大脑后动脉动静脉畸形手术入路探讨

报告１９８０～１９９４年手术治疗大脑后动脉畸形５０例，平均年龄３１．８岁，颅内出血常见为２６例，同向偏盲１９例，本组２６例畸形供血脉位于Ｐ４段，１６例位于Ｐ３段，６例位于Ｐ２段，２例位于Ｐ１段，主要引流静脉是上矢状窦（２５例）和Ｇａｌｅｎ静脉（２０例）。对Ｐ２、３段供血的血管畸形采用经颞叶梭状回（ｆｕｓｉｆｏｒｍｇｙｒｕｓ）入路。颞枕开颅适用于血管畸形位于颞枕皮层者。大脑镰－小脑幕（ｆａｌｃｏｔｅ     

头皮血管畸形的外科治疗

目的：讨论有关头皮血管畸形的诊断和治疗问题。方法：３２例头皮血管畸形经显微手术全切除。年龄６～５９岁，１４岁以下儿童１１例，平均年龄２８．４岁。畸形血管直径３～５ｃｍ１１例，５～１０ｃｍ１８例，大于１０ｃｍ３例。结果：经病理证实毛细血管畸形１例，海绵状血管瘤４例，动静脉畸形２７例。３２例随访１２～４０月，平均１８月，未见复发。结论：头皮血管畸形属先天畸形，但也可能与头部外伤有关，本组４例有头部外伤史。本病以手术切除最为彻底。脑血管造影是确诊的重要手段。单纯颞浅动脉供血属普通型。脑膜中动脉和颈内动脉参与供血属复杂型。     

颅内动静脉畸形的栓塞治疗

颅内动静脉畸形（AVM）的栓塞治疗是现代微侵袭神经外科对该病综合治疗的重要手段之一。我院近期对１０例AVM病人实施了栓塞治疗,总结如下：１对象与方法１．１一般资料本组男８例,女２例。年龄１６～４８岁。首发症状头痛６例,癫痫发作３例,外伤后局部血管异常搏动１例。２例急起发病,８例缓慢起病。病程４d～２０年。病灶部位幕上９例,幕下１例。１．２影像学资料全部病例行CT检查。其中２例示颅内血肿,１例示蛛网膜下腔出血,３例示颅内占位,４例无异常。行MRI检查者６例,其中４例示AVM,２例示颅内占位;行MRA检查者２…     

脊柱节段性血管瘤病的影像特点及治疗

报告自１９８４年至１９９４年１０月，近５００例次脊髓血管造影中检出的７例节段性血管瘤病的诊断及治疗。男性２例，女性５例。年龄１５～５０岁，平均２８．６岁。截瘫４例，进行性肌无力３例。治疗：３例单纯行栓塞治疗，１例单纯手术切除硬膜外血管瘤，３例栓塞后手术治疗。结果：４例截瘫者中１例恢复正常，２例肌力提高至３～４级，大小便可控，１例肌力提高至２级。３例进行性肌无力者２例恢复正常，１例肌力提高２级。作者对节段性血管瘤病的诊断、鉴别诊断以及治疗方法进行了讨论，提出该病的诊断应具备以下条件中的三点：（１）髓内血管畸形；（２）椎管内硬膜外血管瘤；（３）椎体及椎旁血管瘤；（４）皮肤血管痣、血管瘤及皮下组织的血管瘤。栓塞及栓塞后手术治疗可使患者获得良好的恢复。     

胃药致锥体外系副反应32例分析

我院ｌ９９３～１９９９年急诊中共收治由于服胃药而引起的急性肌张力增高的锥体外系反应病人３２例,现报告如下。１ 资料１．１ 一般资料：男１８例．女１４例,年龄４个月～４５岁,其中４～６个月３例;７个月～１岁１２例;２～３岁６例;４～８岁４例;１４～１８岁３例,１９～４５岁４例。其中服胃复安２９例（剂量：７个月～ｌ岁患儿２～２．５ｍｇ／次;２～３岁 ３．３ ｍｇ／次;４～８岁 ５ｍｇ／次;１４～４５岁１０ ｍｇ／次,均每日３次,其中２例成人用药达２周）,吗叮啉３例（４～６个月患儿）。急性起病（服药ｌ～２天…     

高颈段椎管内肿瘤14例诊断及手术治疗体会

高颈段椎管内肿瘤是指位于颈髓１～４节段的肿瘤,因其位置高且与延髓毗邻,治疗不当可致四肢瘫痪,甚至死亡。我院１９８６年４月至１９９８年１０月手术治疗１４例,报告如下。１ 临床资料１.１ 一般资料 本组１４例,男８例,女６例。年龄１０～６１岁,平均３８．４岁。病史１个月～６年,平均２年６个月。１．２ 临床表现 首发症状颈枕部疼痛１０例,颈部僵硬伴一侧肢体麻木２例,一侧肢体无力１例,高位截瘫１例。入院时表现为四肢肌力不同程度下降１０例,一侧肢体瘫３例,感觉障碍８例,尿潴留４例,呼吸困难２例,高热１例。１．３…     

分期双侧脑立体定向术治疗帕金森病

分期双侧脑立体定向术治疗帕金森病吴建庄我院自１９９０年元月至１９９６年５月，共对７２例帕金森氏病进行了脑立体定向手术，其中１０例进行了分期双侧手术。男６例，女４例。年龄２３～６２岁，平均年龄４７．４岁。病程４～１０年，平均６．２年，两次手术间隔６月至...     

脑动静脉畸形11例分析（摘要）

脑动静脉畸形１１例分析（摘要）肖泉，曾敬初，陈秀权我院自１９８０年３月至１９９０年１１月共收治脑动静脉畸形（ＡＶＭ）１１例，手术７例，其中显微手术２例，现报告如下。临床资料男７例，女４例，年龄最小１０岁，最大５０岁。血管畸形于颞叶５例，顶叶２例，额叶...     

脑内动静脉瘘

脑内动静脉瘘石军伟李宝民姜金利董克辛一、临床资料男性３例，女１例；年龄１０～３８岁；病程２～６月。临床表现有头痛、轻度突眼和视乳头水肿；３例可闻及颅内吹风样杂音；一例并有癫痫发作。４例ＣＴ和ＭＲＩ扫描在相应的病变位置存在粗大的球状畸形血管，１例后颅凹...     

手术切除血管内栓塞后巨大脑血管畸形

本文报告１５例巨大动静脉畸形栓塞后手术全切除。男９例，女６例，年龄２０～４３岁（平均２９．４岁）。无手术后死亡，仅２例术后肌力弱和偏盲。经随访肌力差１例已恢复。栓塞后再手术切除巨大动静脉畸形的作用如下：（１）应用氰基丙烯酸异丁酯（ＩＢＣＡ）栓塞供应动脉有助于手术时分离血管畸形；（２）术前应用ＩＢＣＡ栓塞大的血管畸形叮减少手术出血缩短手术时间；（３）栓塞后分期手术切除动静脉畸形可减少正常灌注压突破发生的危险，使原认为无法手术的动静脉畸形变为可以手术。     

Results of surgical treatment for cerebral metastases.

Cerebral metastases are commonly encountered, with an incidence ranging from 20 to 30% of cancer cases. Medical and radiation therapy confer median survival ranging from 3 to 6 months only. A retrospective review of patients undergoing surgery with radiotherapy from January 1997 to January 2000 involved 26 patients (13 males, 13 females), with a mean age of 53.1 years (range 30-69 years). The mean follow-up was 15.8 months (range 1.5-27 months). The primary cancer was breast in nine cases, eight were lung cancers, six colonic cancers, two unknown primaries and one was a soft tissue sarcoma. Patients with extracranial secondaries numbered 17 (61.5%). Patients stayed on average for 15.4 days. No intracranial complications occurred postoperatively. No mortalities occurred in the first month and 11 patients (42.3%) were alive at 1 year. Two patients underwent a radiosurgical boost and six patients underwent adjuvant chemotherapy. Overall median survival was 9 months (95% confidence interval 7.3-12.9 months). Factors which may favour longer survival were female sex (median of 12 vs 6.1 months), younger patients (median of 12 vs 5.8 months) and breast cancer (median of 9 months). Surgical treatment appears beneficial, with subgroups such as breast cancer possibly doing better.     

Dissociation of motor maturation

We prospectively acquired clinical data regarding the presentation, evaluation, and developmental progress of all patients identified with dissociated motor maturation to define their clinical outcomes. Children (N = 8) referred for evaluation of suspected cerebral palsy because of delayed sitting or walking and identified to have dissociated motor maturation were followed with serial clinical examination. All displayed the characteristic "sitting on air" posture while held in vertical suspension and had otherwise normal developmental assessments. This posture is composed of the hips held in flexion and abduction with the knees extended and feet plantar or dorsiflexed. Three children were initially evaluated at 10 months of age owing to absence of sitting and five other children were evaluated at a mean of 14 months (range 12-19 months) owing to inability to stand. Follow-up evaluations were conducted over a mean of 10.5 months (range 5-34 months). Five children were born prematurely at 34 to 36 weeks gestation. Denver Developmental Screening Test and general and neurologic examinations were normal except to note hypotonia in six children and the "sitting on air" posture in all of the children. Four children have older siblings or parents who "walked late" (after 15 months). On average, the children attained sitting by 8 months (range 7-10 months). One child did not crawl prior to independent walking, two children scooted rather than crawled, and five children crawled at an average of 13.5 months (range 10-16 months). All children cruised by a mean of 18 months (range 16-21.5 months) and attained independent walking by 20.1 months (range 18-25 months). Neuroimaging and serum creatine kinase enzyme testing were normal in two children who were tested. These eight children conform to the syndrome of dissociated motor maturation. The "sitting on air" posture serves as a diagnostic sign and anticipated excellent prognosis, but follow-up is required to ensure a normal outcome.     

Reduced expression of endothelial cell markers after long-term transdermal hormone replacement therapy in women with coronary artery disease

The effects of 12 months hormone replacement therapy (HRT) on biochemical markers associated with endothelial function were studied in 98 postmenopausal women with CAD, who were randomized to transdermal HRT or a control group. A significant reduction in the levels of von Willebrand factor in the HRT-group compared to controls was seen after 3 months, maintained after 12 months (p <0.001). Significant reduction in the HRT-group compared to controls was also seen in VCAM-1 after 3 months, sustained after 12 months (p = 0.013 and p = 0.045, respectively), and E-selectin was reduced by about 20% after 3 months on HRT, the reduction being statistically significant after 12 months (p <0.001). Significantly reduced levels of ICAM-1 were also seen after 12 months (p = 0.048). No effects could be observed on tPA-antigen or thrombomodulin. The reduction in procoagulant and proinflammatory markers of endothelial function after long-term transdermal HRT could indicate a beneficial effect on the endothelium and thus a potentially modulating effect on the progression of atherosclerosis in women with CAD.     

Cognitive deficits after cryptogenic infantile spasms with benign seizure evolution

Between 1989 and 1994, 18 children with cryptogenic infantile spasms-defined by normal development before onset of spasms, symmetrical hypsarrhythmia or multifocal spikes, and typical spasms on presentation, and no abnormal findings on aetiological studies including neuroradiology-were diagnosed and treated. To assess the risk of cognitive impairment later in life, 15 of these 18 children whose spasms completely resolved within the first year of life were studied. Age at onset of spasms varied between 4.4 and 9.8 months (mean 6.5 months). Children were effectively treated with adrenocorticotrophic hormone (10 children), pyridoxine (three), vigabatrin (one), or sodium valproate (one). Spasms lasted between 11 and 138 days (mean 50 days) and stopped between the age of 6.3 and 10.2 months(mean 8.1 months). EEGs normalized between the age of 7.1 and 13.2 months (mean 9.4 months). Early development was assessed on presentation and within a few months after spasms had stopped. A detailed neuropsychological assessment was performed between the age of 4.0 and 5.9 years. Twelve children had normal intelligence; specific cognitive deficits were found in five. Three children had mild learning disability. Abnormal developmental status at age 8 to 15 months after complete resolution of spasms and EEG abnormalities was associated with cognitive deficits at age 4 to 6 years.     

Progress and outcomes for children with autism receiving parent-managed intensive interventions

Parent-managed behavioral interventions for young children with autism are under-researched. We analyzed data from 66 children served by 25 different early intervention consultants. After a mean of 31.6 months of intervention IQ scores had not changed (N = 22). Vineland adaptive behavior scores had increased significantly by 8.9 points (N = 21). No children aged > 72 months attained normal functioning, i.e., IQ > 85 and unassisted mainstream school placement (N = 42). Progress for 60 children across 12 months was found for mental age (5.4 months), adaptive behavior (9.7 months), and language (5.1 months). The interventions did not reproduce results from clinic-based professionally directed programs. The effectiveness of the parent-managed intervention model as it has developed and the adequacy of professional services in that model are discussed.     

Progress and outcomes for children with autism receiving parent-managed intensive interventions

Parent-managed behavioral interventions for young children with autism are under-researched. We analysed data from 66 children served by 25 different early intervention consultants. After a mean of 31.6 months of intervention, IQ scores had not changed (N = 22). Vineland adaptive behavior scores had increased significantly by 8.9 points (N = 21). No children aged >72 months attained normal functioning, i.e., IQ > 85 and unassisted mainstream school placement (N = 42). Progress for 60 children across 12 months was found for mental age (5.4 months), adaptive behavior (9.7 months), and language (5.1 months). The interventions did not reproduce results from clinic-based professionally directed programs. The effectiveness of the parent-managed intervention model as it has developed and the adequacy of professional services in that model are discussed.     

A pilot study of the effect of L-threodops on rehabilitation outcome of stroke patients

We investigated whether L-threodops (L-DOPS), a norepinephrine precursor, improves rehabilitation outcome in patients with initial hemiparetic supratentorial ischemic stroke (2 months post stroke). Five patients who agreed to be treated with L-DOPS received 45-minute physical therapy (PT) and occupational therapy (OT) for 2 months, 3 days a week, with an oral dose of 200 mg L-DOPS 2 hours before each session, followed by PT and OT without L-DOPS for 2 months (DOPS group). Eight patients who disagreed received PT and OT for 4 months (control). Each group demonstrated comparable age, sex, complications, Mini-Mental State Examination, and the baseline Functional Independence Measure (FIM, DOPS/control = 36/42), Fugl-Meyer (F-M) motor scale (30/27), and ambulation endurance (10/9 meters). DOPS group had significantly greater gain than control (p < 0.05, Mann-Whitney U test) in FIM score at 4 (51/45) and 6 months (57/49), ambulation at 4 (66/16) and 6 months (82/24), and F-M score at 4 months (40/29). There were no side effects that required discontinuation of the drug. These results suggest that L-DOPS treatment paired with PT and OT may be effective in improving functional outcome in stroke.     

Motor impairments, neurological signs, and developmental level in individuals with Angelman syndrome

The aim of this study was to examine the character of motor dysfunction in individuals with Angelman syndrome (AS). Thirty-three children and adolescents (median age 6 years, range 18 months to 23 years) were consecutively investigated for learning disability, epilepsy, and motor dysfunction to detect suspected AS. Twenty-three individuals (13 males, 10 females; median age 5 years 6 months, range 21 months to 23 years) fulfilled international consensus criteria for AS. Clinical diagnosis was supported by a positive DNA methylation test in eleven participants. Ten participants (seven males, three females; median age six years, range 18 months to 13 years) did not comply with consensus criteria for AS and were regarded as a comparison group. There was no significant difference between the AS and the comparison group regarding age or developmental level. Median developmental quotient level was 26 months (range 8 to 63 months); median gross motor developmental level in participants with AS was 24 months (range 8 to 60 months); median fine motor developmental level was 15 months (range 6 to 60 months). Muscle strength, spasticity, tremor, and coactivation were assessed: distal lower limb spasticity, ataxic like gait, stiff lower limbs, and the presence of coactivation during locomotion were significantly more frequent in participants with AS than in the comparison group (p<0.05). Asymmetry of muscle strength and spasticity were frequent. Neurological abnormalities were insufficient for a diagnosis of cerebral palsy and impeded function less than immaturity in both AS groups. Risk of increasing impairment needs to be anticipated to prevent negative long-term effects of muscle imbalance and motor asymmetries in individuals with AS.     

Study of motor function development at 8 and 12 months of age in preterm and at term children

OBJECTIVE: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. METHOD: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). RESULTS: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). CONCLUSION: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants.     

Short-term nonhormonal and nonsteroid treatment in West syndrome

PURPOSE: West syndrome (WS) is considered an age-dependent epileptic encephalopathy and also a particular type of electrical epileptic status. Short-term hormonal or steroid treatment of WS with good efficacy is reported in the literature. The aim of this retrospective multiinstitutional study was to evaluate the early discontinuation of nonhormonal and nonsteroid treatment for WS. METHODS: Twenty-two WS cases in which treatment was discontinued after a maximum of 6 months, were collected. Inclusion criteria were the presence of typical EEG hypsarrhythmia (HY) and video-EEG recorded epileptic spasms. Exclusion criteria were the presence of partial seizures or other seizure types before spasm onset. The patients were treated with vigabatrin (VGB) in 19 cases and nitrazepam (NTZ) in three. The dose range was 70-130 mg/kg/day for VGB and 0.7-1.5 mg/kg/day for NTZ. The drug was discontinued if spasms stopped and HY disappeared after a mean treatment period of 5.1 months (range, 3-6 months). All patients underwent repeated and prolonged awake and sleep video-EEG, both before and after drug discontinuation. RESULTS: Cryptogenic (15) and symptomatic (seven) WS patients were included. All the symptomatic cases had neonatal hypoxic-ischemic encephalopathy. The mean age at spasm onset was 5.5 months (range, 3-7 months; median, 6). The interval between spasm onset and drug administration ranged from 7 to 90 days (mean, 23 days; median, 20). The interval between drug administration and spasm disappearance ranged from 2 to 11 days (mean, 6 days; median, 6 days). The interval between drug administration and HY disappearance ranged from 3 to 30 days (mean, 9 days; median, 10 days). Drugs were stopped progressively over a 30- to 60-day period. Follow-up ranged from 13 to 50 months (mean, 26 months; median, 22 months). None of our cases showed spasm recurrence. CONCLUSIONS: Our data show that successful nonhormonal and nonsteroid treatment can be shortened to a few months without spasm recurrence in patients with cryptogenic or postanoxic WS.