182例重度脑室出血不同方法脑室外引流疗效分析

目的 探讨重度脑室内出血(IVH)外引流治疗方法.方法 回顾性总结182例重度IVH单侧侧脑室外引流术与双侧侧脑室外引流术、尿激酶脑室内注入脑室外引流术与单纯脑室外引流术的治疗对比.结果 本组总死亡率17.6%,尿激酶脑室内注入脑室引流组死亡率8.4%,单侧脑室外引流组死亡率16.8%,两组死亡率有显著差异(P<0.01),单侧侧脑室外引流组与双侧脑室外引流组死亡率分别为16.8%及19.1%,无显著差异(P＞0.05).结论 重度IVH是一组危重脑出血,脑室外引流术是有效抢救方法,尿激酶脑室内外引流术较单纯脑室外引流术可显著降低死亡率,单侧脑室外引流术与双侧脑室外引流术对治疗结果无明显差异.     

原发性全脑室出血的外科综合治疗

目的 探讨原发性全脑室出血的治疗方法.方法 采用双侧侧脑室外引流及尿激酶脑室灌注联合腰大池置管引流术治疗原发性全脑室出血38例.结果 38例血肿清除32例(84.2%),死亡6例(15.8%).术后2例(5.26%)发生脑积水.结论 采用双侧侧脑室外引流及尿激酶脑室灌注联合腰大池置管引流术为目前治疗全脑室出血的有效方法.     

高血压脑出血脑积水78例的治疗体会

[目的]探讨高血压脑出血早期救治和中后期脑积水的诊治的方法与疗效.[方法]收集本院78例高血压脑出血出现脑积水患者的临床资料并对其治疗情况进行回顾性分析.[结果]78例高血压脑出血出现脑积水的患者中,丘脑出血59例,脑干出血13例,小脑出血6例.所有病例均有出血破入脑室系统,其中侧脑室、第三脑室、导水管及第四脑室全脑室铸型53例;发生颅内感染36例.早期行侧脑室引流、冲洗、尿激酶注入、腰穿治疗,侧脑室引流持续时间7～56 d;中后期出现脑积水46例,均给予侧脑室腹腔分流术.本组病例中中度残废36例,重度残废18例,持续植物状态15例,死亡9例.[结论]高血压脑出血发生脑积水与出血部位、出血破入脑室系统和继发颅内感染有关,早期积极引流、预防感染,中后期及时给予侧脑室腹腔分流术有助于改善预后.     

脑脊液置换联合脑室外引流治疗自发性脑室出血的临床探讨

目的探讨脑脊液置换在脑室出血治疗中的应用。方法52例自发性脑室出血患者随机分为两组,治疗组28例,采用单侧或双侧脑室外引流术、尿激酶灌注,同时给予腰大池持续外引流或反复腰穿置换脑脊液;对照组24例,采用延长脑室外引流时间及尿激酶灌注治疗。结果侧脑室外引流尿激酶灌注加脑脊液置换术提高了自发性脑室出血患者存活率,减少了颅内感染和脑积水等并发症的发生率。结论联合应用侧脑室外引流、尿激酶灌注和脑脊液置换术治疗自发性脑室出血,方法简单,疗效确切。     

脑室内出血行脑室外引流术治疗的疗效观察

目的：探讨脑室内出血行脑室外引流术治疗的适应症及临床意义。材料与方法：对26例脑室内出血患者采用侧脑室外引流，结合脑室内注入尿激酶(UK)灌洗、溶解血凝块，和腰穿置管间断放液为辅的方法。结果：治愈16例，有效5例，总有效率为80．8％；植物生存1例，死亡4例，占19．2％。其中有4例并发脑积水，均行脑室腹腔引流，3例治愈、1例植物生存。结论：侧脑室外引流术治疗脑室内出血是一种操作简单、行之有效的方法，通过引流置换血性脑脊液可以减少脑血管痉挛或梗塞，减少脑积水并发症的发生。     

微创伤手术治疗高血压脑出血破入脑室的诊治体会

目的探讨高血压脑出血破入脑室微创伤手术治疗效果。方法本组73倒中．45例患者采用单侧侧脑室＋腰蛛网膜下腔置管持续外引流术。28例患者采用双侧侧脑室＋腰蛛网膜下腔置管持续外引流术治疗。结果术后评定，Ⅰ级4例，Ⅱ级28倒。Ⅲ级2（1例，Ⅳ级12例，Ⅴ级9例。结论单双侧侧脑室＋腰蛛网膜下腔置管持续外引流微创手术是治疗高血压脑出血破入脑室的一种有效的治疗方法。     

侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血临床分析

目的探讨采用侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血的效果。方法单侧或双侧脑室穿刺引流，术后第2d开始行腰穿脑脊液置换。结果40例高血压脑室出血患者采用侧脑室外引流并腰穿脑脊液置换治疗的病例，存活31例（77．5％），死亡9例（22．5％）。结论应用侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血，能明显降低死亡率，提高生存率。     

脑室腹腔分流术后并发亚急性硬膜下血肿原因分析

目的探讨脑室腹腔分流术后并发亚急性硬膜下血肿的原因,并提出防范对策。方法回顾1例脑室腹腔分流术后并发亚急性硬膜下血肿的临床资料。结果患者1年前因右侧颈内动脉C1段动脉瘤破裂行介入栓塞治疗,术后行腰椎穿刺置管持续外引流术。近日行头颅CT检查示脑积水,故行脑室腹腔分流术。术后第4天患者突发意识不清,行头颅CT检查示右侧硬膜下血肿伴积液,并沿脑室引流管渗入脑组织。急诊行右侧硬膜下钻孔引流术,术后复查头颅CT示硬膜下血肿伴积液明显减少,但患者始终未能苏醒,2个月后死亡。结论脑室腹腔分流术后硬膜下血肿预后不佳,对此类患者应及时复查头颅CT,尽早清除血肿。     

脑室-腹腔分流术治疗各种不同类型脑积水并发症分析

我们从 1 993～ 2 0 0 1年间用脑室—腹腔分流术治疗各种不同类型的脑积水 35例 ,2 8例治愈 ,7例出现并发症 ,其中引流管梗阻 3例 ,分流过度 2例 ,感染 2例 ,现分析如下。1　对象和方法1 .1　对象　本组男 2 1例 ,女 1 4例 ,年龄 8～ 63岁 ,平均 2 6岁。梗阻性脑积水 1 9例 ,交通性脑积水 1 6例 ,35例中高颅压脑积水 2 9例 ,正常颅压脑积水 7例。1 .2　方法　采用右侧侧脑室—腹腔分流术 ,将分流管的脑室端置入右侧脑室额角 ,分流泵置于颞部 ,腹腔端经颈、胸、腹部皮下隧道引至右中腹部后经腹直肌切口送入腹腔 ,置入约 30cm左右。2　结果35…     

侧脑室穿刺引流联合双针鞘内脑脊液置换术治疗脑室出血临床观察

目的:探讨脑室穿刺引流联合双针鞘内脑脊液置换治疗脑室出血的疗效.方法:采用脑穿刺针行侧脑室穿刺置管引流脑室内血性积液同时作双针鞘内脑脊液置换术治疗46例脑室出血患者,与以往单独行脑室穿刺引流治疗的48例脑室出血患者比较,分析两种治疗方法的有效率及脑积水发生率.结果:治疗组存活40例,死亡6例.而对照组存活33例,死亡15例,死亡率分刖为13%和31.3%.结论:侧脑室穿刺联合双针鞘内脑脊液置换术疗效优于单独侧脑室穿刺引流术.     

中、重型脑外伤后脑积水36例临床分析

【目的】探讨中、重型脑外伤后脑积水的诊断和治疗方法。【方法】回顾性分析在本院 1 998～ 2 0 0 2年 36例脑外伤后脑积水临床资料。【结果】36例均行脑室 -腹腔分流术 (8例先行脑室外引流 ,再行脑室 -腹腔分流术 )。术后大部分病例临床症状及影像学检查均得到改善。【结论】分流手术对大多数外伤后脑积水患者临床症状有改善作用 ,可降低重型脑外伤的死残率 ,改善预后     

外部性脑积水的MRI评价

目的:探讨外部性脑积水(EH)的MR特点及临床应用价值。材料与方法:对62例资料较完整的EH进行回顾性分析。结果:特发性EH 24例(38.7%),继发于其他疾病38例(61.3%),其中与围产期有关24例(63.2%),与感染有关3例(7.9%),脑外伤1例(2.6%),佝偻病10例(26.3%)。EH MRI特点为:大脑半球叶间裂前部增宽(≥6mm),额顶区蛛网膜下腔对称性增宽(≥5mm),可伴额顶区脑沟回增宽加深,侧裂池及鞍上池增大,脑室不大或轻度扩大,VT/ST率小于15%。结论:MRI对EH的诊断、病程观察具有重要意义。     

经脐单孔腹腔镜辅助下脑室腹腔分流术的临床应用

目的探讨经脐单孔腹腔镜技术在治疗脑积水手术时脑室腹腔分流管腹腔端放置中的应用价值。方法回顾性分析26例采用经脐单孔腹腔镜行脑室腹腔分流术治疗脑积水患者的临床资料。结果 26例患者均行右肝膈间隙置管脑室腹腔分流术成功,术后颅内高压症均有改善,未发生与经脐单孔腹腔镜手术相关的并发症。结论经脐单孔腹腔镜下脑室腹腔分流术具有创伤小,显露定位好、患者恢复快,切口美观及术后分流管堵塞梗阻率低的优点。     

外部性脑积水的超声诊断

本文旨在探讨超声显像法诊断婴儿外部性脑积水（ＥＨ）的可行性。本组选一岁以内正常儿童７０名，ＣＴ诊断ＥＨ患儿５０名全部进行超声检查。使用高频线阵探头，经前囟作冠状及矢状切面探查。测量额项部蛛网膜下腔的深度及宽度。结果显示：正常组额顶部蛛网膜下腔深度＜０．２５ｃｍ；半球间裂（大脑纵裂）宽度＜０．３ｃｍ；顶叶中央沟宽度＜０．２ｃｍ。患儿组上述各参数测值均大于正常组。     

神经内窥镜的临床应用(附36例报告)

目的总结应用神经内窥镜治疗病人的经验。方法对36例经神经内窥镜治疗的病人进行回顾性研究，分析手术指征、方法和并发症等。结果病人治疗效果良好，无死亡、颅内血肿、感染病例。结论应用神经内窥镜技术在治疗脑积水、垂体瘤、颅咽管瘤、透明隔囊肿、双手多汗症手术中具有手术创伤微小、疗效确切、手术安全的优点，病人住院时间缩短。     

正常压力性脑积水的外科治疗

目的：探讨正常压力性脑积水的发病机理、手术指征及手术时机。方法：22例正常压力性脑积水患者采用脑室-腹腔分流术治疗。结果：随访6个月～2年，无一例因分流管所引起的感染、排斥反应及堵管等现象。术前症状消失或明显改善14例，好转6例，效果不明显但未加重2例。结论：对正常压力性脑积水，在出现典型的“三联症”之前尽早确诊，依据临床表现、影像学检查及腰穿检查选用压力适宜的分流管，及时行脑室一腹腔分流术是治疗正常压力性脑积水理想方法。     

脑室-腹腔分流术治疗脑积水的临床分析

[目的]本文对脑室一腹腔分流术治疗脑积水的手术指征及术后所产生的并发症进行分析总结．以指导临床工作。[方法]时160例脑室一腹腔分流术后患者进行回顾性评定。[结果]并发症主要有：①感染(颅内感染、皮下感染、腹腔内感染)、癫痫;②分流不足(分流管阻塞,颅高压症);③分流过度(颅内出血、缝隙样脑室综合征、中脑导水管综合征);④腹腔内病变等。[结论]认识及了解手术适应证及术后并发症后有利于进一步进高手术疗效。     

内镜手术治疗梗阻性脑积水的临床疗效

目的：探讨内镜在梗阻性脑积水治疗中的临床应用价值。方法：将我院80例梗阻性脑积水患者随机分为治疗组及对照组,对照组患者采用分流术,治疗组患者采用神经内镜下三脑室底造瘘术。结果：治疗组均造瘘成功,无中转分流术。手术时间治疗组明显短于对照组,术后并发症例数也明显少于对照组,差异有统计学意义（P〈0.05）,术后症状缓解率差异无统计学意义（P〉0.05）。两组患者均获随访,时间6～12个月,症状均有锁缓解,复查CT或MRI见脑室均有不同程度缩小。结论：ETV治疗梗阻性脑积水符合当今神经外科微创原则,疗效确切,手术时间短、脑暴露少、对组织损伤小,手术费用降低,并发症少,值得推广。     

CSF circulation disorders: measuring progress in patients through quality of life and hope

Background. Cerebrospinal fluid circulation disorders are complex and multifaceted conditions making reliable assessment of progress problematic. Aims and objectives. It is the aim of this paper to explore how efficient measures of quality of life and hope might be used to assess clinical progress for patients with disorders of cerebrospinal fluid circulation. It will be argued that a single‐item 10‐point quality of life scale and the Herth Hope Index are as effective at measuring progress as the more widely used, but considerably more complex, Short‐Form 36. Design. Patients attending a cerebrospinal fluid clinic were sent a questionnaire containing the three measures of progress. Questionnaires were returned in a stamp‐addressed envelope to allow initial analysis before the clinic appointment and to enable discussion of results during the clinic appointment. Patients were also assessed using the Mini‐Mental State Examination during the clinic appointment. Methods. The relationship between the three measures of progress was calculated using Spearman's rank order correlation. Correlations of 0.40–0.70 are considered modest and correlations of 0.70 are considered strong; 5% levels of significance are considered significant and 1% levels are highly significant. Internal consistency of the Short‐Form 36 was assessed using Cronbach's alpha coefficient. Reliability was considered acceptable for dimension comparisons when α > 0.70. Results. All patients were diagnosed with benign intracranial hypertension (n = 74), congenital hydrocephalus (n = 35) or normal pressure hydrocephalus (n = 171). There was a modest to strong correlation between the quality of life‐10 and all eight dimensions of the Short‐Form 36 for benign intracranial hypertension and congenital hydrocephalus patients. A slightly weaker correlation was demonstrated in seven of the eight Short‐Form 36 dimensions for normal pressure hydrocephalus patients. Normal pressure hydrocephalus patients scored significantly lower on the Mini‐Mental State Examination, which may contribute to explaining the weaker correlation between the three measures and the weaker internal consistency between the dimensions with the Short‐Form 36. Conclusions. This paper demonstrates that efficient indicators of progress (quality of life‐10 and Herth Hope Index) can be as effective at assessing clinical progress as more complex indicators (Short‐Form 36) in patients who do not demonstrate cognitive deficit. Relevance to clinical practice. For clinical application, the Short‐Form 36 is too long, difficult to complete, score and analyse for these patient groups. Quality of life‐10 and Herth Hope Index could provide efficient and effective measures of clinical progress but this requires further psychometric examination.     

Three-dimensional ultrasonography of hydrocephalus

We examined two infants with hydrocephalus using three-dimensional (3-D) ultrasonography. One infant had congenital hydrocephalus with a ventriculoperitoneal shunt. On 2-D ultrasonography, the shunt tube was shown only as “a point.” However, on 3-D ultrasonography, we could easily see the three-dimensional position of the shunt tube, which was situated in the lateral ventricle. The other patient had hydrocephalus associated with an arachnoid cyst. We could understand the complex shape of the cyst and distinguish it from the third ventricle using 3-D ultrasonography. Thus, 3-D ultrasonography imaging is more useful than 2-D ultrasonography imaging in evaluating hydrocephalus.