经面静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘

目的探讨经面静脉途径治疗海绵窦区硬脑膜动静脉瘘（arteriovenous fistula，AVF）的方法和疗效。方法回顾性分析经面静脉途径（导管置入股静脉-面静脉-角静脉-眼上静脉-海绵窦）治疗7例海绵窦区硬脑膜AVF的病例资料，其中5例患者岩下窦闭塞；1例患者岩下窦开放，但其AVF所在的海绵窦和岩下窦之间无交通；1例患者的瘘与岩下窦相通。对该患者先行经岩下窦栓塞海绵窦后部，然后再经面静脉途径栓塞海绵窦前部。其他6例患者只经面静脉途径行栓塞治疗。结果血管造影显示，7例患者的角静脉和眼上静脉的走行清晰，其中有1例眼上静脉闭塞的患者，由于导管无法置入闭塞的眼上静脉，导致经静脉途径治疗终止。其余6例患者经面静脉入路用弹簧圈栓塞海绵窦治疗后，4例达到完全栓塞，2例临床症状明显好转。结论相对其他静脉途径而言，经股静脉-面静脉入路是血管内治疗海绵窦区硬脑膜AVF的一种很有价值的方法，即使该入路对术者手术技能要求较高，但仍然不失为一种安全和有效的血管内治疗方法。     

海绵窦海绵状血管瘤及其影像学特点

目的：阐述海绵窦海绵状血管瘤的MRI表现。方法：回顾性分析5例经手术及病理学证实并行MRI检查的海绵窦海绵状血管瘤病例。结果：5例海绵窦海绵状血管瘤呈外大内小哑铃状改变，在T1加权成像上信号较低，T2加权成像上呈明显高信号，甚至高过脑脊液，增强后病变明显均匀强化。病变侧颈内动脉向前向下推移，并形成假包绕征象。结论：如果中年女性海绵窦内肿瘤表现为MRI T2加权成像信号等于或高于脑脊液，颈内动脉向前向下移位，应首先考虑海绵窦海绵状血管瘤。     

OZFT入路显露基底动脉和岩斜坡区病变的显微解剖研究

目的 研究眶颧额颞入路对处理基底动脉和岩斜区病变的有效性。方法 10具尸体标本20侧眶颧额颞(OZFT)开颅，模拟真实手术过程进行显微解剖。结果 单纯OZFT可良好显露基底动脉顶端，结合前后床突切除，16侧开颅均成功显露基底动脉中段以上；颞下硬膜外切除岩骨前部可由中颅窝显露桥脑前外侧的岩骨斜坡区；OZFT开颅较常规颞下开颅的手术方向更趋前后，经Kawases三角，50％(10侧)的显露可低至基底动脉下端及椎动脉汇合处。结论 正确选择开颅侧别，结合前后床突切除，OZFT开颅可用于处理基底动脉中段以上的动脉瘤；结合切除岩骨前部，可用于夹闭小脑前下动脉动脉瘤等；对同时累及海绵窦及后颅窝的肿瘤，OZFT开颅也是全切肿瘤的良好选择。     

海绵窦海绵状血管瘤及其影像学特点

目的阐述海绵窦海绵状血管瘤的MRI表现。方法回顾性分析5例经手术及病理学证实并行MRI检查的海绵窦海绵状血管瘤病例。结果5例海绵窦海绵状血管瘤呈外大内小哑铃状改变,在T1加权成像上信号较低,T2加权成像上呈明显高信号,甚至高过脑脊液,增强后病变明显均匀强化。病变侧颈内动脉向前向下推移,并形成假包绕征象。结论如果中年女性海绵窦内肿瘤表现为MRIT2加权成像信号等于或高于脑脊液,颈内动脉向前向下移位,应首先考虑海绵窦海绵状血管瘤。     

覆膜支架治疗外伤性颈内动脉海绵窦瘘的临床分析

目的探讨覆膜支架对外伤性颈内动脉海绵窦瘘的血管内治疗效果。方法自2003年10月—2008年3月,采用覆膜支架治疗外伤性颈内动脉海绵窦瘘10例。结果10例外伤性颈内动脉海绵窦瘘的患者中,9例覆膜支架置入成功,其中在3例患者释放支架后,出现少许对比剂内漏,2例以更高的压力再次充胀球囊扩张后,内漏消失;另1例再扩后仍有内漏,置入第2枚覆膜支架后,内漏完全消除。10例中的另1例为患侧颈总动脉及颈内动脉过于迂曲,支架不能到位,在证实侧支循环代偿良好及球囊闭塞试验阴性后,给予可脱性球囊闭塞患侧颈内动脉。所有患者均无手术相关的并发症发生。DSA随访7例,原病变未显示,载瘘动脉通畅。结论对于外伤性颈内动脉海绵窦瘘,覆膜支架是有效的血管内治疗手段。覆膜支架的制作工艺仍有待发展和优化,使其适用于脑血管系统的不同部位应用。     

额底纵裂入路手术治疗鞍上第三脑室底垂体瘤

目的观察经额底纵裂入路手术治疗鞍上第三脑室底垂体瘤的临床疗效。方法对24例鞍上第三脑室底垂体瘤患者行额底纵裂入路手术治疗。结果 24例术中见肿瘤位于鞍内鞍上并且突入第三脑室底,5例伴有脑积水。肿瘤全切16例,次全切6例,大部切除2例。术后随访6个月,16例肿瘤全切者病灶无复发,5例次全切者病灶无明显变化,1例次全切和2例大部切除者术后行伽马刀治疗。结论额底纵裂入路手术对于鞍上第三脑室底的垂体瘤是一种较为理想的术式。     

血管内介入治疗外伤性颈动脉-海绵窦瘘存在的问题

目的总结血管内介入治疗外伤性颈动脉一海绵窦瘘(TCCF)中存在的一些问题，探讨避免引起这些问题的技术方法。方法以可脱性球囊栓塞治疗68例TCCF患者，共进行栓塞术75次。1例经颈部切开穿刺，以球囊栓塞；2例经眼静脉入路以微弹簧圈栓塞海绵窦，其余则经股动脉入路栓塞。结果颈内动脉通畅率为66．2％，有3例在瘘口近端闭塞颈内动脉，有5例在栓塞术后3d内球囊过早泄漏，再次行栓塞术，1例栓塞瘘口后出现假性动脉瘤，1例出现眼静脉的动静脉瘘。结论以可脱性球囊栓塞TCCF是可靠的方法，但目前球囊的性能有待提高，以微弹簧圈栓塞海绵窦瘘可提高颈内动脉通畅率．双侧股动脉穿刺置管可减少并发症。     

正常成人海绵窦CT和MRI研究

目的以断层解剖为依据,研究正常成人海绵窦（CS）不同层面内有关结构的CT和MRI表现。方法50例鞍区及CS正常成人,其中20例同时行MRI冠状和横轴位SET1WI、FSET2WI及SET1WI增强扫描（SET1WIC^＋）;20例行冠状位CT增强扫描（CT—C^＋）;另10例行横轴位CT—C^＋。分析CS及各种结构的CT和MRI表现、显示率。结果在CT和MRI上,CS形态在各层面表现不一,以冠状位容易观察和比较;CS外、上及后壁为硬膜,FSET2WI可直接显示呈低信号;内壁垂体囊部显示不佳,内壁其余部分及下壁邻骨结构,以CT显示为佳;颈内动脉（ICA）在CT—C^＋上与CS间隙同时强化,不易分辨,MRI上呈流空信号;CS间隙呈不均匀等T1等T2信号,CT及MRI增强扫描呈明显强化;CS内神经结构以CT—C^＋和SET1WIC^＋冠状位垂体前叶层面显示为佳,CT—C^＋和SET1WIC^＋对动眼神经（Ⅲ）、三叉神经眼支（V1）、外展神经（VI）和三叉神经上颌支（V2）的显示率分别为：100％和100％,90％和70％,55％和60％,15％和10％;正常CS内有脂肪组织沉积。结论正常成人CS硬膜壁、CS间隙、窦内ICA、颅神经及脂肪组织等在CT和MRI上各具特征性,MRI能更清楚、详尽显示这些解剖结构。     

颈内动脉海绵窦段动脉瘤的处理体会

目的探讨颈内动脉海绵窦段动脉瘤的处理方法。方法颈内动脉海绵窦段动脉瘤12例,行血管内介入栓塞治疗9例,行动脉瘤孤立联合颅内外搭桥手术治疗2例,未治疗而随访观察1例。结果本组10例有症状者,症状消失5例、改善4例、无变化1例;9例影像学检查动脉瘤无残留;1例无症状的小动脉瘤患者,1a后CTA复查体积形态无明显变化。结论对有症状的颈内动脉海绵窦段动脉瘤可采取积极的血管内介入或手术疗法,无症状未破裂的小动脉瘤可定期随访观察。     

显微外科治疗颅眶沟通肿瘤13例报告

近年来 ,我们采用翼点入路、眶额入路、额颞眶颧入路并应用显微技术切除 13例颅眶沟通肿瘤 ,手术效果满意。现报告如下。临床资料 :共收治 13例 ,男 8例 ,女 5例 ;年龄 17～ 6 5岁。病理诊断脑膜瘤 7例 ,横纹肌肉瘤、恶性淋巴瘤各 2例 ,视神经胶质瘤、转移瘤各 1例。眼球突出 12例 ,视力下降 7例 ,眼球活动障碍 4例 ,复视 5例。 CT扫描 13例 ,MRI检查 8例 ,DSA9例。肿瘤全切 12例 ,次全切 1例。手术方法 :采用翼点入路、眶额入路、额颞眶颧入路开颅 ,采取以下 4种方法开眶 :1扩大眶顶骨缺损开眶 :暴露肿瘤后 ,沿肿瘤周边放射状切开肿瘤…     

颅内血管外皮细胞瘤手术辅助放疗和化疗的效果及病理学分析

目的探讨手术切除颅内血管外皮细胞瘤后辅助放疗和化疗的效果及病理学改变。方法回顾性分析首都医科大学宣武医院经病理学检查证实的17例颅内血管外皮细胞瘤患者的临床资料,分析手术切除肿瘤辅以放疗和化疗的治疗效果。其中男13例,女4例;年龄为28～54岁,平均49岁。肿瘤全切除的15例,术后实施全脑放疗,放射剂量为50～60Gy。肿瘤次全切除的2例,采用伽玛刀治疗,放射剂量为30Gy。术后放疗前、术后2周和8周,采用尼莫司汀化疗3次,150mg/次。结果颅前窝底（6例）及矢状窦前1/3处（3例）肿瘤于手术显微镜下全部予以切除,术后头痛、呕吐、视力下降、复视的症状消失。8例小脑幕肿瘤患者中,6例手术显微镜下全切除肿瘤,2例手术显微镜下次全切除肿瘤。术后头痛症状消失,3例视野缺损症状好转,5例无明显改善。所有患者术后未出现新的神经功能缺损,无死亡病例。病理学检查示：肿瘤内有丰富的血管网,状似＂鹿角＂,这些血管扩张明显,近似血窦,肿瘤细胞围绕着血管排列,有分化和未分化两种细胞。未分化肿瘤细胞内有大量的胞质,核呈圆形或卵圆形,可见核分裂。9例患者的肿瘤有囊变,未见钙化征象。免疫组化提示血管外皮细胞瘤对Vimentine及CD34染色呈阳性反应。术后对所有患者MRI随访6～40个月,未见肿瘤复发。结论颅内血管外皮细胞瘤是一种血管丰富的恶性肿瘤,手术彻底切除肿瘤及术后辅以放疗和化疗,可防治其复发和转移。     

闭塞静脉窦治疗颅后窝硬脑膜动静脉瘘的疗效分析

目的探讨经静脉途径闭塞静脉窦治疗颅后窝硬脑膜动静脉瘘（DAVF）的治疗方法及疗效。方法对经全脑血管造影确诊的颅后窝DAVF的10例患者,先采用经动脉栓塞,而后对其中的4例行开颅直视下填塞静脉窦,对6例患者经静脉内弹簧圈填塞瘘口集中的横窦和乙状窦。结果①对10例患者技术操作均获成功,并于术后均行全脑血管造影复查,显示6例瘘口全部消失,4例瘘口消失〉80％,残余瘘口无明显向皮质静脉引流的趋势。②所有患者术后颅内杂音消失。4例开颅直视下填塞静脉窦的患者,在术后10d造影复查未见复发,门诊或电话随访2～24个月,亦未见复发;6例经静脉途径弹簧圈闭塞静脉窦患者中,1例在术后第6个月DAVF复发,表现为搏动性杂音,再次给予动脉栓塞后症状减轻。5例表现为视力下降,其中3例在术后6—12个月内视力有不同程度的恢复,2例患者的视力术后恢复不明显。7例视盘水肿的患者5例有恢复。3例术前患者脑脊液压力〉300mmH2O的患者,术后分别降至240、230、200mmH2O。结论颅后窝DAVF病情复杂,单纯动脉栓塞难以达到良好疗效;无论直视下填塞或经静脉途径闭塞患侧脑静脉窦,对复杂颅后窝DAVF均有肯定的疗效     

脊髓髓内肿瘤显微外科治疗

目的探讨脊髓髓内肿瘤显微手术治疗方法和疗效。 方法回顾性分析海南省人民医院神经外科自2014年6月至2019年6月收治的17例经显微手术治疗的髓内肿瘤患者的病例资料,其中肢体麻木为首发症状13例,有肢体运动功能障碍9例,大小便功能障碍2例,腰背部疼痛2例,痛温觉分离者1例,呼吸困难1例,肌肉萎缩1例。所有患者在术前均行MRI平扫+增强扫描明确髓内占位性病变。全部病例采取全椎板切开术后复位固定。对患者术后病理以及术前、术后症状体征和随访复发情况进行总结,评价外科显微手术治疗髓内肿瘤的效果。 结果本组患者中,11例室管膜瘤10例全切,1例次全切除;2例星形细胞瘤1例全切除,1例次全切除;表皮样囊肿、血管母细胞瘤、胶质母细胞瘤术后转移各1例均全切除;1例炎性组织部分切除。术后症状改善11例,1例术前双下肢瘫和大小便失禁,术后无变化,5例术后症状加重,经康复治疗后2例完全恢复,2例留有轻度功能障碍,1例仅轻微改善,遗留有中度功能障碍,没有死亡病例。17例随访0.1~4.5年,2例肿瘤复发,1例再次手术,1例转放射治疗。 结论对于不同病理和性质的髓内肿瘤采取不同的显微手术方法和手术技巧,获得较好的成功率。术前症状较重者,预后较差。因此,显微外科手术是脊髓内肿瘤有效、安全的治疗方法。     

Preoperative evaluation of digital subtraction pulmonary angiography in primary lung cancer

The preoperative evaluation of the resectability for primary lung cancer was studied by using digital subtraction pulmonary angiography (DSA-PAG). Thirty operative cases with primary lung cancer performed DSA-PAG as preoperative test at random for 3 years from June 1985 were subjected in this study. The apparatus used is DSA device (Angiotoron) of a product of Siemens Co., Ltd. The findings obtained by DSA-PAG were retrospectively studied according to the surgical findings, operative modes and postoperative histopathological findings. Moreover, at the same time, usefulness of DSA-PAG was evaluated comparing its findings with preoperative enhanced CT interpretation. The useful findings were obtained in 10 cases of 30 cases (33%). Its contents were 2 cases with invasion of the left atrium, 2 cases with invasion of superior and inferior pulmonary vein, 5 cases with invasion of truncus pulmonary artery and 1 case with interlobar invasion. The findings in all cases were superior to those obtained by the enhanced CT. The decision of operative modes confirming invasion of tumor or metastatic lymph node is one of the important aims of the preoperative test. DSA-PAG can be carried out simply and safely on out-patient basis, additionally, favorable result can be especially obtained in invasion lesions of blood vessels of hilus regions. From the result, informations of regions unknown by preoperative CT were accurately obtained. As a rule, DSA-PAG should be performed by the preoperative routine test of primary lung cancer.     

Clinical utility of multidetector row computed tomography for diagnosing spinal dural arteriovenous fistulas undiagnosed by magnetic resonance imaging

Two elderly patients with dural arteriovenous fistulas (AVF), the abnormal vessels of which were not presented on magnetic resonance imaging (MRI) are reported. Although spinal AVF was suspected from hyperintensity in the spinal cord, dilated vessels were not detected on MRI. Computed tomography (CT) angiography was performed with a 64‐detector row multidetector row CT (MDCT) system in both cases. The draining dilated vein was observed in both cases and they were interpreted as perimedullary AVF. In case 1, axial scan and the dorsal section of the coronal view demonstrated continuity of the radiculomedullary artery and intercostal artery through the spinal branch at the left Th12 level. After intravascular embolization in case 1 and surgical treatment in case 2, neurological improvement was obtained in both cases. MRI findings suggestive of dural AVF have described that intradural perimedullary tortuous low signal intensities posterior to the spinal cord, known as flow void, on T₂‐weighted images is the most consistent. Recently, MDCT angiography confirmed the presence of a fistula previously suspected after MRI. There are no previous reports that describe cases of dural AVF diagnosed by MDCT angiography of which abnormal vessels were undetected by MRI images. MDCT can detect abnormal vessels which were not depicted on MRI. When dural AVF are suspected on MRI, MDCT angiography should be performed before selective angiography to diagnose. Geriatr Gerontol Int 2010; 10: 255–263.     

Diagnostic and therapeutic challenges following the cytologic diagnosis of in situ carcinoma of the lung.

Clinical challenges associated with the cytologic detection of eight cases of occult pulmonary carcinoma are presented. The pulmonary lesions were successfully localized and resected in three of six cases encountered since the availability of flexible fiberoptic bronchoscopy and selective bronchial brushing. Two of the resected neoplasms were unequivocally in situ, while preoperative radiotherapy precluded accurate pathologic determination of invasiveness in the third. The reported experience with unequivocal in situ bronchogenic carcinoma localized and treated surgically prior to invasion through the basement membrane now totals 17 cases (15 previously reported). Forty-four additional cases (43 previously reported) have been localized and resected following early invasion. From this group totaling 61 occult carcinomas, only two patients (3 percent) are known to have died of pulmonary carcinoma during a followup ranging from 2 to 20 years.     

儿童髓母细胞瘤的综合治疗

目的 探讨儿童髓母细胞瘤（MB）的综合治疗方法及预后。方法 59例MB患儿均行头部CT或MRI检查后行手术切除肿瘤，病理证实。结果 本组52例肿瘤全切除，6例次全切除，1例部分切除。术后症状明显改善56例，3例死亡。结论 对小儿脑髓母细胞瘤尽量应做到手术全切除，解除脑脊液循环梗阻。术后辅以放疗等可明显减少或延缓肿瘤复发，改善患儿生活质量，延长生存期。     

The usefulness of immunohistochemical evaluation of dihydropyrimidine dehydrogenase for rectal cancer treated with preoperative radiotherapy

BACKGROUND/AIMS: DPD (dihydropyrimidine dehydrogenase) activity shows a correlation with 5-fluorouracil chemosensitivity. To quantify DPD activity is important for selection of chemosensitive cases of not only sporadic colorectal cancer but also rectal cancer with preoperative radiotherapy. However, it is not cost-effective. We investigated the relation between the immunohistochemical expression pattern of DPD and its activity in rectal cancer treated with radiotherapy, and compared the immunohistochemical DPD expression pattern of preradiation biopsy specimens with that of resected tissues. METHODOLOGY: DPD expression pattern of preradiation biopsy specimens were compared with that of resected tissues. Eighteen colorectal cancer tissue samples were obtained after surgery from October 2000 to January 2001. DPD activity was quantified by sandwich enzyme-linked immunosorbent assay. The streptoavidin-biotin peroxidase complex technique was used for the immunohistochemical expression pattern. RESULTS: DPD was stained in the cytoplasm of cancer cells. There was a significant correlation between the immunohistochemical expression pattern of DPD and its activity in tumor tissue treated with or without radiotherapy. The immunohistochemical expression pattern of preradiation biopsy specimens was almost the same as that of resected tissues. CONCLUSIONS: The immunohistochemical expression pattern of DPD correlated with its activity in tumor tissue treated with preoperative radiotherapy. Immunohistochemical evaluation is considered to be an effective method of predicting the sensitivity to 5-fluorouracil of rectal cancer treated with preoperative radiotherapy.     

Congenital paravertebral arteriovenous fistulae in children and adolescents

These arteriovenous fistulae (AVF) situated in the paravertebral area present as a murmur which explains their cardiological orientation. They are characterised by the presence of one or more afferent paravertebral arteries giving rise to collateral vessels irrigating the bone marrow. The aim of this study of 13 cases was to study the diagnostic and therapeutic problems, and the evolution of this particular localisation of AVF. Two groups of paravertebral AVF were individualised: - Cervical AVF in which the vertebral artery was always involved (7 cases). Four were simple (only one fistula) and three were complex, having several afferent arteries. Two presented as a rapidly growing vascular tumour. Two caused an asymptomatic angiographic vertebral steal syndrome. Two simple forms were obturated by a detachable balloon and one by surgical excision. Two complex forms were treated by embolisation and surgery. Total closure of the AVF was obtained in all cases without complications. - Dorso-lumbar AVF (6 cases). The afferent vessels are the intercostal (D6 to D8) or lumbar (L2 to L4) arteries. Anatomically, these are extra-medullary fistulae with an extra or intra-vertebral venous drainage. Enlargement in an adjacent conjugating foramen forms a tumour which may narrow the spinal canal (1 case diagnosed by CAT) or erode the vertebral body, so compromising the spinal support. Spontaneous closure of the AVF was observed in 1 case. Three cases were treated surgically with good results; two patients are waiting for embolisation. A review of the literature provides complementary information on the long-term evolution of these AVF and confirms the need for systematic therapy as demonstrated in our study.(ABSTRACT TRUNCATED AT 250 WORDS)     

hPEBP4 as a predictive marker for the pathological response of rectal cancer to preoperative radiotherapy

Purpose

The ability to predict tumor sensitivity toward radiotherapy is important in the personalized application of preoperative radiotherapy for patients with rectal cancer. The aim of the present study was to test the human phosphatidylethanolamine-binding protein 4 (hPEBP4) as a predictive marker of tumor response to preoperative radiotherapy in patients with rectal cancer.

Method

A retrospective analysis was conducted, consisting of 86 patients with locally advanced rectal cancer who underwent short-course preoperative radiotherapy (20 Gy in five fractions for 1 week) followed by a radical resection. Both pretreatment biopsy specimens and resected primary tumor tissue were collected. Immunohistochemistry and tumor regression grading system were used to evaluate the expression of hPEBP4 in the pretreatment biopsy specimens and the response of rectal cancer to radiotherapy, respectively. Expression of hPEBP4 was correlated with tumor regression in the resected specimen and the clinical outcome of the patients as well.

Results

We found that high expression of hPEBP4 was associated with radioresistance in both univariate and multivariate analyses, and patients with a high hPEBP4 expression had a poorer progression-free survival than those with low hPEBP4 expression.

Conclusion

Our study revealed the independent predictive values of hPEBP4 in response of rectal cancer to preoperative radiotherapy, which suggests that upregulating hPEBP4 might be a potential mechanism by which rectal cancer cells avoid the destructive effects of radiotherapy.