脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

目的 前瞻性探讨脑室-腹腔(V-P)分流术后分流管腹腔端位置的动态变化,确定腹腔端的简单、有效处置方法.方法 回顾性总结采用V-P分流术治疗的40例脑积水患者,脑室端均采用额角穿刺,腹腔端采用剑突下4 cm正中切口,腹膜切开3 mm后将分流管腹腔端置入腹腔内.术后第1、3和7天常规复查头颅CT,同时行腹部平片确定腹腔端分流管位置.结果 CT显示40例均分流效果良好.腹部平片显示术后第1天分流管腹腔端位于盆腔31例,下腹腔5例;术后第3天和第7天分流管腹腔端位于盆腔内分别为35和39例.1例术后第5天发生对侧急性硬脑膜下血肿,家属放弃手术自动出院;余患者平均于术后(11±4)d出院.1例术后1年发生腹腔端感染,控制感染后改行脑室-心房(V-A)分流术;余患者术后随访1个月-2年,无相关并发症发生.结论 采用剑突下正中小切口,可减少手术创伤并缩短手术时间,获得良好的分流效果;分流管腹腔端处置的方法简单、实用,分流管腹腔端绝大多数在术后1 d内降入盆腔内,无需特殊固定和处理.

Abstract：

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

Comparison of indocyanine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery

BACKGROUND The potential utility of intraoperative microscope-integrated indocyanine green （ICG） fluorescence angiography in the surgery of brain arteriovenous malformations （ AVMs ） and evaluation of the completeness of resection is debatable. Postoperative catheter angiography is considered the gold standard. We evaluated the value of ICG and intraoperative catheter angiography in this setting. METHODS Between January 2009 and July 2013, 37 patients with brain AVMs underwent surgical resection of their vascularlesions. ICG videoangiography and an intraoperative catheter angiography were performed in 32 cases, and a routine postoperative angiogram was performed within 48 h to 2 weeks after surgery. The usefulness of ICG findings and the ability to confirm total resection and to identify residual nidus or persistent shunt were assessed and compared to intraoperative and postoperative digital subtraction angiography, respectively. RESULTS There were 7 grade 1, 11 grade 2, 11 grade 3 and 3 grade 4 Spetzler-Martin classification AVMs. ICG angiography helped to distinguish AVM vessels in 26 patients. In 31 patients, it demonstrated that there was no residual shunting. In one patient, a residual AVM was identified and further resected. Intraoperative catheter angiography detected two additional small residuals that were missed by ICG angiography, both deep in the surgical cavity. Further resection of the AVM was performed, and total resection was confirmed by a repeat intraoperative angiogram. Postoperative angiography in a patient with a grade 4 lesion revealed one additional small deep residual AVM nidus with persistent late shunting missed on both ICG and intraoperative angiography. Overall ICG angiography missed three out of four residual AVMs after initial resection, while the intraoperative angiogram missed one. CONCLUSION Although ICG angiography is a helpful adjunct in the surgery of some brain AVMs, it＇s yield in detecting residual AVM nidus or shunt is low, especially for deep-seated lesions and hi     

脑室-腹腔分流管移位至心脏二例报告及文献复习

目的 探讨罕见的脑室-腹腔分流管移位至心脏的发病机制、临床特点、诊治方法及并发症.方法 分析2例脑室-腹腔分流管移位至心脏的诊治过程,并结合文献对本病的预防及诊治进行讨论.结果 通过临床表现及影像学检查明确诊断,手术顺利拔除了移位的分流管,术中及术后患者病情平稳.结论 首次在国内报道了脑室-腹腔分流管移位至心脏的病例;在脑室-腹腔分流术中注意通条打皮下隧道时不宜过深或过浅,通条头部不宜过尖;术后出现异常应复查头部CT、胸片及腹片;直接从头部原切口处切开拔除分流管是简单、可行、安全的手术方式.

Abstract：

Objective To discuss the mechanism, clinical features, complications, diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Method The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of ventriculoperitoneal shunt were studied, and relative literatures were reviewed. Results The migratory catheter was successfully extracted after definite diagnosis according to clinical features and imaging findings. There was no postoperative abnormality. Conclusions This is the first report of migration of the distal catheter of ventriculoperitoneal shunt into heart in China.The possible measures to minimize the incidence of the migration include avoiding deep or superficial neck tunneling and using blunt tunneling devices. Head CT, chest and abdominal x - ray are needed if postoperative abnormality is noticed. Percutaneous removal of the catheter from the retroauricular fomer incision is simple and safe.     

儿童颅内蛛网膜囊肿分流术后分流管临时结扎

目的 探讨儿童颅内蛛网膜囊肿分流术后分流管结扎并安全拔除的可能性.方法 选择2004年1月至2009年12月在天津市环湖医院进行囊肿-腹腔分流的9例患儿,在分流术后6个月随访囊肿消失或缩小,直至2年囊肿无变化者,于皮下分流管最明显部分进行结扎,然后继续随访(平均2.4年)观察.结果 9例患儿有4例在术后平均6个月时囊肿消失;5例中颅窝囊肿在随访6个月时病变缩小,症状消失;继续随访囊肿未见增大;1例囊肿在12个月时消失;结扎分流管后平均随访2.4年没有任何异常表现,影像学未见囊肿复发或原有囊肿增大.结论 囊肿-腹腔分流管在囊肿消失或稳定后平均2年可以试行临时结扎,再继续随访,如长时间无变化可以考虑拔除分流管.

Abstract：

Objective In the past decade, thousands of the pediatric patients with intracranial arachnoid cysts ( ACs) undertook the operation of the cyst - peritoneal shunt ( C - Ps). More and more complications caused by the insertion and long time staying in the body of the shunt device were reported in recent years. Therefore,it is just the aim of this article to make clear how to removal the shunt device timely and safely. Method 9 pediatric patients hospitalized in Tianjin Huanhu Hospital from January 2004 to December 2009 were taken into the study. We investigated the clinical symptoms and neuroimaging findings just at the time of 6 months after C - Ps. If the cyst disappear or reduce in size were found, follow - up would be continue for 2 years. When the change of the cyst in size could not be found, ligating of the shunt tube would be performed at an appropriate position subcutaneously, and a long time follow - up would be performed. Results The cysts disappeared in 4 out of 9 patients in an average 6 months of follow - up. At the same period the cysts reduced in size in 5 patients. No symptom or sign were found during the following up of 2.4 years after the shunt tube ligation. Conclusions Ligating of the shunt tube can be tried after 2 years of C-P shunt without any change in cyst size and clinical symptoms. The removal of the shunt device will be carried out finally.     

Effect of partial hepatectomy on the memory ability in rats

BACKGROUND: Patients suffer from changes of cognitive function postoperatively, which has attracted extensive attentions in clinic. It is still to be investigated whether operation damages both antegrade memory and retrograde memory, or either of them. OBJECTIVE: To observe the effects of operation on the anterograde and retrograde memory with Y maze test. DESIGN: A randomly controlled animal trial. SETTING: Department of Anesthesiology, Pudong New Area Gongli Hospital of Shanghai City. MATERIALS: Sixty-three male healthy Sprague-Dawley (SD) rats of clean degree, weighing 200–250 g, 10 weeks old, were provided by the animal center of Chinese Academy of Sciences. The rats were tested by antegrade and retrograde respectively. The rats were randomly divided into normal control group (n =7), anesthesia group (n =14), sham-operated group (n =14); partial hepatectomy group (n =14), short-term retrograde memory group (n =7) and long-term retrograde memory group (n =7). According to the time of Y maze training started, rats in the anesthesia group, sham-operated group and partial hepatectomy group were observed at 1 and 7 days after anesthesia. METHODS: The experiments were carried out in the central laboratory of Pudong New Area Gongli Hospital of Shanghai City from February to June in 2006. ① Test for antegrade memory: Rats in the normal control group were only treated with intraperitoneal injection of saline without aesthesia and operation; Those in the anesthesia group were anesthetized with intraperitoneal injection of 10 g/L pentobarbital sodium (40 mg/kg); Those in the sham-operated group were anesthetized, then intraperitoneal exploration was performed without hepatectomy; Those in the partial hepatectomy group were anesthetized, then fixed in a supine position after righting reflex disappeared, and an incision of 1.5–2.0 cm was made along the midline of xiphoid lower abdomen, then left lateral lobe of liver (about 1/3 of total liver) was freed, and ligated at distal pedicel with 1# filament. The abdomen was closed layer by layer after complete hemostasis. The learning and memory abilities were tested after operation. The rats were exposed to Y maze exercise from the 1st or 7th day after surgery, the error numbers, the time to complete whole trials per day and active avoidance numbers were recorded to evaluate the antegrade memory ability. ② Test for short-term retrograde memory: Rats in the short-term retrograde memory group were trained in Y maze as the above methods for 1 day, then partial hepatectomy was performed immediately, and the effects on short-term memory were evaluated at 24 hours postoperatively. ③ Test for long-term retrograde memory: Rats in the long-term retrograde memory group were trained in Y maze till reached the standard for grasping, then partial hepatectomy was performed in those reached the standard for grasping within 3 days, and the effects on long-term memory were evaluated at 48 hours postoperatively. MAIN OUTCOME MEASURES: The error times, the time to complete whole trials per day and active avoidance times were observed every day. RESULTS: Totally 63 SD rats were used, including 6 failed in the partial hepatectomy in the partial hepatectomy group, 3 died due to over-anesthesia, and 5 in the long-term retrograde memory group grasped the tasks in Y maze till the 4th day, which were supplemented by other rats. ① Impairment of anterograde memory after partial hepatectomy: The results of Y maze test in the partial hepatectomy group were not obviously different from those in the other groups on the 1st day. The error times on the 2nd and 3rd days of training in the partial hepatectomy group at 1 and 7 days after anesthesia were obviously more than those in the normal control group (F =6.08, P < 0.01), and the active avoidance numbers were obviously fewer than those in the normal control group (F =10.85, P < 0.05); For the rats at 1 day after anesthesia, the error times on the 3rd day of training in the partial hepatectomy group were obviously more than those in the normal control group (F =12.34, P < 0.01), and the active avoidance numbers were obviously fewer than those in the normal control group (F =3.91, P < 0.05). There were no obvious differences in the anesthesia group and sham-operated group as compared with those in the normal control group. ② Impairment of retrograde memory after partial hepatectomy: The results of Y maze test in the normal control group and retrograde short-term memory group at 24 hours after operation were better than those in each group on the 1st day of training (F =35.22, 22.56, P < 0.01), and the results on the 2nd day had no obvious differences between the two groups. For the rats reached the standards for grasping in the retrograde long-term memory group, the results of Y maze test on the 3rd day of training were obviously better than those on the 1st day (F =52.38, 43.86, P < 0.01). At 48 hours after operation (the 5th day of training), the results of Y maze test in the normal control group and retrograde short-term memory group were still obviously better than those in each group on the 1st day of training (F =52.38, 43.86, P < 0.01), but there were no obvious differences between the two groups on the 5th day. CONCLUSION: Partial hepatectomy mainly impaires the anterograde memory abilities of rats, and it has no effect on the retrograde short-term memory and long-term memory.     

自发性脑脊液鼻漏的神经内镜治疗体会

目的 探讨神经内镜下治疗自发性脑脊液鼻漏的疗效.方法 回顾性分析8例经神经内镜修补的自发性脑脊液鼻漏的临床资料,鼻漏持续时间14 d-20年,伴有脑积水者1例.所有患者均采用神经内镜下修补手术,伴有脑积水者行脑室-腹腔分流术,术后给予降颅压治疗.结果 所有患者均一次治愈,其中7例术后配合腰椎穿刺、腰大池引流,另1例伴有脑积水患者行脑室-腹腔分流术.术后随访6-42个月均无复发.结论 神经内镜下脑脊液鼻漏修补术是治疗自发性脑脊液鼻漏的有效方法,配合腰椎穿刺、腰大池引流或脑室-腹腔分流有助于手术的成功.

Abstract：

Objective To investigate the treatment of spontaneous cerebrospinal fluid rhinorrhea under endoscope.Methods Clinical data of 8 cases of spontaneous cerebrospinal rhinorrhea.The time ranged from 14 days to 20 years.The cerebrospinal fluid rhinorrhea was accompanied by hydrocephalus in 1 patient.All patients were treated under endoscope, and the patient with hydrocephalus was taked ventriculo -peritoneal( V -P) shunt exploration, the treatment of lowering intracranial pressure were performed in all the patients.Results We performed endoscopic repair in all 8 patients, combined with lumbar puncture and lumbar cisterna drainage in 7 cases, and ventriculo - peritoneal( V - P) shunt in 1 case with hydrocephalus.A follow - up of 6 to 42 months was performed, and no case recurred.Conclusion Combined with lumbar puncture, lumbar cisterna drainage or V - P shunt, Endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea can be an effective method.     

Treatment of singultus following craniocerebral injury★ Intranasal cavity drip infusion versus intramuscular injection of aminazine

BACKGROUND: Craniocerebral injury always accompanies with singultus, while frequent singultus may cause increased intracranial pressure. Simultaneously, respiratory alkalosis and cerebral hypoxia induced by respiratory disorder may aggravate craniocerebral injury. OBJECTIVE: To observe the therapeutic effects of intranasal cavity drip infusion of aminazine and intramuscular injection on singultus following craniocerebral injury. DESIGN: Contrast observation. SETTING: Department of Neurosurgery, Xi'an Aerospace General Hospital. PARTICIPANTS: A total of 102 patients with singultus following craniocerebral injury were selected from the Department of Neurosurgery, Xi'an Aerospace General Hospital from June 2001 to June 2006. Patients with craniocerebral injury were diagnosed with CT examination and randomly divided into nasal cavity medication group (n =62) and intramuscular injection group (n =40). There were 44 males and 18 females in the nasal cavity medication group and their mean age was (33±4) years; while, there were 26 males and 14 females in the intramuscular injection group and their mean age was (29±4) years. All patients and their relatives provided the confirmed consent. METHODS: Patients in the nasal cavity medication group were slowly dripped aminazine solution into bilateral nasal cavity with the dosage of 12.5 mg (0.5 mL). Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was stopped if symptoms were also observed after the fifth medication. In addition, patients in the intramuscular injection group received intramuscular injection of 50 mg aminazine. Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was changed if symptoms were also observed after the fifth medication. MAIN OUTCOME MEASURES: Therapeutic effects of different medications in the two groups. RESULTS: All 102 patients were involved in the final analysis. Effective rate in the nasal cavity medication group was higher than that in the intramuscular injection group, and there was significant difference (χ2= 11.882, P < 0.01). At 6 hours after onset of singultus, effective rate in the nasal cavity medication group was higher than that in the intramuscular injection group, and there was significant difference (χ2 =8.188, P < 0.01). CONCLUSION: Therapeutic effects of intranasal cavity drip infusion of aminazine on singultus following craniocerebral injury are superior to those of intramuscular injection.     

Treatment of epilepsy in China Formal or informal？

Antiepileptic drugs are the preferred treatment approach for epileptic patients. However, informal treatment is important for intractable epilepsy. In this study, 500 epileptic patients were recruited from the General Hospital of Beijing Military Area Command of Chinese PLA during the period of October 2009 to January 2012. These involved patients that had been medically treated for at least 1 year. Information on the initial treatment and changes to treatment regimens for each patient was collected through questionnaires. The survey results showed that 52.3% of the epileptic patients searched for treatment after the first seizure, and the mean numbers of seizures was 12.8; 59.8% of the epileptic patients were diagnosed at the first visit, and the mean onset time was 17 months after the first seizure. After diagnosis, patients were treated for an average of 20 days, and the median time was 1 day. Formal anti-epileptic drugs were selected as the first treatment regimen by 67.8% of patients, and 77.5% of these drugs were monotherapies. The mean and median numbers of seizure were respectively 36.9 and 3.0 times before the first regimen was changed. The regimen was changed within the first 6 months by 46.6% of patients, and after the first and second years of treatment, the proportions increased to 54.0% and 71.8%, respectively. In total, 78.5% of the regi- mens were changed to informal treatments. The informal treatment of epilepsy in China is common, being initiated by either patients or physicians. Enhancing epileptic treatment services in hospital, improving physicians＇ professional quality, and strengthening health propaganda may promote the normalization of drug treatment of epilepsy in China.     

Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

BACKGROUND: The clinical treatment of neuropathic pain is very troublesome, and the physical method of radiofrequency thermocoagulation is a good choice for its treatment. OBJECTIVE: To observe the curative effect of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia. DESIGN: A case follow-up analysis. SETTING: Minimally Invasive Surgery Room, Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA. PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006, including 73 males and 58 females, aging 37-72 years old, AND the disease course was 2-15 years. ① Drug treatment failed to alleviate the pain or induced obvious side effects; ② With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment. Distribution of the neuropathic pain: ① Trigeminal neuralgia, which were lighting attack, located at V2 in 28 cases, V3 in 46 cases, V1 V2 in 3 cases, V2 V3 in 28 cases, and V1 V2 V3 in 1 case; ② Migraine located at (except the frontal branch of trigeminal nerve) greater and lesser occipital nerves in 6 cases, auriculotemporal nerve in 3 cases, temporal and zygomatic nerves in 3 cases; ③ Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case, and chest intercostals neuralgia in 2 cases; ④ Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer. METHODS: ① All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve, then nerve block was performed firstly for anesthesia, and the pain disappeared immediately at this moment, there was hypoesthesia or numbness in the area of innervation, which manifested the puncture apposition was correct, then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for further functional localization. ② The RFG-3C radiofrequency therapeutic instrument (Radionics, USA) was used, the tip of the radiofrequency electrode was exposed for 5 mm, the temperature was kept at 80-85 ℃, 30-60 for each time, and treated for 3 or 4 times. The neuralgia following herpes zoster could also be treated by thermocoagulation at several points. ③ Evaluation standards for the therapeutic efficacy: Excellent meant the pain disappeared completely without taking any anodyne. Good referred to the pain was alleviated as compared with the preoperative one, and it could be effectively controlled by anodyne at relapse, but radiofrequency therapy was unnecessary. MAIN OUTCOME MEASURES: Therapeutic efficacy of neuropathic neuralgia of different types after treatment of percutaneous radiofrequency thermocoagulation. RESULTS: All the 131 patients were involved in the final analysis of results, no one missed. ① Therapeutic efficacy: In the 24-month follow-up, the therapeutic efficacy was excellent in 106 cases (80.9%), good in 21 cases (16.0 %) and had no change in 4 cases (3.1%). For 13 of the patients with trigeminal neuralgia, the pain relapsed after the lesion of peripheral branches, and it disappeared after the second treatment. The treatment was invalid for 1 patient with lung cancer suffering from pain in the operative area after thoracotomy, and the pain was alleviated by spinal cord stimulation. The pain disappeared after treated for 3 times in the patients with cervical neuralgia following herpes zoster. ② The pain relapsed in 28 cases (21.4%) at 12 months of the follow-up. ③ Adverse events and side effects: Except the hypoesthesia of different severity at the site of pain, there was no other complication after treatment. CONCLUSION:The follow-up results showed that percutaneous radiofrequency thermocoagulation is one of the effective methods for treating neuropathic neuralgias of various types.