Acute intracranial hematomas in term neonates

Acute intracranial hematomas in 17 term neonates are reported: 3 were subdural in the posterior fossa; 14 supratentorial, either subdural (8), intracerebral (1 frontal, 4 occipital) or intraventricular (1). The hematomas were aspirated in 3 cases and surgically evacuated in 10. In the remaining 4, the effusion was left in situ. Three patients died: 2 due to dramatic preoperative deterioration and 1 to hemostatic difficulties during surgery. In the 14 survivors, neurological sequellae are major in 3, nil or minor in 11. Comparison of these cases to the 110 others already published allows the following conclusions: (1) the cause of such hematomas is usually multifactorial, combining obstetrical trauma, anoxia and/or coagulation disorders; (2) early diagnosis of the hematoma requires early echography and/or tomodensitometry; (3) when the hematoma causes a midline shift, the authors advocate its early evacuation by aspiration, or craniotomy if it is clotted; (4) the prognosis is poor when there is associated severe perinatal anoxia; if there is no anoxia, the prognosis seems good, but as the follow-up is usually short, definite conclusions are difficult; (5) in our series hydrocephalus requiring treatment occurred in 2 of the 14 survivors.     

颅脑损伤术后并发迟发性颅内血肿分析（附22例报告）

本文报告了２２例颅脑损伤开颅术后并发２５个迟发性颅内血肿。发生在幕上２２个，幕下３个。脑实质内１１个，硬膜下４个，硬膜外１０个。并对其发生机理进行探讨，认为脑血管舒缩机制障碍、手术前后颅内压急骤变化、以及凝血机制障碍是术后发生迟发性颅内血肿的重要因素。对其诊断和治疗提出建议。     

Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management

In the management of craniosynostosis subdural intracranial pressure (ICP) monitoring has proved a useful and safe means of identifying those children with raised ICP who are at risk from its long-term sequelae and who would benefit from early surgical intervention. Overnight subdural ICP recordings have been obtained in 136 unoperated cases of craniosynostosis. Fifteen patients were studied both before and after cranial vault remodelling procedures. ICP was raised (>15 mmHg) in 35%, borderline (10–15 mmHg) in 27% and normal (<10 mmHg) in 27% of cases. Raised ICP was present in 28/53 of the syndromic craniofacial dysostosis cases and in 20/83 non-syndromic craniosynostosis cases investigated (P<0.001). Raised mean ICP and periodic plateaux of sustained ICP during sleep were particularly associated with the syndromic cases. Of the 15 patients studied following cranial vault surgery, 9 showed a reduction in ICP, 3 were unchanged and 3 had higher ICP postoperatively. The results of ICP monitoring can contribute significantly to formulating a rational and staged surgical management plan incorporating the need to normalise ICP and correct the frequently severe functional and cosmetic consequences of these disorders.     

以侧裂区血肿为表现的脑血管疾病临床分析

目的：探讨以侧裂区血肿为表现的脑血管疾病的临床特征。方法2005-10-2012-10我院收治侧裂区血肿的脑血管疾病患者72例,其中颅内动脉瘤38例,非动脉瘤34例（7例动静脉血管畸形,27例高血压脑出血）,对2组临床资料进行回顾性分析。结果蛛网膜下腔出血发生率动脉瘤组高于非动脉瘤组（P＜0.001）;动脉瘤组CTA阳性率高于非动脉瘤组（P＝0.001）。结论侧裂区血肿形成应首先考虑动脉瘤可能;血肿大小、蛛网膜下腔出血及CTA有助于动脉瘤的检出。     

术中超声导航辅助切除脑动静脉畸形

目的探讨术中实时超声导航在脑动静脉畸形(AVM)外科治疗中的应用价值。方法26例脑AVM显微手术切除术中,使用Aloka SSD 4000型超声检查仪扫描,进行AVM定位、辨别供血动脉和引流静脉;确定血肿与AVM的关系以及血流动力学监测。病变切除后重复超声检查AVM残留与否,并与术后脑血管造影结果对比。结果26例畸形血管团均住实时超声下清晰显示并获得全切除。血肿区为高同声无血流信号;供血动脉与正常血管在血流动力学上有差别;术中超声影像所示的病变全切除为术后血管造影所证实。结论术中实时超声能够对脑AVM进行准确定位,指导皮质切口的设计,并可判定病灶是否全切除.对于术前的MRI、DSA检查起到很有价值的补充作用。     

外伤性急性颅内出血后血肿扩大的相关因素分析

外伤性急性颅内出血后血肿扩大是指一次出血不断发展，在一定时间内血液成分从受损血管不断渗漏的过程其发生机制主要为：凝血机制障碍，损伤局部代谢异常．局部压力的改变等。受年龄、血管顺应性、出血量及血肿形状等因素的影响，发生时间多在脑外伤后72h内，尤其是伤后1h内因而在伤后3d内，应密切观察病情变化，多次复查CT，以便早期诊断。治疗上遵循急性颅内血肿的治疗原则，同时应及时补充凝血因子，合理使用脱水剂，以有效预防。     

颅内外肿瘤的显微外科治疗

目的回顾性分析我院1992年至今采用术前供血动脉栓塞和显微外科治疗的60例颅内外肿瘤患者,为改善此类疾病的预后提供依据.方法男性患者42例,女性18例,年龄11月～68岁,平均32.2岁.肿瘤分布于前颅窝30例,中颅窝16例,后颅窝14例.48例术前行DSA检查,其中45例经颈外动脉栓塞颞浅动脉,耳后动脉和硬脑膜动脉等肿瘤供血动脉.采用不同手术入路和显微外科技术切除肿瘤.结果 42例肿瘤被全切,其余为次全切,术后致残率为0.7月～7年的随访结果表明34例重新开始正常生活,18例生活不能完全自理,8例部分恢复.结论术前肿瘤供血动脉栓塞可减少术中出血,增加肿瘤全切的可能性.显微外科和分块切除肿瘤技术结合不同的手术入路可改善患者的预后.     

颅内动脉瘤3D-CTA诊断效能的临床研究

目的 评价三维CT血管成像(3D—CTA)在外科治疗颅内动脉瘤中的诊断效能。方法 24例可疑动脉瘤患者行脑血管造影、3D—CTA、MRA和DSA检查。结果 本组共发现28个动脉瘤。21例病人有一个，2例有两个，1例有三个动脉瘤。3D—CTA发现瘤体呈球形为20个、椭圆形5个、分叶形3个。手术暴露的24个动脉瘤，其瘤体形态与3D—CTA发现完全吻合。动脉瘤颈平均直径为5.9mm，最小为1.6mm，最大为13．7mm。根据3D—CTA计算的动脉瘤颈结果与手术发现非常接近。3D—CTA对载瘤动脉和分枝动脉的形态描述明显优于脑血管造影、MRA和DSA。结论 3D—CTA在了解动脉瘤的三维结构和制定手术治疗方案有重要辅助作用。     

脑底异常血管网病合并颅内动脉瘤的外科治疗分析

目的 探讨脑底异常血管网病合并颅内动脉瘤的外科治疗方式及其疗效。方法 回顾性分析2016年1月至2019年12月收治的18例脑底异常血管网病合并颅内动脉瘤的临床资料。根据病人的具体情况选择个体化治疗方案。结果 10例非血流相关性破裂动脉瘤中,5例行动脉瘤夹闭+颞肌贴敷术,4例行动脉瘤栓塞术,1例行动脉瘤栓塞+二期单侧颞浅动脉-大脑中动脉（STA-MCA）分流术;3例烟雾血管破裂出血中,1例行血肿清除+脑室外引流术,1例保守治疗,1例行STA-MCA分流术;5例未出血病人中,1例行STA-MCA分流+动脉瘤夹闭术,2例行STA-MCA分流术,2例行动脉瘤栓塞+STA-MCA分流术。围手术期死亡1例;存活17位出院后随访1～5年,1例保守治疗2年因再出血死亡;1例发生颅内再出血。16例存活病人末次随访改良Rankin量表评分0分10例,1分3例,2分2例,4分1例（再出血病人）。结论 脑底异常血管网病合并颅内动脉瘤的病人,可以根据是否有出血症状及所合并的是否为血流相关性动脉瘤,采取相应的手术方式。存在血流相关性动脉瘤,但没有颅内出血的病人,可以行单纯STA-MCA分流术,而不需要处理动脉瘤...     

自发性低颅压综合征伴双侧硬膜下血肿二例

目的探讨自发性低颅压综合征的临床表现及影像学特征,以及其并发症慢性硬膜下血肿的处理。方法收集河北医科大学第二医院就诊的2例自发性低颅压综合征伴慢性硬膜下血肿的临床资料。分析该病的主要临床表现及影像学特征,及其慢性硬膜下血肿的处理。结果自发性低颅压综合征伴慢性硬膜下血肿,若有血肿进展或意识改变应及时外科治疗。结论自发性低颅压综合征伴慢性硬膜下血肿应密切观察患者病情,随访CT/MRI,了解有无血肿的进展,以便及早给予相应的治疗。     

微创理念对手术治疗高血压基底节脑出血预后的影响(附57例报道)

目的 探讨以微创理念指导高血压基底节脑出血的手术治疗对其预后的影响. 方法 将仙游县医院自2007年1月至2011年6月收治的高血压基底节脑出血手术患者57例分为2008年12月以前收治的A组(26例,根据血肿量来判断手术指征,具备手术指征者予术前准备并手术治疗)和2008年12月以后收治的B组(31例,有血肿扩大趋势者即予术前准备,以微创的理念指导手术行血肿彻底清除并妥善止血),分析在微创理念指导下以血肿扩大趋势为手术依据并手术行血肿彻底清除、妥善止血对高血压基底节脑出血预后的影响. 结果 术前意识状态分级及血肿量在2组间比较差异无统计学意义(P＞0.05).A组发现15例有责任血管,B组发现27例,比较差异有统计学意义(P＜0.05).A组血肿清除率约为75％,术后近期再出血4例(15.4％);B组血肿清除率＞90％,术后近期再出血2例(6.5％),均为未找到责任血管者.A组术后3个月良好率为46.2％(12/26),B组为74.2％(23/31),比较差异有统计学意义(P＜0.05). 结论 以微创理念指导高血压基底节脑出血的手术治疗,把血肿扩大趋势作为手术依据,尽快发现有手术适应证者,并在最短时间内手术,手术讲究彻底清除血肿、妥善止血,从而能有效改善其疗效.     

Our experience with surgically treated epidural hematomas in children

Objective

Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children.

Methods

This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients'' medical records, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury.

Results

The mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance.

Conclusion

Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.     

颅内血肿清除术并发脑梗死治疗经验总结

目的总结分享颅内血肿清除术并发脑梗死的治疗经验。 方法回顾性分析济宁医学院附属金乡医院神经外科自2010年6月至2017年12月收治的22例行颅内血肿开颅手术并发脑梗死患者的临床资料,对其治疗和结果进行总结。 结果22例患者中,术后即刻或24 h内复查颅脑CT,术后患者死亡7例,重残3例,轻残5例,基本正常7例。术后3~7 d复查颅脑CT,显示低密度区局部可见脑回密度,其中大脑中动脉供血区梗死1例,大脑后动脉供血区梗死基本均恢复,大脑半球梗死患者未见脑供血恢复情况。 结论提早发现颅内血肿清除术并发脑梗死的高风险因素,可大幅提高抢救的成功率,降低患者致死致残率。     

锁孔手术治疗合并颅内血肿的前循环破裂动脉瘤

目的 探讨经锁孔入路手术治疗合并颅内血肿的前循环破裂动脉瘤的可行性和安全性.方法 回顾性纳入2012年12月至2015年8月福建医科大学附属第一医院神经外科收治的32例合并颅内血肿的前循环破裂动脉瘤患者,对所有患者经锁孔入路行动脉瘤夹闭术和血肿清除术治疗,意识较差且脑室系统扩大的患者行侧脑室外引流术.术后当天复查头颅CT,术后3d内复查头颅CT血管成像（CTA）.对所有患者行门诊随访,进行改良Rankin量表评分（mRS）.结果 32例患者共34个颅内动脉瘤均一期夹闭完全,夹闭率为100％.术后当天复查头颅CT,2例血肿扩大,其余血肿均已清除或部分清除.术后3d内复查头颅CTA,34个颅内动脉瘤均夹闭完全.术后并发血肿扩大2例（6.3％）,脑疝形成4例（12.5％）,肺部感染11例（34.4％）,脑血管痉挛12例（37.5％）,脑梗死6例（18.8％）,深静脉血栓形成1例（3.1％）,电解质紊乱6例（18.8％）,无肺梗死.16例行侧脑室外引流者,颅内感染的发生率为25.0％（4/16）,未行外引流者颅内感染发生率为12.5％（2/16）,两者间的差异无统计学意义（P〉0.05）.32例患者的随访时间为6-24个月,平均（16.0±5.4）个月.术后6个月mRS评分为：3例为6分,1例为4分,1例为3分,2例为2分,9例为1分,16例为0分.其中84.4％（27/32）的患者预后良好.结论 经锁孔入路行手术治疗合并颅内血肿的前循环破裂动脉瘤患者的疗效理想,可作为一种有效、安全的选择.     

显微外科手术治疗外伤性脑内血肿

目的探讨显微外科手术治疗外伤性脑内血肿的优越性。方法回顾性分析总结收治的22例显微外科手术治疗的外伤性脑内血肿病例的临床资料并与25例常规肉眼清除血肿手术组术后并发症及治愈情况相比较。结果在伤后1个月根据GOS评估：显微手术组良好15例,中残4例,重残2例,死亡1例,常规手术组GOS评估：良好9例,中残8例,重残5例,死亡3例。结论显微外科手术能提高手术疗效,降低术后并发症,减少残障率。     

手术辅以中低剂量放疗对儿童颅内生殖细胞瘤疗效观察

目的 探讨儿童颅内生殖细胞瘤手术后辅以中低剂量放射治疗后的临床效果.方法 对1999年至2008年收治的54例儿童(≤16岁)颅内生殖细胞瘤患者进行手术联合γ-刀中低剂量放射治疗.其中肿瘤位于松果体区34例,松果体并鞍区10例,鞍区4例,松果体区并侵及邻近脑室3例,基底节区3例.所有患者经术后病理证实均为生殖细胞瘤,手术后辅以中低剂量( 25 ～ 35Gy)的放疗,并获得随访的46例.结果 46例随访者中40例(87％)复查MRI显示肿瘤无复发,患者生存质量明显改善,6例患者经治疗后复发,经再次手术或放疗后效果差.结论 手术后辅以中低剂量的放射治疗应为治疗儿童颅内生殖细胞瘤的较好方案.     

Skull fractures in children: their assessment in relation to developmental skull changes and acute intracranial hematomas

Retrospective analysis of 12,072 pediatric head injury cases revealed 1,297 skull fractures. Patients with skull fractures were divided into four age groups according to the fusion of skull sutures and other developmental radiological skull changes. Results revealed that the patients with open skull sutures (aged <2 years) and with linear skull fractures alone had a negligible chance of developing intracranial hematomas. With the fusion of metopic and mendosal sutures associated with other skull changes (>2 years), the children became progressively more susceptible to developing intracranial hematomas if they had a skull fracture. The risk of developing intracranial hematomas was the highest among those patients (11–15 years) whose paranasal sinuses had reached adult size and spheno-occipital synchondrosis had begun to fuse.     

颅内蛛网膜囊肿临床诊断和手术治疗

报告２１例颅内蛛网膜囊肿（ＩＡＣ），对其临床表现、诊断、手术适应证、手术方法选择和术中注意事项进行了讨论。ＩＡＣ约占颅内占位性病变的０．８７％，最常见于外侧裂池。认为：ＣＴ、ＭＲＩ是最可靠的诊断方法。凡囊肿有颅内高压者，充分建立囊腔与周围脑池或腹腔之间的交通是手术成功的关键。     

老年人外伤性颅内血肿的临床特点及治疗

目的　探讨老年人外伤性颅内血肿的治疗。　　方法　分析 60岁以上老年人外伤性颅内血肿 1 1 7例临床资料。致伤原因多为跌伤及交通事故 ,大多为对冲部位血肿 ( 55 6% )及多发血肿( 2 5 6% ) ,手术治疗 87例 ,非手术治疗 3 0例。　　结果　按GOS评定 :良好 46 1 % ,中残 1 2 8% ,重残 4 3 % ,植物生存 2 6% ,死亡 3 4 2 %。　　结论　指出意识状态、是否合并脑疝、颅内血肿大小和部位等对预后有直接影响 ,提出颅内血肿手术与非手术治疗的适应证 ,强调积极防治并发症是降低死亡率的有效措施     

外伤性进展性颅内血肿的诊断和治疗

目的探讨外伤性进展性颅内血肿的临床特点,总结其发病机制及诊断、治疗方法。 方法选取自2011年1月至2015年12月中国人民解放军第二五一医院神经外科收治的97例外伤性进展性颅内血肿的临床资料进行分析。 结果本组97例占同期外伤性颅内血肿的15.3%,手术63例,死亡7例;保守治疗34例,死亡1例,总死亡率8.2%。 结论外伤性进展性颅内血肿临床意义重大,绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,而应进行动态观察和CT监测,根据患者血肿量的变化及时调整治疗方案。