微创置管引流治疗外伤性颅内血肿的临床分析

目的探讨微创置管引流液化术治疗外伤性颅内血肿的临床应用与疗效。方法对52例外伤性颅内血肿病人采取微创置管技术,以CT片为导引图四点测量法定点,锥颅后置入12F带侧孔硅胶管予以引流和液化冲洗。结果治疗急性硬膜外血肿30例,急性硬膜下血肿5例,亚急性硬膜下血肿6例,脑挫伤并脑内血肿11例,均行2～4次液化冲洗,2～5d拔管,平均住院8d出院,无1例继发出血和颅内感染等并发症,临床症状改善或消失快,血肿清除率90%以上。结论对有相应适应证的外伤性颅内血肿患者采用微创置管手术治疗,可以提高治愈率,减少并发症,缩短病程,降低费用,简单易学,安全有效,值得推广。     

微创溶解引流术治疗慢性硬膜下血肿60例疗效观察

目的探讨应用微创钻孔置管注入尿激酶溶解冲洗引流治疗慢性硬膜下血肿的手术疗效。方法采用钻孔置管注入尿激酶溶解血肿，持续引流治疗慢性硬膜下血肿。一般引流时间2～3d，至无引流物拔除引流管。结果60例中血肿全部消失者,51例，气颅6例，3例经引流病情无好转，开颅清除血肿，术中见血肿呈多房性，全组无1例死亡，无颅内感染、癫痫等并发症。结论微创钻孔置管注入尿激酶溶解冲洗引流治疗慢性硬膜下血肿，能显著减少创伤及缩短手术时间，是一种有效且安全的方法。     

钻孔引流颅内血肿清除术189例临床分析

目的总结钻孔引流颅内血肿清除术的适应证与方法,以期望达到较好效果。方法选择CT提示混杂密度、高密度占位效应明显或部位较深的颅内血肿进行钻孔引流术,部分患者术后用尿激酶溶解冲洗,亚急性和慢性血肿不用尿激酶,生理盐水冲洗后直接做持续引流。恢复期辅以中医药治疗,加强疗效。结果189例患者无1例死亡,术后症状立即缓解156例,缓慢恢复33例．术后3d复查颅脑CT（除5例有不同程度的再出血外）,占位效应解除,血肿基本引流干净。结论钻孔引流颅内血肿清除术,能够使因血肿引起的颅内高压迅速得到缓解,对及时挽救患者生命及最大限度的保护其功能意义重大,起到了快速抢救和清除颅内血肿、挽救患者生命及功能的目的。     

锥颅微创置管引流术治疗慢性硬膜下血肿40例

目的探讨慢性硬膜下血肿的发病机制及治疗。方法总结40例经锥颅微创置管引流术治疗的慢性硬膜下血肿病人的临床资料,从临床表现、疗效及并发症等方面进行分析。结果本组平均手术时间(0.5±0.3)h,术中平均出血量(15±5)ml,平均住院时间(6±2.1)d。40例术后复查颅脑CT,硬膜下血肿均达大部分清除。术后并发颅内积气6例,硬膜外血肿1例,硬膜下积液5例,颅内感染1例。40例病人随访3个月,血肿复发1例,未见新增神经功能障碍。结论锥颅微创置管引流术治疗慢性硬膜下血肿手术时间和住院时间短,术后并发症少,具有一定的临床价值。     

钻孔引流治疗硬膜外血肿的临床体会

目的探讨硬膜外血肿的小创伤手术治疗方法、手术适应证及临床实用性.方法对35例病人进行选择,从不同年龄阶段、不同血肿部位、不同血肿大小中选出20例较典型的病例施行钻孔置管注入尿激酶溶解血肿引流治疗,对治疗效果进行总结,对病例进行随访.结果全组病例血肿清除快,住院时间短,费用低,恢复好.结论该方法是治疗外伤性硬膜外血肿的一种简易、有效、经济、适用广的小创伤手术方法.     

软通道微创颅内血肿清除术治疗高血压脑出血探讨

目的 探索软通道微创颅内血肿清除术治疗高血压脑出血效果.方法 根据病人术前CT片,采用大连七颗星设计的微创定向颅内置管装置,治疗高血压脑出血病人120例,血肿位于壳核81例,丘脑20例,脑叶3例,小脑1例,脑室15例;血肿＜10 mL 2例,10～30 mL 33例,＞30～50 mL 56例,＞50～100 mL 28例,＞100 mL1例.所有病例术中微创置管脑内血肿抽吸和术后残余血肿尿激酶溶解引流的方式及对血肿破入脑室病人配合腰穿置换治疗.结果 血肿腔内置管准确率100%,术中血肿清除率和术后残血清除留管时间均值为35.1%和4.9 d.术后1个月内病死率7.5%.结论 微创定向脑内血肿置软管吸引术治疗高血压脑出血是一种定位准确、方法简单、适宜抢救、创伤微小、易于推广的新技术.     

微创钻孔引流治疗硬膜外血肿

目的探讨硬膜外血肿的手术治疗。方法回顾性分析15例硬膜外血肿患者进行微创钻孔引流术的临床资料、手术方法和治疗效果。结果15例中有1例在引流中出血,注入凝血酶后血止住。1例出现硬膜下积液,没作任何处理,3周后吸收。15例患者均治愈,最短3d出院,最长12d出院。1例轻瘫患者出院后一月完全恢复。结论与传统手术相比,微创钻孔引流治疗硬膜外血肿是一种行之有效的治疗方法,安全、创伤小,对一些血肿稳定,不需要减压的硬膜外血肿患者行微创钻孔引流术更合适。     

微创颅内血肿清除术治疗高血压性脑出血108例临床分析

目的 总结微创颅内血肿清除术的适应证与方法,期望达到较好效果.方法 选择CT提示混杂密度、高密度占位效应明显或部位较深的颅内血肿进行钻孔引流术,术后用尿激酶溶解冲洗,冲洗后持续引流.恢复期辅以中医药治疗以加强疗效.结果 108例患者中6例死亡.术后神志转清38例,术前深昏迷、术后昏迷程度变浅51例,意识无明显变化的19例.结论 钻孔引流颅内血肿清除术,能够使血肿引起的颅内高压迅速得到缓解,对及时挽救患者生命及最大限度的保护其功能意义重大,起到了快速抢救和清除颅内血肿、挽救患者生命的目的 .     

锥颅穿刺置管引流治疗稳定型硬膜外血肿的临床分析

目的探讨锥颅穿刺治疗稳定型硬膜外血肿的疗效及适应证。方法 48例患者动态复查头颅CT示硬膜外血肿出血稳定后,局麻下行硬膜外血肿锥颅穿刺置管引流术,术后予以尿激酶5万U+0.9%氯化钠注射液3 mL注入,并夹闭2 h后放开引流,每天2次。结果术后48例患者的症状均明显缓解。复查头颅CT示,血肿完全消失42例,少量残留6例,无发生再出血;手术效果良好。结论锥颅穿刺置管引流治疗稳定型硬膜外血肿的疗效确切,损伤小,安全可靠。     

136例慢性硬膜下血肿的手术治疗

目的探讨不同手术方式治疗慢性硬膜下血肿的疗效。方法2007年12月至2012年12月收治慢性硬膜下血肿136例,采用钻孔冲洗引流术72例、经皮微创穿刺冲洗引流术25例、神经内镜辅助钻孔引流术39例。结果钻孔引流术患者治愈67例,复发5例,术后发生颅内积气20例;经皮穿刺引流术治愈20例,复发3例,术后并发硬膜外血肿1例,硬膜外血肿1例;神经内镜辅助钻孔引流术均治愈,术后残留少量积液、积气8例。结论三种手术方法均有其适用范围及局限性,神经内镜辅助钻孔引流术适用范围更广,术后并发症更少。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.