锥颅治疗脑内血肿:单孔引流与多孔引流的效果对比

目的 比较简易头皮下定位锥颅单孔引流与多孔引流治疗自发性脑内血肿的效果.方法 回顾性分析55例自发性颅内血肿患者,头皮定位单孔引流31例[血肿量(52.9±13.2)ml],头皮定位多孔锥颅24例[血肿量(55.3±15.4)ml],术后给予尿激酶溶解血肿.比较引流时间、血肿残留量及日常生活能力Barthel指数.结果 多孔引流组引流时间[(6.5±2.7)d]明显短于单孔引流组[(10.6±3.2)d](P<0.05);在治疗后3个月,多孔引流组的Barthel指数(71.87±7.53)明显高于单孔引流组(50.62±17.20)(P<0.05).结论 对于较大的且形状不规则的血肿应该在定位下实施多点穿刺.微创穿刺血肿腔引流加尿激酶冲洗简单易行,血肿清除率高,术后恢复好.     

微创手术在老年迟发性外伤性颅内血肿中应用优势分析

目的分析微创手术在老年迟发性外伤性颅内血肿中应用优势。方法选取2013-02—2014-04收治的100例老年迟发性外伤性颅内血肿患者,平均分成2组,对照组采用开颅血肿清除术治疗,实验组采用微创穿刺清除术治疗,比较2组的治疗临床效果、并发症发生率。结果实验组的清除血肿所需时间(4.78±1.31)d,对照组为(7.38±2.24)d,差异无统计学意义(P0.05);实验组并发症发生率(10.00%)显著低于对照组(36.00%),实验组总有效率(90.00%)显著高于对照组(62.00%),差异有统计学意义(P0.05)。结论微创手术治疗老年迟发性外伤性颅内血肿具有明显优势,在临床上具有重要的应用价值。     

微创颅内血肿清除术治疗高血压性脑出血的临床研究

目的评价微创颅内血肿清除术治疗高血压性脑出血的疗效。方法对67例中、重症高血压性脑出血患者随机分为2组:A组(微创治疗组)33例,B组(保守治疗组)34例,A组采用微创技术清除血肿,B组单纯行保守治疗,并分别观察2组的临床疗效。结果(1)A组有效率(63.6%)及显效率(39.4%)均明显高于B组(35.3%,20.6%)(P<0.05),而A组病死率(27.3%)明显小于B组(55.5%)(P<0.01);(2)A组血肿消失速度[(15.1±3.4)d]明显快于B组[(35.3±5.2)d](P≤0.01);(3)治疗前、后15d A组神经功能缺损明显快于B组(P≤0.05)。结论微创颅内血肿清除术治疗高血压性脑出血较单纯保守治疗效果好,且能明显提高有效率、降低病死率及缩短患者血肿消失时间,促进患者神经功能的恢复。     

颅内血肿微创清除术治疗高血压脑出血与内科保守治疗对照分析

目的 探讨CT定位颅内血肿微创清除术治疗高血压脑出血的临床疗效.方法 将216例高血压脑出血患者按治疗方法的不同,分为颅内血肿微创清除术组(手术组)120例和内科保守治疗组(保守组)96例,两组患者给予常规治疗,包括吸氧、保持呼吸道通畅,降颅压,调整血压,预防感染、消化道出血、肾功能衰竭等并发症,维持水电解质平衡等.手术组另外行颅内血肿微创清除术.比较观察两组的临床疗效、并发症发生率及死亡率.结果 手术组疗效明显优于对照组(P<0.001),手术组并发症发生率和死亡率比对照组明显减少(P<0.01).结论 采用CT定位颅内血肿微创清除术治疗高血压脑出血,明显提高基本治愈率,有效降低并发症发生率和病死率.     

开颅手术前微创穿刺减压救治脑疝期外伤性颅内血肿42例分析

目的 探讨脑疝期颅内血肿术前快速微创穿刺抽吸减压术的临床效果。方法 对脑疝期颅内血肿42例采用术前微创穿刺抽吸血肿减压，然后再进行常规骨瓣开颅血肿清除术。结果 术前微创法吸出血肿10-80mL，从确定手术至微创抽出积血减压所需时间约5～15min，平均为10min。结论 对脑疝期颅内血肿患者，术前微创穿刺减压能迅速缓解颅内高压，降低死亡率及致残率。     

定向软通道微创颅内血肿清除术治疗高血压脑出血的疗效观察

目的观察定向软通道微创颅内血肿清除术治疗高血压脑出血的疗效。方法选择我院2013-01—2014-01收治的48例高血压脑出血患者,按照随机数字法分组,每组24例,观察组采取定向软通道微创颅内血肿清除术治疗,对照组采取传统大骨瓣开颅血肿清除术治疗,比较2组疗效及病死率。结果观察组术中出血量、手术时间、住院时间分别为(56.7±15.6)mL、(22.5±7.9)min、(21.9±7.6)d,均明显低于对照组(89.9±22.1)mL、(235.7±27.4)min、(27.8±8.5)d(均P<0.05);观察组经治疗后,疗效明显优于对照组;观察组不良反应9例(37.5%),死亡1例(4.2%),均显著低于对照组的13例(54.2%)、3例(12.5%)。结论定向软通道微创颅内血肿清除术治疗高血压脑出血疗效较佳,患者预后好,不良反应及病死率较低。     

微创颅内血肿清除术治疗颅内血肿

目的 探讨微创颅内血肿清除术治疗颅内血肿的效果.方法 对收治的46例颅内血肿患者采用微创颅内血肿清除术治疗.结果 46例均一次穿刺成功,39例术后3天复查CT证实原血肿已基本消失,5例术后5天复查CT证实血肿已基本消失,2例术后病情恶化而死亡.结论 用CT定位颅内血肿微创清除术治疗颅内血肿疗效明显、死亡率低、致残率下降,生存率及生存质量显著提高,住院周期缩短,减低了病员医疗费用,是治疗颅内血肿安全有效的手段.     

微创穿刺术与简易碎吸术治疗高血压基底节出血临床分析

目的 探讨简易碎吸术与微创穿刺术治疗高血压脑出血的临床效果.方法 将281例基底节压出血分为2组,简易碎吸组92例,采用直径5mm槽型手锥锥透颅骨,LXS-1型颅内血肿碎吸机负压吸引,硅胶管引流加尿激酶溶解血肿;微创穿刺组189例,采用YL-1型颅内血肿粉碎穿刺针正压冲洗引流加尿激酶溶解血肿.结果 脑卒中临床神经功能缺损(FAM)评分,简易碎吸组术前(38.7±8.1),术后28d为(19.6±7.4);微创穿刺组术前(39.1±8.3),术后28d(11.48±5.4),2组对比有显著差异(P<0.05).术后6个月ADL优良率,简易碎吸组54.3%,微创穿刺组77.8%(P<0.005).病死率简易碎吸组42.4%,微创穿刺组21.2%(P<0.05).结论 微创穿刺术治疗脑出血近期、远期疗效均好,病死率低.     

神经内镜辅助下大骨瓣开颅手术治疗Ⅲ～Ⅳ级高血压性基底节区出血

目的探讨神经内镜辅助下大骨瓣开颅手术治疗Ⅲ~Ⅳ级高血压性基底节区出血的效果。方法 2010年7月至2014年6月收治高血压性基底节区出血47例,采用神经内镜辅助下行大骨瓣开颅血肿清除术18例(内镜组),显微镜下大骨瓣开颅血肿清除术29例(对照组)。结果内镜组血肿清除时间[(43±16)min]显著低于对照组[(58±23)min;P0.05],而血肿清除率[(92.6±6.2)%]则显著高于对照组[(83.2±9.6)%;P0.05]。术后7 d,内镜组GCS评分[(8.9±2.4)分]显著高于对照组[(7.9±2.7)分;P0.05]。术后6个月,两组GOS评分无显著性差异(P0.05)。结论在大骨瓣开颅高血压性基底节区出血清除术中,神经内镜也可作为很好的辅助手段。     

微创颅内血肿清除术治疗老年高血压脑出血的疗效观察

目的观察微创颅内血肿清除术对老年高血压脑出血(hypertensive cerebral hemorrhage,HICH)的临床疗效及安全性,为老年HICH的临床治疗提供依据。方法选取我院收治的老年HICH患者272例,按照随机数字表分为微创组及开颅组各136例,分别实施微创颅内血肿清除术和开颅血肿清除术,比较2组疗效、神经功能缺损程度评分(CSS)和并发症情况,并分析其治疗3个月后Glasgow结果评分(GOS)及日常生活活动能力(ADL)分级,比较其预后。结果 2组治疗后CSS评分均显著降低,微创组降低程度更显著(P0.05);微创组总有效率90.4%,开颅组总有效率69.9%,微创组疗效显著优于开颅组;微创组共出现并发症发生率30.1%,显著低于开颅组的40.4%,差异有统计学意义(P0.05);微创组GOS评分(4.3±0.5)分,开颅组GOS评分为(4.1±0.9)分,差异无统计学意义(t=1.017,P0.05);微创组ADL预后良好率为41.9%(57/136),显著高于开颅组的31.6%(43/136),差异有统计学意义(P0.05)。结论微创颅内血肿清除术具有治疗及时、操作方便、创伤较小等多种优势,能够在发病早期清除患者颅内血肿,有效避免脑组织损害的加重,且并发症率较低,安全性较好,有助于老年HICH患者日常生活功能的恢复,值得临床推广应用。     

Association among intracranial compliance,intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds

Abstract

Objective: To investigate the association among intracranial compliance (ICC), intracranial pulse pressure amplitude and intracranial pressure (ICP) in patients with intracranial bleeds.

Methods: Five patients with intracranial bleeds had their ICC and ICP monitored during days 1–8 after ictus. The recordings were stored as raw data files and analysed retrospectively. The parameters mean ICC, mean ICP wave amplitude and mean ICP were determined and average values were calculated in 1 hour time periods.

Results: A total of 2621 hour recordings were analysed. There was a significant correlation between mean ICC and mean ICP wave amplitude and between mean ICC and mean ICP. The mean ICP wave amplitude was significantly higher during the 1 hour periods with mean ICC<0.5 ml/mmHg and significantly lower during 1 hour periods with mean ICC 1.5–3.0 ml/mmHg. Correspondingly, in the 1591 hour recordings with mean ICP wave amplitude≥5.0 mmHg, mean ICC was significantly lower than in the 103 recordings with mean ICP wave amplitude<5.0 mmHg. Mean ICP was normal (i.e. <20 mmHg) in 260 of 262 (99.2%) of the 1 hour recordings; in the 491 hour recordings with mean ICP>15 mmHg, mean ICC was significantly lower than in the 213 recordings with mean ICP<15.0 mmHg.

Conclusion: In this cohort of pressure recordings, there was a strong association between ICC and intracranial pulse pressure amplitude. There also was a strong association between ICC and mean ICP, but mean ICP was normal in 260 of 2621 hour recordings (99.2%).     

Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds

OBJECTIVE: To investigate the association among intracranial compliance (ICC), intracranial pulse pressure amplitude and intracranial pressure (ICP) in patients with intracranial bleeds. METHODS: Five patients with intracranial bleeds had their ICC and ICP monitored during days 1-8 after ictus. The recordings were stored as raw data files and analysed retrospectively. The parameters mean ICC, mean ICP wave amplitude and mean ICP were determined and average values were calculated in 1 hour time periods. RESULTS: A total of 262 1 hour recordings were analysed. There was a significant correlation between mean ICC and mean ICP wave amplitude and between mean ICC and mean ICP. The mean ICP wave amplitude was significantly higher during the 1 hour periods with mean ICC<0.5 ml/mmHg and significantly lower during 1 hour periods with mean ICC 1.5-3.0 ml/mmHg. Correspondingly, in the 159 1 hour recordings with mean ICP wave amplitude> or =5.0 mmHg, mean ICC was significantly lower than in the 103 recordings with mean ICP wave amplitude<5.0 mmHg. Mean ICP was normal (i.e. <20 mmHg) in 260 of 262 (99.2%) of the 1 hour recordings; in the 49 1 hour recordings with mean ICP>15 mmHg, mean ICC was significantly lower than in the 213 recordings with mean ICP<15.0 mmHg. CONCLUSION: In this cohort of pressure recordings, there was a strong association between ICC and intracranial pulse pressure amplitude. There also was a strong association between ICC and mean ICP, but mean ICP was normal in 260 of 262 1 hour recordings (99.2%).     

Rebound intracranial hypertension after treatment of spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and the cause is usually cerebrospinal fluid leaks in spine level. Most patients with SIH have a benign course. Epidural blood patch (EBP) is the treatment of choice when initial conservative managements are ineffective. We reported a patient with SIH diagnosed by using magnetic resonance imaging and radionuclide cisternography. Acute rebound intracranial hypertension developed after EBP and was successfully treated with intravenous osmotic agent.     

Static and pulsatile intracranial pressure in idiopathic intracranial hypertension

Objective

The aim of this observational study was to characterize the static and pulsatile intracranial pressure (ICP) in conservatively (medically) treated idiopathic intracranial hypertension (IIH) patients in need of shunt surgery, and also in patients with chronic daily headache (CDH) without visual disturbances.

Methods

The material includes 14 IIH patients and 7 CDH patients in whom ICP was monitored continuously over-night. Static ICP was characterized by mean ICP, pulsatile ICP was characterized by the wave amplitude, rise time, and rise time coefficient.

Results

In the IIH group all 14 had headache and visual disturbances. Mean ICP was high (>15 mmHg) in only 7 patients (50%), while mean ICP wave amplitude was high (≥4 mmHg) in all 14 (100%). All IIH patients were shunted and improved clinically thereafter (i.e., relief from visual disturbances and/or headache). None in the CDH group had high mean ICP or mean ICP wave amplitude, and none were shunted.

Conclusions

In this cohort of 14 conservatively treated IIH patients with lasting and shunt-responsive headache and visual disturbances, the mean ICP wave amplitude was elevated (≥4 mmHg) in all patients despite normal mean ICP (<15 mmHg) in 7 patients (all but one on medication). Therefore, the pulsatile ICP may be more relevant than the static ICP in the diagnostic setting for patients with IIH. Further prospective standardized approaches are warranted.     

颅内动脉瘤破裂并颅内血肿的手术治疗

目的探讨颅内动脉瘤破裂并颅内血肿的诊断和手术治疗经验。方法回顾性分析21例颅内动脉瘤破裂并颅内血肿患者手术治疗的临床资料。结果21例患者共24个动脉瘤均成功夹闭,无死亡病例。术后3个月19例患者得以随访,GOS5分10例,4分3例,3分4例,2分2例。脑积水2例分流术后痊愈。结论3D-CTA应作为该类患者术前首选检查手段,明确诊断后积极清除颅内血肿的同时夹闭动脉瘤能有效改善患者预后。     

Wilms' tumor with intracranial metastases presenting with intracranial hemorrhage

Intracranial metastasis of Wilms' tumor is very rare. Furthermore, intracerebral hemorrhage is an unusual presentation of metastases. We report the case of a 4-year-old girl who had multiple intracranial metastatic lesions, initially presenting as an intracranial hemorrhage. Removal of the tumors and hematoma was followed by radiation therapy and chemotherapy. Thereafter, complete remission occurred. It is thought that this malignant tumor with metastases may be curable through combined therapy.     

颅内高压状态下TCD频谱参数与颅内压关系的实验研究

目的 探讨颅高压状态下经颅多普勒超声(TCD)频谱参数与颅内斥(ICP)的关系。方法 制备新西兰兔球囊注水法颅高压模型，监测大脑中动脉的TCD频谱，测量参数?结果 TCD频谱参数cf、PI、RI、Vd、Vm与ICP均呈指数关系，其中cf与ICP的相关系数最大。结论 TCD频谱参数与颅内压的升高密切相关。