儿童髓母细胞瘤中枢外转移一例

患儿：男性，6岁。因间断性呕吐8月余，行走不稳3个月在外院行头颅MRI检查为后颅窝小脑蚓部占位性病变、梗阻性脑积水，考虑为髓母细胞瘤。遂在全麻下行脑室外引流并后颅窝开颅，小脑蚓部肿瘤切除术，术后上述症状缓解，但阻断脑室外引流后脑积水再现，遂行脑室腹腔分流术。因分流术后颅内感染而转入我院。术后病理报告为促纤维增生型髓母细胞瘤，采用直线加速器X射线全脑全脊髓放射治疗，     

枕部经小脑幕入路切除中线旁小脑幕裂孔缘周围病灶17例

目的 总结和探索枕部经小脑幕入路切除中线旁小脑幕裂孔缘周围病灶的优缺点及注意事项.方法 回顾分析枕部经小脑幕入路手术切除的中线旁小脑幕裂孔缘周围病灶17例,病灶位于丘脑枕部6例,中脑后外侧部6例,中脑桥脑交界区后外侧部1例,小脑半球前上部3例,骑跨小脑幕裂孔缘1例.结果 病灶全切除16例,大部分切除1例,术后均未出现视野缺损等新的神经功能障碍.结论 枕部经小脑幕入路开颅简单,大多不需牺牲桥静脉,术野开阔,操作角度多样,易于保护深部血管,适用于中线旁小脑幕裂孔缘周围病灶的切除.     

PET显像与癫痫灶定位

本文从癫痫的脑代谢显像、脑血流显像、神经递质受体显像、阿片受体显像及单胺氧化酶活性显像等方面阐述了正电子发射断层显像 (PET)定位癫痫灶的机制和应用现状 ,并展望其应用前景。     

COVID-19疫情期神经外科59例肺炎特点与防控经验

目的回顾分析COVID-19疫情爆发2月内,神经外科收治的112例患者中合并有59例肺炎的情况,总结COVID-19防控措施。方法回顾性分析2020年1月25日~3月30日神经外科急诊收治的住院患者共112人,年龄3~83岁（49.5±18.9岁）。在急诊核酸检测资源匮乏情况下,分析我科所有肺炎患者的类型及胸部CT表现,比较不同肺炎的CT影响学特征,并与COVID-19相鉴别。总结我科COVID-19高度疑似患者的处理办法,及在病人准入流程、医务人员管理、病房管理等疫情防控上的经验措施。结果入院时有86例患者在急诊完善了胸部CT检查,明确合并肺炎患者59例（68.6%）。其中最多的为吸入性肺炎者54例（62.8%）;CT影像显示磨玻璃影的患者有8例（11.76%）;疑似患者被收入神经外科病房仅2例,后转感染科诊治并确诊为普通肺炎;所有入院患者的首次咽拭子核酸检测均为阴性,对部分可疑患者入院后复查仍为阴性。在我科的严格防控下,无新冠肺炎确诊病例。结论神经外科病患肺炎发生率高,专科医师应加强肺炎的认识及读片能力,更好地鉴别肺炎早期胸部CT改变。实行严格的防护措施,尤其是憋气操作以及良好的通风条件,对神经外科这类非传染病专科在今后防范新的不明原因或者变异传染性肺炎的具有借鉴价值。     

松果体区肿瘤的临床应用解剖与显微外科治疗

随着人们保牙观念的增强及根管治疗技术的日渐成熟完善,冠修复的应用已成为口腔科的重要工作,因而残冠残根的利用价值就越来越高。同预成螺纹桩、铸造桩比较,由于纤维桩的弹性模量与牙本质非常接近,以及良好的透明性等优点,已越来越多地应用于残根残冠的修复。我们采用松风公司的纤维桩修复49颗前牙、前磨牙残根、残冠效果良好,现报告如下。     

松果体区肿瘤的临床病理研究

目的 研究松果体区肿瘤(PRTs)的病理分布特点及不同病理类型的临床特点.方法 回顾性分析南方医院神经外科自2000年1月至2009年1月经手术治疗并取得完整病理资料的133例PRTs患者的临床资料及病理特点.结果 133例患者中生殖细胞肿瘤61例(45.9%),松果体实质肿瘤17例(12.8%),神经上皮肿瘤28例(21.1%),其他肿瘤27例(20.2%).生殖细胞肿瘤中男女比例为14.25:1,平均15.3岁.松果体实质肿瘤中男女比例为2.4:1,平均24.7岁.神经上皮肿瘤中男女比例为1.15:1,平均28.1岁.有33例血清免疫学检查异常,除1例为转移瘤外,其余均为生殖细胞肿瘤.结论 PRTs病理类型多样,以生殖细胞肿瘤为主;影像学检查、血清免疫学检查及活检均不能准确判断病理类型,积极手术获得完整病理标本对于PRTs的病理研究有重要意义.     

原发性松果体区胚胎癌的诊断与治疗(附二例报告及文献复习)

Objective Primary embryonal carcinoma in pineal region is extremely rare Here we report two such cases and combined literatures review to discuss its diagnosis, treatment and prognosis. Method Two primary embryonal carcinoma in pineal region verified histologically were presented. In one cases, the preoperative serum alpha - fetoprotein (AFP) level reached significantly high level, 6 810μg/L, but showed negative staining forβ-human chorionic gonadotropin (β- HCG) . In the other one, accompanied by elevation of β-HCG level, 5 260 mIU/ml, the serum AFP was negative. The tumors were microsurgically removed by transeccipito-tentorial approach. Endoscopic third ventriculostomy was used after tumor removal because of recurrent hydrocephalus. Both patients received adjunctive treatments included radiation therapy (whole central nervous system 30 Gy and tumor bed 50 Gy) and 4 course of chemotherapy. Results In both patients, the tumors were totally removed. Postoperative tumor immunohistochemistry indicators were present in case 1 with positive reaction for cytokeratin(CK) and AFP, in case 2 with positive CK and β - HCG. After adjunctive treatments, the serum AFP and β - HCG of two patiants were decreased to normal ranges. After post - operative follow - up of one year,two patients still survived and the serum markers were almost normal. Conclusions Measurement of serum β-HCG and AFP is extraordinarily significant for the diagnosis and post - treatment monitoring of pineal region embryonal carcinoma. Pathological differential diagnosis requires immunohistochemical indicators including cytokeratin (CK),AFP andβ- HCG. With radically surgical removal and combined adjunctive therapy including radiation and chemotherapy, good consequence could be obtained.     

Discussion of diagnosis and therapy strategy for pineal region tumors

<正>Objective To define optimal diagnosis and theraputic strategy of pineal region tumors. Methods Clinicalmaterials of 154 cases with pineal region tumors were analyzed retrospectively. Results The patients with pineal region tumors often complained of increased intracranial pressure and ocular movement deficiency.     

1例中颅窝底鼻硬结病并发侵袭性毛霉菌病的诊断与治疗

鼻硬结病是一种较少见的慢性进行性感染性肉芽肿性疾病,可累及鼻、咽、喉、鼻窦及呼吸道各处,鼻硬结病的致病菌为克雷伯鼻硬结杆菌(KlebsiellaRhinoscleromatis,KR),其发病与机体的免疫功能受抑制密切相关[1]。侵袭性毛霉菌病是指由毛霉菌引起的真菌感染,是一种机会性感染[2]。毛霉菌可寄生于健康人的鼻、咽部而不致病,在免疫力低下时可呈现侵袭性生长而引起严重感染,病死率高。这两种病均罕见,合并发生尚未见报道。本文通过对我院1例中颅窝底硬结病合并侵袭性毛霉菌病的介绍,以探讨这两种疾病的诊断与治疗。1资料患者,女,汉族,59岁,广东…