头颈部副神经节瘤的术前栓塞治疗

目的：分析头颈部副神经节瘤的ＤＳＡ表现及评价术前栓塞的作用。材料与方法，８例患者均行双侧颈总动脉及椎动脉ＤＳＡ检查，而后行患侧超选择性插管，以明胶海绵颗粒或真丝段作为栓塞材料。结果：５例颈静脉球瘤，２例颈动脉体瘤及１例迷走神经体瘤的动脉期均显示主要由颈外动脉的分支供血，如咽升动脉，耳后动脉，枕动脉等，颈静球瘤如侵犯后颅凹，颈内动脉或椎动脉的分支也可参与供血，实质期，肿瘤呈分叶状，不均匀染色，静脉期     

头颈部副神经节瘤影像学诊断

目的:探讨头颈部副神经节瘤的影像学特征。方法:回顾性分析19例头颈部副神经节瘤的CT、MRI和DSA表现,其中颈静脉球瘤3例,鼓室球瘤2例,颈动脉体瘤12例,迷走体瘤2例。结果:颈静脉球瘤的CT特征为颈静脉孔扩大和虫蚀骨质破坏,1例双侧因肿瘤为1cm首次平扫漏诊;鼓室球瘤均较小,发生于鼓岬区,临床特征为搏动性耳鸣和鼓膜充血;颈动脉体瘤位于颈总动脉分叉处,特征为颈内、外动脉分离和动脉镶嵌于肿瘤边缘或肿瘤内;迷走体瘤与颈动脉体瘤的区别在于颈内、外动脉受压后均向前移位。增强后肿瘤均见明显强化,MRA图像有助于确认肿瘤内的滋养血管,术前栓塞是治疗的有效方法,能减少约50%~70%肿瘤供血。结论:头颈部副神经节瘤具有特定的解剖学位置和影像学表现,对临床诊断和治疗有重要价值。     

头颈部副神经节瘤的影像学诊断

目的总结头颈部副神经节瘤的影像学表现,提高少见部位副神经节瘤的认识.资料与方法搜集1990年1月～2004年4月经手术病理证实的副神经节瘤27例,回顾性分析其超声、CT、MRI和DSA表现.结果 27例副神经节瘤中,19例(22个肿瘤)来自颈动脉体(其中3例双侧)均发生于颈总动脉分叉处,1例发生于迷走神经节,2例发生于颈静脉球,1例位于鼓室, 1例位于颏下,1例位于眶内肌锥外,2例恶性副神经节瘤,肿瘤破坏骨质.其共同影像学特点:实性肿块,血供丰富,强化明显,MRI显示肿瘤内有流空的血管影.结论头颈部副神经节瘤具有典型的影像学特征和特定的定位征象,对诊断有决定性价值.发生于罕见部位者,诊断困难,但如有上述典型征象,仍要考虑本瘤的可能.     

头颈罕见部位副神经节瘤的CT和MRI诊断

目的 探讨头颈区少见部位副神经节瘤的影像诊断.方法 收集2000-01-2009-03本院经手术病理证实的10例头颈罕见部位的副神经节瘤,男6例,女4例,年龄15~53岁,平均35.4岁.详细分析其临床与影像学表现.结果 颈静脉孔区3例,其中2例长入桥小脑角区,斜坡1例长入鼻腔;舌根部1例;颌下1例;颈后部2例;鼓室1例;颈椎椎管1例,长入一侧神经孔.10例均为单发,8例周围骨质有不同程度破坏.CT平扫呈等低密度或混杂密度;MRI平扫病灶信号不一;CT及MRI增强扫描均显示肿瘤实性部分中等至明显强化.结论 生长部位不典型的头颈区副神经节瘤,有其共同的影像特点,结合临床,术前多可以诊断.     

颈动脉造影及选择性栓塞术在颈部副神经节瘤诊治中的价值

目的 评价颈动脉造影及介入栓塞在颈部副神经节瘤诊治中的价值。资料与方法 回顾性分析12例颈部副神经节瘤的诊治情况,其中5例行造影及栓塞术。结果 6例颈动脉体瘤（CBT）中4例未行动脉造影均诊断不明确或误诊,2例行颈动脉造影明确诊断并行术前栓塞,术中出血平均140ml,术后均无严重并发症发生,其中有一侧瘤体仅行栓塞术随访半年肿瘤未见增大。6例颈静脉球瘤（JP）中5例行外科全部或大部分切除,其中1例恶性者术中出血500ml,未完全切除后行介入栓塞残留瘤体,2例经造影明确诊断并行栓塞术,后行切除术中平均出血125ml,明显少于未行栓塞者。患者随访期间症状未见加重。结论 颈部副神经节瘤诊断中常规行颈动脉造影,必要时予以血管内栓塞治疗,可以减少术中出血及降低手术的风险,同时也可作为一种姑息性治疗方式。     

Direct Percutaneous Embolization of Bleeding Stomal Varices

Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.     

Head and Neck Imaging

Neuroimaging techniques play a central role in the diagnosis and management of Central nervous system (CNS) diseases. The use of Magnetic Resonance Imaging (MRI) has helped to diagnose and understand disease processes early on. The use of contrast media has improved visualization of normal and abnormal tissues. New developments in contrasat media agents have shown great promise: Goadobutrol, the first one molar paramagnetic contrast agent has shown to be of use in MR angiography and in perfusion of the brain while newer applications such as to the diagnosis of inflammatory diseases such as multiple sclerosis are promising. Another product, Gadofosveset (Vasovist®) is an intravascular MRI contrast agent that has shown to be of interest for imaging of vascular pathology as well as brain tumours. These two new MRI contrast media should allow expanding and strengthening the armamentarium at our disposal for the diagnosis and management of CNS diseases.     

Catastrophic Head and Neck Injuries

Improved conditioning, a helmet standard, and rules forbidding butt blocking and face tackling account for the lowest incidence of football head and neck injuries in 18 years.