便携式超声仪在海战颅脑伤中的应用研究

目的 评价便携式超声仪在海战颅脑伤手术中的应用价值。方法 急诊手术病例6例,包括血肿清除术5例,内镜颅内子弹取出术1例。所有手术均在实时超声辅助下进行。结果 术中超声检查均与术前头颅CT结果一致。所有病变均在超声辅助下精确定位,并完整切除。无症状恶化及死亡者,无严重手术并发症发生。结论 术中实时超声应用于急诊脑内血肿清除和颅内异物取出术,能够更好地定位病变部位,决定皮层的切口和手术路径,动态了解病灶情况,判断病变的切除范围,避免损伤重要血管,在海战颅脑伤救治中具有良好的应用前景。     

改良术式局麻下治疗慢性硬膜下血肿(附33例报告)

目的:探讨老年合并严重心肺疾患慢性硬膜下血肿患者的简易手术.方法:对33例慢性硬膜下血肿患者在局麻下进行钻孔引流,不进行冲洗.结果:33例患者,1例术后因经济原因放弃治疗,1例因术后疗效不佳改行骨瓣开颅清除血肿治愈,31例术后1个月复查头颅CT,23例硬膜下血肿完全消失;6例少量残留;2例复发,经再次手术治愈.结论:局麻下行慢性硬膜下血肿钻孔引流手术(不冲洗)较传统手术可缩短手术时间,简化手术操作,减少麻醉及手术并发症,且疗效好.     

改进法闭式引流治疗慢性硬膜下血肿的疗效分析

 目的 比较改进慢性硬膜下血肿闭式引流手术方法与常规闭式引流手术方法的效果.方法 回顾性分析18例改进法闭式引流术后1 d和22例常规闭式引流术后3～4 d慢性硬膜下血肿患者的头颅CT扫描以及两组术后10 d头颅CT扫描,测量两组患者血肿腔内残留气体和液体量并进行统计学分析.结果 改进法闭式引流组仅有微量气体和液体残留,而常规法闭式引流组则有较多气体和液体残留,两组血肿腔积气和液体残留量比较有显著统计学意义(P<0.001).结论 改进法闭式引流手术是治疗慢性硬膜下血肿的更好的方法,符合生理,引流彻底,手术效果好.     

外侧裂区急性硬膜下血肿的临床分析

目的 探讨外侧裂区急性硬膜下血肿的治疗方法。方法 对46例患者进行回顾性分析,全部病例入院后即行头颅CT检查,其中44例行手术治疗。结果 本组外侧裂区急性硬膜下血肿主要是因脑挫裂伤,皮层血管破裂出血所致,手术是其主要治疗手段。本组死亡15例,重残3例,轻残8例。结论 外侧裂区急性硬膜下血肿死亡率较高,应尽快明确诊断,及时手术,手术宜采取大骨瓣开颅。术后可给予活血药物以改善脑缺血缺氧。     

汶川大地震颅脑损伤概况及多层螺旋CT的诊断价值

目的 总结汶川大地震颅脑损伤情况及多层螺旋CT的诊断价值.方法 对收治的汶川地震伤员1557例中因颅脑外伤的292例进行CT检查,其中CT检查阳性者225例.回顾性总结225例颅脑损伤患者的损伤类型及多层螺旋CT表现,分析多平面重组(MPR)及三维(3D)重组成像的应用价值.结果 颅脑损伤225例,主要包括颅骨骨折66例,脑挫裂伤50例,颅内血肿55例,蛛网膜下腔出血16例,硬膜下积液16例,头皮异物20例,外伤性脑梗死2例.其中22例进行了手术治疗.结论 地震住院救治伤员中颅脑损伤占的比例较大,MPR及3D图像可以为神经外科医师术前提供直观可靠的依据.     

创伤性硬膜下积液转化为慢性硬膜下血肿11例临床诊治体会

目的总结创伤性硬膜下积液转化为慢性硬膜下血肿的临床诊治体会。方法在111例创伤性硬膜下积液转变为慢性硬膜下血肿患者的诊疗过程中,行CT／MRI动态检查,诊断明确后均采取手术治疗。结果创伤性硬膜下积液转化成慢性硬膜下血肿多见于老年人,动态CT和／或MRI检查有助于发现TSE向CSDH的早期转变,手术治疗效果良好。结论创伤性硬膜下积液转化成慢性硬膜下血肿多见于老年患者,其动态转化的时间不确定,动态CT和／或MRI检查有助于早期发现慢性硬膜下血肿形成。手术治疗（包括钻孔引流和开颅血肿清除血肿外膜剥离手术）效果良好。     

MSCT三维重组在非标准体位CT扫描患者颅脑手术定位中的价值

目的 探讨多排螺旋CT图像三维重组技术在非标准体位头颅CT扫描患者颅脑手术定位中的价值.方法 实验组选择40例头颅扫描体位不标准但需要行颅脑手术的患者,对头颅CT扫描数据按OM基线及其垂直线行轴位及冠状位重组,根据所得重组图像定位并制定手术方案;对照组选择40例按标准体位头颅扫描、需要行颅脑手术的患者,根据OM基线手术定位;对两组患者手术定位准确率进行统计学分析.结果 实验组40例患者均行轴位及冠状位标准重组,39例通过后处理图像定位并顺利手术,1例患者未及手术死亡.其中手术医师认为定位非常准确36例,比较准确3例;对照组38例顺利完成手术,手术医师认为定位非常准确35例,比较准确3例.实验组手术定位准确率(92.3％)同标准体位扫描的对照组的手术定位准确率(92.1％)无显著统计学差异(P=0.97 ＞0.05).结论 多排螺旋CT图像三维重组技术对非标准体位头颅CT扫描患者颅脑手术定位有确实的帮助.     

快速吸收的急性硬膜下蛛网膜下腔混合出血的CT特征

目的 探讨快速自行吸收的急性硬膜下蛛网膜下腔混合出血的CT特征.方法 对17例常规CT表现为不典型急性硬膜下血肿及蛛网膜下腔出血的颅脑损伤病人进行了短时间CT复查,并对其结果进行回顾性分析.结果 17例均表现为类似急性硬膜下血肿的新月形混杂高密度影.病灶特点:①病灶吸收很快,在动态CT监测下,病灶多在短时间(1～7 d)内吸收.②病灶密度混杂,可见不规则形或带状低密度区.③病灶临近脑池脑沟密度升高.④病灶多位于额颞部.⑤部分病灶可沿蛛网膜下腔"游动"(血肿重分布).结论 快速自行吸收的急性硬膜下蛛网膜下腔混合出血具有一定的CT特征,由于硬膜下腔及蛛网膜下腔沟通,加速了出血的吸收,应归属于蛛网膜下腔出血,准确诊断及严密观察可避免患者的手术之苦.     

术中灰阶及彩色多普勒超声在颅内占位性病变切除术中的应用

目的评价灰阶及彩色多普勒超声技术在颅内占位性病变手术中的应用价值.资料与方法回顾性分析经头颅 CT、MRI 证实的26例颅内占位性病变患者的临床资料,对比患者术前 CT 或 MRI 与术中实时超声显示的病变范围、病变周围组织变化的差异;对其中17例脑内实体性占位病灶的矢状位、冠状位和轴位径线进行测量并计算体积,与术前影像学结果进行对比;通过术中超声指导手术切除占位病变,与术后 MRI 对比,总结手术全切率.结果术中超声对26例患者的病灶范围、周围脑组织变化情况及病变的血流分布情况均能有效显示,并与术前 CT 或 MRI 结果一致;且术中超声对实体性占位体积的测量结果与术前影像学结果相一致(t =1.757, P >0.05),术后经超声探查未发现术腔残留,与术后头颅 MRI 复查对比证实术中超声引导下的占位全切除率为93%.结论术中超声对颅内病灶定位的准确性与 CT、MRI 相当,并且能实时便捷地在术中应用,指导神经外科微创手术治疗.     

颅脑术后继发癫痫的外科治疗(附25例临床分析)

目的 探讨颅脑术后继发的难治性癫痫的术前评估方法及适应证选择,总结二次开颅手术切除致痫灶的经验,以提高颅脑术后继发癫痫的治疗效果.方法 2005年1月-2012年5月行手术治疗的颅脑术后继发癫痫患者25例,术前认真评估,仔细询问病史,并行视频脑电图(V-EEG)检查,每位患者均接受发作期和发作间期脑电图检查,或颅内埋置硬膜下电极.根据脑电图、MRI、CT平扫及加强扫描确定癫痫病灶.手术按原颅脑手术切口入路,切开硬脑膜,充分显露脑瘢痕区,采用皮层电极详细探测致痫灶棘波区的位置及范围,在显微镜下一并切除脑组织瘢痕和致痫灶,切除后再次采用皮层电极监测,直到脑电节律正常为止.结果 25例手术均顺利,无死亡病例,无严重手术并发症.术后随访6个月～7年,发作控制Engle Ⅰ级18例,EngleⅡ级5例,EngleⅢ级2例;18例(72％)无发作,其中9例已停药.结论 颅脑术后继发癫痫药物治疗效果欠佳,二次开颅手术可取得满意疗效.     

彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...     

Traumatic injuries: imaging of head injuries

Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for clinical state, MRI is warranted. Follow-up is best done with MRI as it is more sensitive to parenchymal changes. In routine MR protocol gradient-recalled-echo sequences should be included at any other time after a traumatic event since they are very sensitive in detection of hemosiderin as well as former hematoma without hemosiderin. The MR signal intensity varies depending on sequences and time scanning after trauma.     

慢性硬膜下血肿临床治疗效果分析

目的总结慢性硬膜下血肿的诊断和治疗经验。方法回顾性分析72例慢性硬膜下血肿患者的临床特点、手术方式和预后情况。结果本组病例全部达到治愈标准。临床症状均在7天内消失，2周后CT复查血肿消失。结论单孔或双孔钻颅血肿引流是治疗慢性硬膜下血肿的有效方法。     

手术治疗慢性硬脑膜下血肿318例

目的　探讨慢性硬脑膜下血肿的手术治疗方法。　方法　回顾性分析 318例慢性硬脑膜下血肿 (CSDH)病人的临床特点、神经影像学资料、手术方法和结果。　结果　 318例病人首次手术均采用颅骨钻孔冲洗并闭式引流术 ,仅 37例血肿复发后需再次手术处理 ,其中 33例接受骨瓣开颅血肿及包膜清除术或内窥镜手术后痊愈 ,另 4例老年脑萎缩病人在再次手术前死于伴随疾病。　结论　颅骨钻孔冲洗并闭式引流术是治疗CSDH的首选方法 ,即使对术前发现血肿包膜增厚者亦适用。骨瓣开颅血肿及包膜清除术适用于血肿壁坚厚、脑萎缩致脑膨起困难者及分隔型血肿等情况。对分隔型血肿 ,内窥镜手术可替代常规开颅术。     

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies

CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Of the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hemorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully. Correspondence to: M. Ochi     

特殊部位硬膜下血肿的CT诊断

目的 探讨大脑镰,小脑幕硬膜下血肿的CT特点。资料与方法 回顾性分析32例大脑镰,小脑幕硬膜下血肿的CT和临床资料。结果 32例中大脑镰硬膜下血肿20例,CT表现为内缘平直,外缘弧形或波浪形的带状高密度影;小脑幕硬膜下血肿12例,CT表现为高密度片状影3例,新月状影3例,U形影2例,累及大脑镰后部4例,呈Y形或镰刀状。结论 大脑镰,小脑幕硬膜下血肿的CT表现具有特征性,CT复查对其诊断和鉴别诊断很有意义。     

首诊轻型颅脑损伤伤情恶化41例临床分析

目的 分析总结首诊为轻型颅脑损伤病情恶化的临床特点。方法回顾性分析我科1999年12月～2003年1月间收住的41例轻型颅脑损伤病人病情恶化即出现昏迷或手术治疗的临床资料。结果本组病情恶化原因为颅内创伤性病变形成,硬膜外血肿占首位(46．3％),其次为脑挫伤及脑内血肿(29．2％),硬膜下血肿119．5％)。32例恶化发生在伤后24小时内,36例病人需手术治疗。按GOS标准评定,本组27例恢复良好,6例中残,3例重残,1例植物生存,死亡2例,自动出院2例。结论尽早完善检查,明确诊断,严密动态观察病情变化,掌握手术指征,及时手术治疗处理继发性损伤,是防治轻型颅脑损伤伤情恶化的关健。     

颅脑减速伤的损伤特点研究

目的研究颅脑减速伤的损伤特点,探讨其在颅脑创伤的伤情判断和影像诊断中的应用价值。方法分析361例临床典型颅脑减速伤患者的颅脑CT影像资料,结合致伤病史及临床资料,总结归纳颅脑减速伤的损伤特点。结果颅脑减速伤损伤的主要特点为:撞击部位头皮损伤、颅盖骨折、硬膜外血肿、硬膜下血肿和脑挫裂伤,对冲部位硬膜下血肿、颅底骨折和脑挫裂伤;颅骨骨折以撞击部位多见,硬膜下血肿以对冲部位多见,蛛网膜下腔出血主要位于脑底部及脑挫裂伤区;额、颞叶严重对冲伤是常见颅脑减速伤的重要特征。结论根据颅脑减速伤的损伤特点,结合致伤病史或颅脑CT表现,可为临床颅脑减速伤伤情的快速判断与救治、CT扫描及诊断、创伤事故原因的评判提供理论依据。     

Differentiation between meningeal fibrosis and chronic subdural hematoma after ventricular shunting: value of enhanced CT and MR scans

Unenhanced CT in four patients with long-standing ventricular shunts demonstrated bilateral low-density extraaxial collections that were indistinguishable from chronic subdural hematomas. After administration of contrast material, however, there was marked enhancement of the collections as well as prominent paratentorial and parafalcial enhancement. MR imaging, performed in three patients, demonstrated the extent and paradural location of the collections better than CT did, but, as with unenhanced CT, the collections could not be distinguished from chronic subdural hematomas. On follow-up CT and MR, there was no change in the size, enhancement, or intensity of the collections. Histologic examination of biopsies from two patients demonstrated fibrosis of the meninges characterized by granulation tissue and collagen deposition. Meningeal fibrosis is a rare postshunt phenomenon that may mimic chronic subdural hematoma on unenhanced CT and MR. Recognition of this entity is important, particularly if therapeutic intervention is being considered. Therefore, an enhanced CT or enhanced MR scan should be obtained in chronically shunted patients to differentiate between a drainable chronic subdural hematoma and meningeal fibrosis.     

'Reverse crescent pattern' on SPECT brain perfusion scan in chronic subdural hematoma.

A SPECT brain perfusion scan was performed on a patient who had symptoms of dementia. The SPECT scan showed marked crescentic medial displacement of the left cerebral hemisphere ("reverse crescent pattern"), and mildly decreased cortical perfusion in the affected hemisphere. Crossed cerebellar diaschisis was not present. On x-ray CT, the underlying abnormality was found to be a unilateral chronic subdural hematoma causing a significant mass effect. A reverse crescent pattern without crossed cerebellar diaschisis on SPECT brain perfusion scan in patients with dementia may suggest the diagnosis of chronic subdural hematoma.