1例寰枕畸形唇下经鼻腔入路齿状突磨除术的护理

寰枕畸形主要是枕骨底部及第一、第二颈椎发育异常。此病还包括其它多样畸形．除骨骼为主的发育异常外还合并有神经系统和软组织发育异常。其中颅底陷入是寰枕畸形中最常见的一种，常伴有小脑扁桃体下疝畸形。颅底陷入主要是以枕骨大孔为中心的颅底组织内翻，枢椎齿状突高出正常水平并进入颅骨大孔，后颅窝体积减小。有相当病例合并脊髓空洞。病人在临床上可有高颈髓压迫症状，延髓压迫症状和／或小脑症状，严重者甚至吞咽困难，呼吸困难。此类病人通常采用经口咽齿状突磨除术。但本例病人因斜坡发育不良，齿状突至MeGregor线（硬腭一枕骨最低点）上1．8cm（正常不超过0．5cm）。采用通常的经咽人路很难达到齿状突顶端，因此，决定采取经鼻腔入路齿状突磨除术。     

1例颅底陷入症经口咽入路齿状突切除术病人的护理

颅底陷入症临床上较少见，其主要特点是枕骨大孔向围的颅底结构向颅内陷入，枢椎齿状突高于正常水平，甚至突入枕骨大孔；枕骨大孔的前后径缩短，颅后窝狭小，因而使延髓受压和局部神经受牵拉。以先天性发育畸形常见，可与扁平颅底、寰枢椎畸形、小脑扁桃体下疝合并存在。外伤颈部过度屈曲等因素可使齿状突向后上移位压迫延髓生命中枢，导致脊髓损伤，出现高位截瘫、呼吸循环衰竭而危及生命。2006年10月我院收治1例颅底陷入症病人，手术治疗效果满意。现报告如下。     

1例颅底陷入症经口咽入路齿状突切除术病人的护理

颅底陷入症临床上较少见,其主要特点是枕骨大孔周围的颅底结构向颅内陷入,枢椎齿状突高于正常水平,甚至突入枕骨大孔;枕骨大孔的前后径缩短,颅后窝狭小,因而使延髓受压和局部神经受牵拉.以先天性发育畸形常见,可与扁平颅底、寰枢椎畸形、小脑扁桃体下疝合并存在[1].外伤颈部过度屈曲等因素可使齿状突向后上移位压迫延髓生命中枢,导致脊髓损伤,出现高位截瘫、呼吸循环衰竭而危及生命.2006年10月我院收治1例颅底陷入症病人,手术治疗效果满意.现报告如下.     

3例颅颈交界区畸形行哈罗氏架固定患者的护理

颅颈交界区畸形主要是指枕骨底部及第一、二颈椎发育异常,其中包括有扁平颅底、颅底陷入、寰枕融合、颈椎分节不全、寰枢椎脱位、小脑扁桃体下疝(Arnold-chiari氏畸形)等[1],常伴有脊髓空洞症.     

后颅窝减压治疗颅底凹陷症的护理

颅底凹陷症是枕骨大孔区常见畸形,枕骨大孔区枕骨向颅底方向内陷,枕大孔前后径缩短,枢椎齿状突高于正常水平,使后颅窝体积缩小,常伴有小脑扁桃体下疝及环枕融合等畸形。主要为后组颅神经、小脑、上部颈髓及颈神经受压症状。首发症状以四肢麻木、走路不稳并伴有头痛、...     

1例寰枕畸形唇下经鼻腔入路齿状突磨除术的护理

寰枕畸形主要是枕骨底部及第一、第二颈椎发育异常.此病还包括其它多样畸形,除骨骼为主的发育异常外还合并有神经系统和软组织发育异常.其中颅底陷入是寰枕畸形中最常见的一种,常伴有小脑扁桃体下疝畸形.颅底陷入主要是以枕骨大孔为中心的颅底组织内翻,枢椎齿状突高出正常水平并进入颅骨大孔,后颅窝体积减小.有相当病例合并脊髓空洞.     

颅底凹陷症的研究进展

颅底凹陷症(basilar invagination)是指枕骨大孔周围颅底骨组织内陷进入颅腔,进而寰枢椎向上移位进入颅腔,尤其是齿状突尖移位,造成枕骨大孔狭窄,继而引起脑干、延-颈脊髓腹侧、小脑、低位颅神经(Ⅸ、Ⅹ、Ⅻ)及周围血管受压的一系列临床     

复杂颅颈交界区畸形合并寰枢椎脱位行后路减压复位内固定术的护理配合

寰枢椎脱位病人常因延脊髓受压导致四肢瘫痪甚至呼吸肌麻痹而死亡;病人可合并齿状突发育异常、颅底凹陷症及先天性寰枕融合、脊髓空洞症等先天性畸形。经口腔入路齿状突切除联合后路内固定术仍是目前该病的标准外科手术方法。     

枕大孔区畸形误诊40例分析

枕大孔区畸形包括颅底凹陷、环枕融合、环枢椎脱位及小脑扁桃体下疝畸形 ,常合并脊髓空洞。是神经外科的常见病之一 ,因其表现复杂多样 ,多数患者在就诊于神经外科之前常存在误诊问题 ,本文总结所经治的 40例进行分析如下。1　临床资料1.1　一般资料　本组男 2 4例 ,女 16例 ,10岁以下 2例 ,11～2 0岁 17例 ,2 1～ 40岁 15例 ,41～ 5 0岁 6例。最小 9岁 ,最大 5 0岁。1.2　辅助检查　 2 0例仅做普通 X线检查 ,拍摄颈椎正侧位片显示环枕融合 15例 ,环枢椎脱位 3例 ,颅底凹陷 5例。 2 0例做MRI检查 ,小脑扁桃体下疝畸形并脊髓空洞 15例 ,颅…     

3例颅颈交界区畸形行哈罗氏架固定患者的护理

颅颈交界区畸形主要是指枕骨底部及第一、二颈椎发育异常,其中包括有扁平颅底、颅底陷入、寰枕融合、颈椎分节不全、寰枢椎脱位、小脑扁桃体下疝(Arnold-chiari氏畸形)等[1],常伴有脊髓空洞症。脊髓空洞症是脊髓内由于多种原因(主要为颅颈交界区压迫阻塞脑脊液循环)的影响形成管状空腔,在空洞周围常有神经胶质增生[1],常发生在颈段及上胸段的中央管附近,靠近一侧后角,形成管状空洞,延续多个节段,并不一定与中央管相通。空洞逐渐扩延,管形空洞也逐渐扩大,病人症状进行性加重。目前治疗上主张单纯颅颈交界区减压解除压迫,脊髓空洞大多可以缩…     

Basilar migraine with electroencephalographic findings of occipital spike-wave complexes: a long-term study in seven children

Basilar migraine is characterized by headache preceded by prodromal symptoms and signs of posterior cerebral circulation dysfunction. Few studies have focused on EEG findings in this condition or on the prognosis of occipital spike-wave complexes observed in either migraine or epilepsy. We now report a long-term follow-up (8–16 years) in seven children affected by basilar migraine who had EEG findings of occipital spike-wave complexes. Basilar migraine resolved and the EEG became normal in all subjects during the observation period, as did migraine with aura and seizures which developed in some of the patients after basilar migraine attacks ceased.     

Paramedics Accurately Apply the Pediatric Assessment Triangle to Drive Management

Abstract

Objective. To provide an evaluation of the Pediatric Assessment Triangle (PAT) as an assessment tool for use by paramedic providers in the prehospital care of pediatric patients. Methods. Paramedics from Los Angeles Fire Department (LAFD) received training in the Pediatric Education for Prehospital Professionals (PEPP) course, PAT study procedures, and completed training in applying the PAT to assess children 0–14 years of age. A convenience sample of LAFD paramedic assessments of the pediatric patients transported to 29 participating institutions, over an 18-month period ending July 2010, were eligible for inclusion. Patients who were not transported were excluded from the study, as were the assessments of children with special health-care needs (CSHCN). PAT Study Forms, emergency medical services (EMS) report forms, and emergency department (ED) and hospital charts were entered into a secure database. Two study investigators, blinded to paramedic PAT assessment, reviewed hospital charts and determined the category of illness or injury. Results. A total of 1,552 PAT Study Forms were collected. Overall, 1,168 of the patient (75%) assessments met inclusion criteria, were transported, and had all three data points (PAT Study Form, paramedic EMS report form, and ED/hospital chart) available for analysis. When paramedics used the PAT to identify abnormalities in the three arms of the triangle (PAT Paramedic Pattern) and applied that pattern to form a general impression (PAT Paramedic Impression), the agreement resulted in a κ coefficient of 0.93 [95% CI: 0.91–0.95]. The PAT paramedic impression was congruent with field management, as the majority of patients received consistent interventions with local EMS protocols. The PAT Paramedic Impression for instability demonstrated a sensitivity of 77.4% [95% CI: 72.6–81.5%], a specificity of 90.0% [95% CI: 87.1–91.5%] with a positive likelihood ratio (LR+) of 7.7 [95% CI: 5.9–9.1] and a negative likelihood ratio (LR-) of 0.3 [95% CI: 0.2–0.3]. Conclusion. The PAT is a rapid assessment tool that can be readily and reliably used by paramedics in the prehospital setting. The PAT should be used in conjunction with other assessments but can safely drive initial field management.     

MR imaging of the craniovertebral junction

The rapid growth of MR imaging has brought a renewed interest in the craniovertebral junction. Many congenital and acquired lesions affect this region and compress the underlying cervicomedullary junction and cranial nerves. Basilar invagination, basilar impression, and cranial settling are readily assessed with MR imaging in the sagittal plane, and evaluation of this region on all cranial and cervical spine studies should become routine.     

Open functional magnetic resonance imaging of structural defects of the alar ligaments

Summary To investigate longstanding cervicocephalic symptoms after trauma to the atlanto- occipital joint – applying exclusion criteria – 95 patients, 56 females (n = 59 %), 39 males (n = 41 %) with an average age of 39 years – between 21 and 55 years of age – were investigated on an open 0.2 Tesla magnet MAGNETOM OPEN using a special coil device. Functional dynamic MRI studies of the upper cervical spine were conducted between November 1995 and December 1996. Two continuous functional studies were performed, tilting of the upper cervical spine to the right and left and then axial rotation in dorsal decubitus position also to the right and left. The types of rupture were classified as Type I: Complete rupture – 3 %; Type II a: Incomplete rupture with an extensive structural lesion – 20 %; Type II b: Intraligamentous rupture of fibres with resulting scar formation and local bulging – 11 %; Type III-lesion: a central intraligamentous alteration of signal – 39 %. With the presently available diagnostic methods no demonstrable lesion could be recognized in 27 % patient involving the liagments of the atlanto-occipital region. This study clearly shows that type I and type II a lesions are accompanied by injuries to the ypsilateral transverse ligament of the atlas. The functional MRI-examination of the atlanto-occipital joint in an open system is an appropriate modality to document morphological alterations. With the MRI-studies, until the end point of rotation was reached, a deviation of the dens could be demonstrated in the presence of ligamentous pathology. Instability of the atlanto-occipital joints was documented as a result. The frequency of structural lesions in the vicinity of the dens offer an argument for the assumption that overstretching by mechanical shear- and forces of overheating become effective at the point of contact between the periosteum of the dens and the alar ligaments as a result of excessive rotation of the atlanto-occipital region.      

Systematic combined noncontrast CT–CT angiography in the management of unexplained nontraumatic coma

BackgroundNontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis.Study objectivesThe aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management.MethodsCombined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection.ResultsThis study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness.ConclusionsSystematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO.     

基底动脉夹层动脉瘤的磁共振血管壁成像表现

目的总结分析基底动脉夹层动脉瘤的MR血管壁成像表现特点。材料与方法 27例经临床证实的基底动脉夹层动脉瘤病例,对基底动脉夹层动脉瘤的磁共振血管壁成像表现特点进行总结分析。结果基底动脉夹层动脉瘤影像征象包括血管迂曲扩张、内膜征、双腔征、壁内血肿、长段不规则或丝线样狭窄、鼠尾状闭塞。结论对于基底动脉夹层动脉瘤患者,行基底动脉磁共振血管壁成像能够清晰显示血管迂曲扩张、内膜征、双腔征、壁内血肿、长段不规则或丝线样狭窄、鼠尾状闭塞异常,是基底动脉夹层动脉瘤的一种有效准确的检查方法。     

CT诊断枕骨板障静脉池

目的探讨枕板障静脉池的CT诊断价值。方法分析68例枕板障静脉池病例的CT表现,探讨其CT特征。结果 68例枕板障静脉池的骨质缺损区域以枕内隆突附近或两侧枕板板障层为主,多呈管状、囊状、串珠样、花瓣样、不规则样;31例内板、15例外板及25例邻近板障见边缘硬化细管道影;边缘清晰并轻微硬化,为软组织样密度,6例于CT静脉血管造影均呈静脉血管样强化,4例于骨压迫吸收区内外板附近出现与之相连通的引流静脉血管影。结论枕板障静脉池具有一定特征性的CT表现,CT静脉血管造影检查对枕板障静脉池具有一定诊断价值。     

The relationship between dens height and alar ligament orientation: a radiologic study

Objective

This study examined the anatomical assumptions underlying multiplanar alar ligament stress testing. The alar ligament has been described as occurring in 1 of 3 planes: caudocranial, horizontal, and craniocaudal. This has been stated to result from variation in dens height. Stress testing in all 3 planes is suggested, with increased translation present in all positions to infer instability.

Methods

Computed tomography scans with no diagnosed bony or ligamentous abnormally were prospectively collected over a 3-month period from a teaching hospital in Newcastle, Australia, and sequentially analyzed. The height of the dens relative to the occipital condyles was measured using McRae's line and the bimastoid line. The orientation of the alar ligament was measured relative to the vertical axis of the dens as well as a vertical line defined by specified occipital and spinal bony landmarks. These results were correlated with dens height.

Results

After exclusions, 42 individual computed tomography studies were analyzed yielding 64 clearly discernible ligaments. A vertical line derived from the digastric line provided the smallest variation in results. The mean ligament orientation given by this measure was 110.06° (85°-127°). There was no correlation between measured dens height relative to the occiput and ligament orientation.

Conclusion

Our findings reinforce the existence of normal anatomical variation in dens height and alar ligament orientation. However, variation in dens height as a cause of variation in ligament orientation was not supported by this study.     

共同性斜视患者立体视觉相关皮层的BOLD-fMRI表现

目的观察共同性斜视患者立体视觉相关皮层的全脑BOLD-fMRI的表现。方法选取共同性斜视患者12例(共同性斜视组)和立体视觉正常者10名(正常组),接受BLOD-fMRI。采用SPM5软件包对数据进行预处理及分析。结果在立体图形刺激下,共同性斜视组可见右侧舌回和左侧枕中回激活,正常组可见双侧枕中回、双侧中央后回、右侧顶下小叶、左侧颞中回激活。共同性斜视组激活强度低于正常组(P<0.05),主要位于左侧枕中回、右侧枕下回、双侧缘上回、双侧颞下回、双侧额下回、左侧岛叶。结论在立体图形刺激下,共同性斜视患者脑区激活范围小于正常者,其立体视觉异常的中枢神经机制可能与顶叶、颞叶功能下降有关。     

应用MRA评价后交通动脉开放与后循环形态的关系

目的 应用3.0T磁共振血管成像(MRA)技术探讨后交通动脉开放情况与双侧大脑后动脉及基底动脉形态之间的关系.方法 对108名受试者行MRA及常规MRI.观察双侧大脑后动脉P1段粗细及后交通动脉开放情况,测量基底动脉直线长度及内径,并进行统计学分析.结果 大脑后动脉P1段粗细与其同侧后交通动脉粗细相关(Kendall等级相关,右侧:相关系数rk=0.44,P<0.01;左侧:相关系数rk=0.50,P<0.01).双侧后交通动脉均未开放者基底动脉长度比单侧或双侧后交通动脉开放者长(P<0.05).双侧后交通动脉均未开放者基底动脉管腔平均直径比单侧或双侧后交通动脉开放者宽(P<0.01).结论 大脑后动脉P1段粗细及基底动脉长度、直径与后交通动脉是否开放有关.