小骨窗纵裂入路开颅手术治疗大脑前动脉-胼周动脉动脉瘤

目的探讨小骨窗纵裂入路治疗大脑前动脉-胼周动脉动脉瘤的临床效果。方法回顾分析10例经小骨窗纵裂入路显微手术治疗的大脑前动脉-胼周动脉动脉瘤患者的临床资料。结果 10例病人均成功夹闭动脉瘤,8例恢复良好,1例遗留一侧下肢轻瘫,1例在外院行介入治疗失败后转入我科行手术治疗,术后患者重残。手术无死亡。结论采用小骨窗纵裂入路治疗大脑前动脉-胼周动脉动脉瘤只要处理得当,临床效果满意。     

翼点与纵裂联合入路手术治疗大脑前动脉-胼周动脉瘤

目的探讨翼点联合纵裂入路手术治疗大脑前动脉-胼周动脉瘤的临床效果。方法回顾性分析20例行翼点联合纵裂入路手术治疗的大脑前动脉-胼周动脉瘤患者的临床资料。结果20例患者均恢复良好,手术后平均住院时间18天。无术中动脉瘤破裂,无手术死亡,未发生神经系统并发症。出院时GOS预后评分均为良好。结论应用翼点联合纵裂入路手术治疗大脑前动脉-胼周动脉瘤,可获得满意的临床效果。     

翼点与纵裂联合人路手术治疗大脑前动脉-胼周动脉瘤

目的 探讨翼点联合纵裂人路手术治疗人脑前动脉-胼周动脉瘤的临床效果.方法 回顾性分析20例行翼点联合纵裂入路手术治疗的大脑前动脉-胼周动脉瘤患者的临床资料.结果 20例患者均恢复良好,手术后平均住院时间18天.无术中动脉瘤破裂,无手术死亡.未发牛神经系统并发症.出院时GOS预后评分均为良好.结论 应用翼点联合纵裂入路手术治疗大脑前动脉一胼周动脉瘤,可获得满意的临床效果.     

单纯钻孔治疗慢性硬脑膜下血肿43例体会

慢性硬脑膜下血肿（ＣＳＤＨ）系指伤后２周以上出现症状者,一旦确诊应手术治疗为妥「１」。我院从 １９８９年 １０月－１９９８年 ６月经ＣＴ确诊ＣＳＤＨ４３例,均以单纯钻孔冲洗治疗,效果良好,报告如下。１临床资料１．１一般资料本组男４１例,女２例。年龄最小３３岁,最大７０岁,平均５０．４岁。病程最短１８天,最长２年零５个月。有头部外伤史２６例,询问不出外伤史１７例;有头部外伤史２６例中,伤后有原发性昏迷１１例,无原发性昏迷１５例。１．２临床症状、体征症状常出现于伤后３周,数月或数年［２］,本组以头痛为…     

电解可脱性微弹簧圈栓塞治疗颅内动脉瘤

目的总结电解式可脱性微弹簧圈（ＧＤＣ）栓塞治疗颅内动脉瘤的经验。方法１９９８年２月至１９９８年８月用ＧＤＣ栓塞治疗颅内动脉瘤５６例,其中蛛网膜下腔出血（ＳＡＨ）急性期病例１３例。术前Ｈｕｎｔ氏分级;７例为Ⅳ级,１４例为Ⅲ级,３５例为Ⅰ－Ⅱ级。采用美国ＢｏｓｔｏｎＳｃｉｅｎｔｉｆｉｃＣｏ．的ＧＤＣ进行栓塞治疗。结果５６例栓塞后无死亡及永久并发症,有２例前交通动脉瘤栓塞后出现一过性偏瘫,经内科治疗１周,症状、体征消失。５６例中４４例造影证实为完全闭塞,有８例为大部分闭塞。本组由于治疗时间均在半年内,无随访资料。结论ＧＤＣ栓塞治疗动脉瘤,是目前比较理想的治疗方法,但其远期疗效有待随访观察。     

细菌性颅内动脉瘤的手术治疗——附二例报告

报告两例表现为蛛网膜下腔出血的细菌性颅内动脉瘤,经血管造影、手术和病理确诊。动脉瘤位于脑动脉的末梢部位(小脑后下动脉和胼缘动脉),例1经保守治疗一段时期后重复了血管造影,该瘤有扩大。两例均经手术切除了动脉瘤,术后满意。有关发病率,发病机理,临床表现和治疗作了扼要讨论。     

电解可脱式弹簧圈介入治疗破裂性颅内动脉瘤的体会

蛛网膜下腔出血 (ＳＡＨ)是神经科的常见病之一 ,其常见原因是颅内动脉瘤破裂。研究表明动脉瘤性蛛网膜下腔出血后再次ＳＡＨ多发生在第一次出血后 7ｄ内〔1〕,且迟发性脑血管痉挛也发生在这一时期。因此 ,在ＳＡＨ后及早对颅内动脉瘤进行治疗能明显改善病人预后。电解可脱卸弹簧圈 (ＧＤＣ)栓塞颅内动脉瘤是近十年发展起来的新技术 ,其操作简便、创伤小、术后恢复快 ,可达到近似手术夹闭的效果〔2〕,对部分不能手术或手术失败的病例 ,ＧＤＣ栓塞治疗可能是仅有的办法〔3〕,这项技术进入国内仅两年即已得到迅速开展 ,本文报告ＧＤＣ栓塞治疗…     

急性脑血管病并／不并多器官功能衰竭患者下丘脑—垂体—肾上腺皮质轴功能研究

应用放射免疫分析法对１６７例急性脑血管病（ＡＣＶＤ）患者血清泌乳素（ＰＲＬ）、生长激素（ＧＨ）、皮质醇（Ｆ）及血浆促肾上腺皮质激素（ＡＣＴＨ）水平变化进行了观察。结果发现：ＡＣＶＤ患者ＰＲＬ、ＧＨ、ＡＣＴＨ与Ｆ水平均显著高于对照组，ＡＣＶＤ并多器官功能衰竭（ＭＤＦ）患者４种激素水平显著高于ＡＣＶＤ各疾病组，随ＡＣＶＤ病程不同，４种激素水平也相应改变，１周时水平最高，２周后逐渐恢复、ＡＣＶＤ并ＭＤＦ重型患者（ＭＤＦ积分＞４分）ＰＲＬ、ＧＨ与Ｆ水平显著高于轻型患者（ＭＤＦ积分≤４分）。结果提示ＰＲＬ、ＧＨ和Ｆ可能参与了ＡＣＶＤ并ＭＤＦ的病理生理过程。     

脑弥漫性轴索损伤的CT及临床：（附382例分析）

目的探讨脑弥漫性轴索损伤（ＤＡＩ）的ＣＴ及临床特征诊断正确性。方法对３８２例ＤＡＩ的临床及ＣＴ改变特点作回顾性分析。结果“脑剪应力伤”是ＤＡＩ的病理改变核心。轴索神经微丝断裂病人伤后即刻昏迷并呈持续状态，ＧＣＳ计分≤８是ＤＡＩ临床特点。弥漫性脑密度减低伴散在性小点片状出血灶，脑室变小，脑池变形或消失是ＤＡＩ特征性ＣＴ表现。结论ＣＴ检查是诊断ＤＡＩ有效非创伤性方法，典型临床及ＣＴ表现是诊断ＤＡＩ的依据。     

经皮穿刺胸腺介入治疗重症肌无力10例报告

探讨重症肌无力胸腺介入治疗的方法和疗效。方法对１０例重症肌无力（ＭＧ）患者由超声或ＣＴ导向，于胸骨切迹上方经皮穿刺胸腺，用我院研制２４５０ｍＨｚ微波治疗机微波天线针分点辐射治疗，并局部注射氟美松。一般１周治疗１次，共２～３次。结果于１周内即见效，显效快。近期疗效：痊愈１例，基本痊愈３例，显著好转３例，好转３例。均未发生出血、气胸及感染并发症。９例３年后随访，痊愈及基本痊愈各２例，显著好转４例，好转１例。其中１例胸腺瘤广泛浸润纵隔大血管，开胸探查无法切除病灶，经皮穿刺胸腺活检，确诊为上皮细胞型胸腺瘤，介入治疗后病情好转。结论此疗法适用于ＭＧ伴胸腺增生或胸腺瘤、不做胸腺手术或无法手术、少年以上能配合治疗的患者。须严格掌握适应证，避免并发症。     

Delayed rupture of pre-existing cerebral aneurysm in a young patient with minor head trauma.

An intracranial saccular aneurysm is not commonly diagnosed in a patient with head injury. We present a patient with a history of minor head trauma and a CT scan of the brain revealing minimal subarachnoid hemorrhage 17 days prior to admission, complaining of severe headache, dysarthria and focal right limb seizures 3 hours prior to admission. A traumatic aneurysm was suspected based on clinical history and radiological findings including hematoma in the falx region on a CT scan of the brain and an aneurysm of the pericallosal artery on magnetic resonance angiography and four-vessel cerebral angiography. However, at craniotomy, an intracranial non-traumatic saccular aneurysm at the bifurcation of the pericallosal artery was found. The patient recovered fully after successful clipping the aneurysm.     

Traumatic occlusion of both internal carotid arteries

Summary Two cases of bilateral occlusion of the extracranial internal carotid artery after blunt trauma to the head and neck are presented. Sixteen similar cases have been reported in the literature, and at least 150 case reports exist on unilateral blunt trauma of carotid arteries. The 25-day post-traumatic latent interval in one of our cases is the longest to date. The diagnosis of both of our cases was established by directional cw-Dopplersonography, whereas previously the only diagnostic method available in cases with negative CT scan and latent interval was angiography. In the differential diagnosis of craniocerebral or craniocervical trauma, particularly following delay between injury and onset of neurological symptoms, Dopplersonography is a necessary test additional.     

A case of isolated focal myositis successfully treated by arterial injection of prednisolone--its findings by CT scan and MRI

A 25-year-old woman with a 2 years history of painful enlargement of the left calf visited our clinic because of ache in the left calf which became severe enough to interfere her walk. She had no history of trauma to the calf, and family history was negative for muscle disease. Physical examination showed an enlarged left calf muscle with pain which was evoked by stretching of the Achilles tendon. There was no muscle weakness or neurological abnormality. Laboratory tests were all within normal limits, including erythrocyte sedimentation rate and serum enzymes such as creatine kinase and aldolase. The CT scan revealed an isolated round-shaped low density area in the left calf muscle, which showed up as a markedly high signal intensity on T2 weighted images of MRI. The lesion was confirmed to be the lateral head of the gastrocnemius muscle. The specimen obtained from the affected muscle demonstrated degenerative and inflammatory changes together with excess fibrosis. There was no sarcoid lesion or malignancy. From the above results, the present case was thought to have isolated focal myositis. Prednisolone 80 mg (40 mg, twice, at 4-day intervals) was given to the left femoral artery without any trouble. Thereafter the patient became free from pain and difficulty in walking, and the lesion demonstrated by CT scan disappeared in 15 days. However, the high signal intensity on T2 weighted images faintly remained until the 54th day after the treatment. In summary, MRI is more sensitive than CT scan for detection of isolated focal myositis, which might be successfully treated by arterial injection of prednisolone within a short period than any other conventional methods.     

Diagnosis and treatment of pericallosal artery aneurysms

Objective

Pericallosal artery aneurysms are not common clinically. The microsurgery and endovascular therapy are surgically challenging operations. The objective of the study is to summarize their clinical symptoms and optimal treatment strategies of pericallosal artery aneurysms.

Hyperdense Basilar Artery An Early Computed Tomography Sign of Thrombosis

Noncontrast computed tomographic scans (CT scans) may show a hyperdense basilar artery before a brainstem infarct is visualized. This early sign should assist clinicians in confirming the diagnosis of basilar artery thrombosis. In a review of admission records of 750 patients with acute cerebrovascular disease from July 1991 to June 1993, at Saint Louis University Hospital, 20 patients were identified with clinical signs of nonlacunar, vertebrobasilar distribution infarction. Eight of these had pontomesencephalic ischemia. Their neuroimaging studies and medical records were evaluated. Four patients with acute clinical signs of pontomesencephalic infarction were found to have a hyperdense basilar artery on CT scans. The scans of 2 patients were excluded because of dolichoectasia; in the other 2 patients, the basilar artery appeared normal on the CT scan. The hyperdense basilar artery was detected within the early hours of neurological symptoms and often was the only detectable abnormality on the scan. In 3 patients extensive brainstem infarcts subsequently developed and they died. Basilar artery thrombosis was confirmed by pathological study in all these patients. In the fourth patient basilar artery occlusion and a large pontine infarct were evident by magnetic resonance imaging and angiography. A hyperdense basilar artery is a common feature on CT scans of patients presenting with an early clinical diagnosis of thrombosis. Untreated, the hyperintense basilar artery often portends a poor prognosis. Its ready recognition should guide further interventional studies and treatment.     

Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.     

Basal ganglia calcification on computed tomography: clinical characteristics in 25 patients

Twenty-five patients presenting basal ganglia calcification were assessed. This finding comprised 0.68% of all skull CT scan carried out during the period. Two patients were neurologically asymptomatic and 23 presented a variety neurological disorders--headache (7 patients), stroke (5 patients), extrapyramidal syndromes (2 patients), tumor (2 patients), epilepsy (1 patient), mental retardation (1 patient), dementia (1 patient), cranial trauma (1 patient), other neurological conditions (3 patients)--or were asymptomatic from the neurological point of view (2 patients). Findings in the CT scan other than the basal ganglia calcification were observed in 15 (60%) patients. There was a clinical-CT scan correlation in these cases but not in those in which the basal ganglia calcification was an isolated finding. This study highlights the fact that basal ganglia calcification is often a nonspecific finding on CT scan and that it may not be possible to establish a clinical-pathological correlation between them.     

In Situ Rescue Bypass for Iatrogenic Avulsion of Parent Artery during Clipping Large Pericallosal Artery Aneurysm

A case of large aneurysm arising from the distal end of an azygous A2 segment is presented. Multiple clip application inadvertently tore the aneurysmal neck, resulting in near avulsion of a right pericallosal artery origin. After an unsuccessful attempt to repair the avulsion, it was treated by occlusion of the origin of the pericallosal artery and an A4-A4 anterior cerebral artery in situ bypass without neurological deficits. The surgical technique and previous reports on side-to-side in situ bypass are discussed.     

Relevance of emergency head CT scan for fall in the elderly person

ObjectivesFall of the elderly person is a public health problem. The objectives of our study were to evaluate the relevance of systematically performing in emergency a computed tomography (CT) scan for fall in the elderly person, to identify specific criteria predicting the appearance of lesions.Material and methodsWe performed a retrospective analysis of 500 consecutive patients aged 65 and over, who underwent an emergency head CT scan for fall from their height. Outcome at the end of the acute care, clinico-biological data and delays between trauma an d CT were collected, and crossed with a detection of head lesion on the CT scan.ResultsOf 500 patients, 38 (7.6%) had traumatic lesions depicted on the CT scan and 267 (53.4%) were hospitalized after the CT scan. Three (0.6%) had been operated for urgent head surgery. Nine of the 38 (23.6%) patients with traumatic lesion returned home. Presence of a lesion depicted on the CT scan was not correlated with the orientation of the patient (P < 0.0001). Post-traumatic injury was significantly associated with male sex (RR = 2.19, P = 0.0217), consciousness impairment (RR = 1.56, P < 0.0001), focal neurological deficit (RR = 6.36, P = 0.0362) and past history of post-traumatic brain injury (RR = 7.17, P = 0.0027). Anticoagulant therapy was not associated with increased risk of traumatic lesions (P = 0.3315). ROC analysis determined that a 5-hours time-interval between head trauma and CT allowed optimal detection of lesions.ConclusionThe systematic indication of an emergency head CT scan for fall in elderly patients presents a low diagnostic and therapeutic yield and is not relevant. Male sex, consciousness impairment, focal neurological deficit, past history of post-traumatic brain injury and time-interval between head trauma and CT are statistically related to the presence of lesions and should therefore be taken into account.     

Revised indications for head CT in elderly patients with minor traumatic injuries: A retrospective analysis

PurposeThe purpose of this study was to assess the performance of a decision-tree for head-CT indication in elderly patients presenting minor traumatic injuriesMaterials and MethodsA single-centre retrospective study was performed and analyses were based on emergency CT scans of all patients aged 65 and over who experienced minor head trauma due to falls. The primary judgement criteria was the diagnosis of a traumatic intracranial haemorrhagic lesion (tICH) depicted on the CT scan. Focal neurological deficit and history of tICH on a previous CT scan were used to create the decision-tree.ResultsA total of 1001 patients were included. Ninety-five (9.5%) had tICH on the CT scan. Of these patients, 42 (46.1%) had an abnormal Glasgow Coma Scale, 30 (31.6%) a focal neurological deficit and 13 (13.7%) a history of tICH on a previous CT scan. The presence of at least one of these 3 risk factors was associated with the occurrence of tICH (p <0.001). The decision-tree developed from these risk factors allowed the appropriate classification of 63 of 95 patients (66.3%) with tICH. Undetected haemorrhagic lesions in patients with no clinical severity criteria evolved favourably. The decision-tree correctly identified 97% of patients without any tICH on the CT.ConclusionSystematic head CT for elderly patients presenting minor head trauma could be irrelevant. A decision-tree based on objective clinical severity criteria for the indication of head CT could detect the majority of tICH requiring surgical intervention. Prospective randomized studies are mandatory to confirm these hypotheses.