组织肿块,增强后不强化或轻度强化;肾盂癌2例,CT表现为肾盂内软组织肿块影,增强后不强化或轻度强化。肾母细胞瘤(Wilms瘤)3例,CT表现为较大不规则的分叶肿块,增强后不强化;肾良性肿瘤3例(11%),均为肾血管平滑肌脂肪瘤(ALL),两例CT表现为多种不同成分的混杂密度肿块,一例表现为均匀等密度肿块,增强后软组织部分强化,而脂肪成分不强化。其它4例(14%),3例肾囊肿,CT表现为典型的边界清楚的囊性病灶,增强后未见强化;1例肾脓肿,CT表现为实质性与囊性混杂密度的肿块,增强后实质性部分有轻度强化,囊性部分不强化。结论CT平扫及增强扫描,以及诊断过程中密切结合病史,对肾占位性病变有重要的鉴别诊断价值。     

Diffusion MRI in Evaluation of Pediatric Posterior Fossa Tumors

Background: To evaluate the role of diffusion MRI in differentiating pediatric posterior fossa tumors and determine the cut-off values of ADC ratio to distinguish medulloblastoma from other common tumors. Methods: We retrospectively reviewed MRI of 90 patients (7.5-year median age) with pathologically proven posterior fossa tumors (24 medulloblastoma, 7 ependymoma, 4 anaplastic ependymoma, 13 pilocytic astrocytoma, 30 diffuse intrinsic pontine glioma (DIPG), 4 ATRT, 3 diffuse astrocytoma, 2 high grade astrocytoma, 2 glioblastoma, and 1 low grade glioma). The conventional MRI characteristics were evaluated. Two readers reviewed DWI visual scale and measured ADC values by consensus.  ADC measurement was performed at the solid component of tumors. ADC ratio between the tumors to cerebellar white matter were calculated. Results: The ADC ratio of medulloblastoma was significantly lower than ependymoma, pilocytic astrocytoma and DIPG. The ADC cut-off ratio of ≤ 1.115 allowed discrimination medulloblastoma from other posterior fossa tumors with sensitivity, specificity, PPV and NPV of 95.8%, 81%, 67.6% and 97.9%, respectively. ADC ratio cut-off level to differentiate medulloblastoma from ependymoma was ≤ 0.995 with area under the curve (AUC)= 0.8693. ADC ratio cut-off level for differentiate medulloblastoma from pilocytic astrocytoma at ≤ 1.17 with AUC = 0.9936. ADC cut-off level for differentiate medulloblastoma from DIPG at ≤ 1.195 with AUC = 0.9681. The ADC ratio was correlated with WHO grading by the lower ADC ratio associated with the higher grade. Furthermore, High DWI visual scale was associated with high grade tumor. Conclusion: Diffusion MRI has a significant role in diagnosis of pediatric posterior fossa tumors. ADC ratio can be used to distinguish medulloblastoma from other posterior fossa tumor with good level of diagnostic performance.     

Three-dimensional Anatomical Analysis of Surgical Landmarks for the Middle Cranial Fossa Approach

This study describes the microsurgical anatomy of the middle cranial fossa approach using temporal bone three-dimensional (3D) computed tomography (CT) reconstruction, which should contribute to determining the drilling point for the internal auditory meatus (IAM) when bony landmarks are absent. Thirty temporal bone CT scans were reviewed retrospectively. We measured the shortest and longest distances to IAM from the petrous ridge, and measured the angle between the facial nerve and various labyrinth structures. Three-dimensional reconstructed images were obtained using high-resolution axial temporal bone CT (0.7-mm-thick slices, FOV 90 × 90, KVp 120, 305 mA, width 2,800, and level 800). The mean shortest and longest distances to IAM from the petrous ridge were 5.22 and 10.1 mm, respectively. The mean distance to the IAM from the cochlea was 9.91 mm. The mean angle between the IAM and superior semicircular canal was 47.21°, which was more acute than previously reported. The mean angle between the IAM and geniculate ganglion (GG) and external auditory canal was 113.8°, and the mean distance from the GG to the IAM was 15.44 mm. Understanding the 3D relationships among the microsurgical structures will help to decide the drilling point for the IAM when bony landmarks are absent. A preoperative evaluation might be useful for preserving important neurovascular structures while approaching the middle fossa.     

跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学诊断

目的提高对跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学认识。方法60例经病理证实的跨中、后颅窝轴外肿瘤及肿瘤样病变按位置分为中央型和外侧型，后者又分中颅窝型、后颅窝型及骑跨型，分析各型构成情况及影像学特征。结果中央型12例，脊索瘤5例，垂体瘤3例，鼻咽癌2例，颅咽管瘤、脑膜瘤各1例。外侧型48例，三叉神经肿瘤14例，脑膜瘤12例，表皮样囊肿11例，硬膜型海绵状血管瘤4例，皮样囊肿、转移瘤各2例，血管外皮瘤、颈静球脉瘤、鼻咽癌各1例。多数病变可根据影像学特点做出诊断并明确范围。结论按位置特征对跨中、后颅窝轴外肿瘤及肿瘤样病变分型，有助于定性诊断及范围描述，有较高的临床应用价值。