脊髓空洞腹腔分流术治疗外伤后脊髓空洞症（附8例报告）

目的研究脊髓空洞腹腔分流术治疗外伤后脊髓空洞的手术效果。方法回顾性分析8例外伤后脊髓空洞症患者采用脊髓空洞腹腔分流手术前后的临床资料,比较手术前后的临床症状。结果有5例症状较术前得以改善,1例症状无明显变化,2例加重。结论脊髓空洞腹腔分流术是治疗外伤后脊髓空洞症的有效方法,分流术后神经功能得以改善,空洞复发主要和分流管堵塞相关。有效的脊髓空洞症的外科治疗方式最终还要取决于对病因学及病理学机制的进一步研究。     

脊髓空洞症的外科治疗(附35例分析)

目的 探讨脊髓空洞症的手术方式及适应证。方法 对35例患者术前行神经功能及MR检查,根据原发疾病及影像学特点选用不同的手术治疗方法。结果 随访6个月至5年,35例患者无死亡,1例在实行后颅窝减压术后出现脑脊液漏。症状明显改善13例,好转16例,加重或出现新的症状6例。7例术后MR提示脊髓空洞塌陷。结论 脊髓空洞症的诊断主要依靠MR,其治疗方法主要根据原发疾病制定。     

脊髓空洞症的外科手术治疗

目的 探讨脊髓空洞症手术治疗适应证、手术方式及效果。方法 对52例MRI证实的脊髓空洞症患者的手术治疗情况行回顾性分析，其中28例行后颅窝减压术，10例行后颅窝减压术＋脊髓空洞蛛网膜下腔分流术，5例行脊髓空洞蛛网膜下腔分流，9例手术治疗原发病。结果 患者术后临床症状明显改善37例，无改善但稳定12例，恶化3例。随访27例患者，空洞消失或基本消失者19例。缩小者6例，无改变者2例。结论 后颅窝减压术。脊髓空洞切开分流术及后颅窝减压术＋脊髓空洞蛛网膜下腔分流术是治疗脊髓空洞症的有效方法。     

后颅窝减压及脊髓穿刺治疗脊髓空洞症(附19例报告)

目的　探讨脊髓空洞 (积水 )症的手术治疗方法。方法　以颅后窝减压、脊髓穿刺 ,松解四脑室正中孔蛛网膜粘连治疗脊髓空洞症 1 9例。结果　术后 1 2例随访 5个月至 3年 ,临床症状完全消失 1 0例 ,好转 2例 ;复查MR中央管口径明显恢复 9例 ,2例恢复 70 % ,1例恢复 50 %。结论　后颅窝减压、脊髓空洞穿刺术治疗脊髓空洞症 ,手术效果满意。     

内窥镜下脊神经后根分流术治疗脊髓空洞症(2例报告)

近年来脊髓空洞症的外科治疗有了很大进展,并收到了较满意的效果。最近我院对以往脊髓空洞症的手术方法进行了改进,采用电视内窥镜引导下脊神经后根分流术治疗了2例脊髓空洞症的病人,近期疗效满意。现报告如下。     

全脊髓空洞症伴脊髓低位一例报告

1 病例报告 患者女，20岁，学生。以“右上肢痛觉减退4年，伴右下肢无力2月余”于2002-01-31入院。4年前发现右上肢皮温较左上肢低，且痛、温觉均较左侧减退，活动尚灵活，此后渐发觉右下肢较左下肢细。2月余前出现右下肢无力，行走稍长时间后拖步，近1个月来右脚踝部活动欠灵活，右足趾下垂，伴颈部及腰骶部间断性疼痛。大小便正常。     

脊髓空洞症外科治疗的远期疗效观察(附10例报告)

脊髓空洞病因尚不明确，多数伴有小脑扁桃体下疝（Chiari＇s畸形）。内科疗效不佳，近年开始外科手术治疗。现就我院随访２年以上的１０例病人疗效追踪如下：１临床资料男４例，女６例，年龄２３～５６岁，平均发病年龄２６．６岁，病程２～１０年。临床表现为截瘫１例，偏瘫３例，单瘫６例。感觉障碍：节段性２例，偏侧２例，单肢６例。肢体不自主抽搐：双下肢１例，偏侧上下肢２例，单肢３例。肌萎缩：双下肢及偏侧各１例，单肢８例。大小便障碍９例。所有病例均行CT、MRI、颅X线平片检查。Chiari＇s畸形：I型３例，II型７例。颅底陷…     

脊髓空洞症的临床类型：附7例报告

脊髓空洞症是脊髓内慢性进行性病变,其主要病因有脊髓先天性发育障碍、外伤、出血、感染及肿瘤等。因脊髓空洞位置、形态及大小的不同。临床表现很不一致。本文接受损解剖部位不同,报告7例脊髓空洞症。     

脊髓空洞症的外科治疗

我们手术治疗脊髓空洞症14例,根据不同类型,采用不同手术方式,收到了比较满意的效果。现就手术时机、手术方式及预后等问题提出讨论。1 临床资料 本组14例,男7例,女7例,年龄8～43岁,平均31岁。交通型11例,非交通型3例,伴扁平颅底和Chiar Ⅰ型畸形6例。本组全部有节段性感觉分离症,有大小鱼际肌萎缩。其中2例伴一侧上肢根性疼痛,2例四肢肌力Ⅲ级并强迫头位,2例双下肢肌力Ⅱ级不能站立和行走。MRI检查:脊髓空洞较细,局限于C_6以上者2例;空洞较粗大,范围C_2-圆锥5例;空洞较粗大,范围从延髓-圆锥1例;空洞较粗大,范围局限于T_4以上者6例。手术方式:空洞-蛛网膜下腔分流术9例,后颅凹减压 空洞-蛛网膜下腔分流术3例,单纯后颅凹减压术2例。     

脊髓空洞症的治疗

报告脊髓空洞症５３例，其中１８例保守治疗症状末能改善，３５例行显微手术治疗。术后按Ｔａｔｏｒ标准，优３０例，良２例，病情无变化２例，１例死于心脏病窦综合征。文内讨论了脊髓空洞显微手术的必要性及手术技巧。     

脑室-腹腔分流术后并发感染临床分析(附9例报告)

脑室-腹腔分流术后感染因其反复发作,最终分流管梗阻而致手术失败;可导致颅内感染,形成脑室-腹腔分流术后最为严重的并发症脑室炎;抗感染治疗以及治疗后再分流时机的选择较困难.我科自2003年1月至2005年1月共治疗脑室-腹腔分流术后并发感染患者9例,现对其诊断及治疗分析如下.     

Thecoperitoneal shunt for post-traumatic syringomyelia.

A case of post-traumatic syringomyelia developing two years after spinal cord injury is presented. The patient was treated with the placement of a thecoperitoneal shunt incorporating a low pressure valve. Response was excellent with restoration of neurological function and almost complete collapse of the cavity at one year follow up. The rationale of this form of treatment is discussed in the light of recent evidence concerning the pathogenesis of the condition.     

Familial syringomyelia: a report of four cases.

The clinical and neurological features of four siblings (2 male, 2 female) affected by syringomyelia are described. A fifth sister was affected by an acoustic neurinoma. Since neither parent showed signs of syringomyelia, this is considered to be a datum substantiating the dysembryogenetic theory of the syringomyelia syndrome.     

Treatment of syringomyelia with a syringosubarachnoid shunt

The surgical results in 40 patients with syringomyelia, treated with a syringosubarachnoid shunt or other procedures are reviewed. The principal indication for surgery was that of significant neurological deterioration. There were 12 patients with idiopathic syringomyelia without tonsillar ectopia, 12 with an associated Chiari malformation, 11 with post-traumatic syringomyelia and five patients with spinal arachnoiditis. There were 38 syringosubarachnoid shunts performed in 35 patients, and an excellent or good result was achieved in 26 patients (74.3%). In terms of the type of syringomyelia, the best results were obtained in the idiopathic group without tonsillar ectopia and in the post-traumatic group. A short duration of pre-operative symptoms favoured a better outcome, and in our opinion, early surgical treatment is indicated for all patients with neurological deterioration. All eight patients in whom a posterior fossa decompression was performed as the initial surgical procedure required a second operation, either a syringosubarachnoid or syringoperitoneal shunt to achieve neurological improvement or stabilization. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for patients with syringomyelia, particularly for the idiopathic and post-traumatic groups. More than one surgical procedure may be required to achieve cessation of deterioration. Overall, excellent or good results were achieved in 29 (72.5%) of the 40 patients.     

腰池-腹腔分流术治疗特发性颅内压增高症(附43例报告)

目的 分析43例腰池-腹腔分流术治疗特发性颅内压增高症患者的临床资料及手术效果,探讨腰池-腹腔分流术治疗特发性颅内压增高症的临床进展.方法 术前常规检查视力、视野、眼底像并行腰穿测压和相关内分泌及影像学检查,根据术前视力情况进行分组同时对比术后随访资料,评价腰池-腹腔分流术治疗特发性颅内压增高症的临床意义.结果 术前视力在0.1≤视力<0.5的患者术后视力恢复率达86.3%,与其他组别对比差异有统计学意义.结论 腰池-腹腔分流术治疗特发性颅内压增高症有明显疗效,尤其是对于0.1≤视力<0.5的患者应积极手术治疗.     

大型脑动静脉畸形的伽玛刀体积分割治疗

目的 探讨伽玛刀体积分割治疗大型(体积＞10 cm3)脑动静脉畸形(AVM)的临床疗效.方法 回顾性分析2007～2017年收治的13例大小脑AVM的临床资料,均采用伽玛刀体积分割治疗,时间间隔3～18个月,治疗的AVM总体积平均为18.2 cm3(13.5～52 cm3),首次治疗的体积平均为14.1 cm3(8～2...     

A modified technique for syringo-subarachnoid shunt for treatment of syringomyelia.

Syringo-subarachnoid shunting is a well-established procedure for the treatment of syringomyelia. However, the standard surgical procedure requires a laminectomy and posterior midline myelotomy, which have potential complications. In this study, we describe our clinical experience with a modified technique for syringo-subarachnoid shunt insertion in eight patients between 1998 and 2002. The technique comprises a limited hemilaminectomy, a 2 mm myelotomy at the site of dorsal root entry zone, introduction of a 1.5 mm thick catheter into the syrinx and placement of the distal tip of the catheter in the anterolateral subarachnoid space. Using this technique there was no operative morbidity or mortality. Collapse of the syrinx, in the first post-operative month, was demonstrated by MRI in all cases. There were no relapses in the follow-up period. Although our experience is limited and the results preliminary, this technique is less invasive than commonly used techniques and the results are favorable.     

微创脑室-腹腔分流术治疗脑积水346例临床分析

目的总结微创脑室-腹腔分流术治疗脑积水的临床经验及治疗效果。方法自1996-01~2010-01对收治的346例脑积水患者行微创脑室—腹腔分流术,并对其临床资料及随访结果进行回顾性分析。结果术后随访0.5~14 a,有5例(1.4%)术后1~3周出现颅内感染,均为开颅术后脑积水患者,其中2例(0.6%)感染难以控制,予以终止分流。有2例(0.6%)出现慢性硬膜下血肿,均为本组早期患者。2例(0.6%)术后1~3个月出现脑室端引流管阻塞,均为开颅术后脑脊液混浊患者。结论开颅术后脑积水患者,分流术后感染几率、分流管阻塞几率相对较高。微创脑室-腹腔分流术简单易行,创伤小,并发症明显减少,效果良好,值得推广。     

椎管内原发性畸胎瘤的诊治分析（附13例报道）

目的 探讨椎管内原发性畸胎瘤的临床特点及治疗情况。方法 回顾性分析2016年12月至2019年6月手术治疗的13例椎管内原发畸胎瘤的临床资料。结果 肿瘤全切除1例,次全切除12例。13例术后病检结果均为成熟性畸胎瘤。术前肢体无力6例中,改善5例;术前大小便功能障碍7例中,改善6例;2例性功能障碍、9例腰背部疼痛、7例肢体疼痛麻木,术后均改善。术后发热3例,感染1例。术后随访1~29个月,中位数为7个月,平均11.2个月;4例复发。结论 椎管内原发性畸胎瘤发病率低,多位于胸、腰段,髓内、髓外均可,显微手术为主要治疗方法,并发症少,病理检查以成熟性畸胎瘤居多。     

Willis覆膜支架在颅内动脉病变治疗中的临床应用

目的 总结 Willis覆膜支架治疗颅内动脉疾病的初步临床经验。方法 回顾性分析2015年10月至2018年2月采用 Willis覆膜支架治疗的13例颅内动脉病变的临床资料。结果 13例中,海绵窦动静脉瘘3例;动脉瘤10例。13例共置入Willis覆膜支架13枚,均一次成功置入支架。9 例动脉瘤术后即刻动脉瘤不显影;1例巨大型动脉瘤术后即刻少量内漏;2例海绵窦动静脉瘘术后即刻病变完全消失,责任动脉通畅;1例海绵窦动静脉瘘术后即刻少量内漏。13例术后随访7~25个月,平均（15±4.6）个月;病变均无复发,责任动脉通畅;2 例术后即刻少量内漏,随访期间内漏自行闭塞;1例CTA显示支架近心端中度狭窄;13例改良Rankin量表评分均为0分,随访期间未出现任何相关临床不适。结论 Willis覆膜支架治疗颅内动脉疾病操作简便,安全有效,但需严格掌握适应证。