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31.
BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial.
OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach.
DESIGN: Retrospectively clinic case investigation.
SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University.
PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three.
METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up.
MAIN OUTCOME MEASURES: Operative effect.
RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans.
CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up. 相似文献
32.
Lei Ding Christopher Wilke Bobby Xu Xiaoliang Xu Wim van Drongelen Michael Kohrman Bin He 《Journal of clinical neurophysiology》2007,24(2):130-136
SUMMARY: It is desirable to estimate epileptogenic zones with both location and extent information from noninvasive EEG. In the present study, the authors use a subspace source localization method (FINE), combined with a local thresholding technique, to achieve such tasks. The performance of this method was evaluated in interictal spikes from three pediatric patients with medically intractable partial epilepsy. The thresholded subspace correlation, which is obtained from FINE scanning, is a favorable marker, which implies the extents of current sources associated with epileptic activities. The findings were validated by comparing the results with invasive electrocorticographic (ECoG) recordings of interictal spike activity. The surgical resections in these three patients correlated well with the epileptogenic zones identified from both EEG sources and ECoG potential distributions. The value of the proposed noninvasive technique for estimating epileptiform activity was supported by satisfactory surgery outcomes. 相似文献
33.
目的探讨经尿道等离子双极电切术(PKRP)治疗良性前列腺增生(BPH)术后对阴茎勃起功能的影响。方法PKRP、经尿道前列腺电切术(TURP)治疗BPH各95例,评价其术后1个月、3个月及1年阴茎勃起功能。结果PKRP、TURP术后1个月、3个月及1年阴茎勃起功能障碍(ED)发生率分别是3.2%、2.1%、2.1%和13.7%、10.5%、9.5%。结论PKRP术后ED发生率比TURP低,是一种对阴茎勃起功能较为安全的治疗良性前列腺增生的方法。 相似文献
34.
脑血管意外尿失禁的机制探讨 总被引:4,自引:0,他引:4
目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。 相似文献
35.
膀胱癌中环氧化酶-2的表达与临床病理的关系(英文) 总被引:4,自引:2,他引:2
目的 探讨环氧化酶 - 2 (COX - 2 )表达与膀胱癌生物学行为的关系及其意义。方法 采用免疫组化SABC法检测 5 4例膀胱癌、2 9例癌旁组织和 10例正常膀胱粘膜中的COX - 2表达 ,结合临床病理资料进行分析。结果 COX - 2在不同膀胱组织中的表达差异有显著性 (P <0 .0 5 ) ,即膀胱癌组织 >癌旁组织 >正常膀胱粘膜。COX - 2表达随膀胱癌病理级和临床分期的增加而增加 (P <0 .0 5、P <0 .0 1) ,且癌组织中COX - 2表达与淋巴转移有关 (P <0 .0 5 )。结论 COX - 2表达与膀胱癌病理分级、临床分期、淋巴转移有关 ,提示它可能在胱癌的发生、发展中扮演重要角色 ,通过抑制COX - 2活性可能为膀胱癌的防治提供新途径。 相似文献
36.
重度联合免疫缺陷小鼠的繁育及其应用初报 总被引:4,自引:1,他引:3
应用带过滤罩的透明鼠在层流柜内繁育T和B淋巴细胞缺失的重度联合免疫缺陷(scid)小鼠获得成功,1993年5月至1994年4月,共繁育scid小鼠221只,寿命均超过12个月。平均每窝产仔数为5.5只,显著低于对照组BALB/c小鼠,不育率为14.9%,离乳率为88.2%,与BALB/c小鼠相比均无明显差异。scid小鼠4~10周龄的体重与同龄BALB/c小鼠相比无明显差异,微生物学检测均符合SP 相似文献
37.
阴茎背深静脉包埋术治疗勃起功能障碍5例 总被引:8,自引:2,他引:6
目的 :评价阴茎背深静脉包埋术治疗勃起功能障碍 (ED)的疗效。 方法 :对 3例静脉性和 2例动静脉混合性ED病人施行阴茎背深静脉包埋术 ,术后随访疗效。 结果 :术后 2个月首次随访 ,3例静脉性ED病人获得满意性交 ,2例动静脉混合性ED病人基本能勃起 ,口服西地那非 5 0mg后可以完成性交。 5例术后随访 3~ 12个月(平均 7个月 )保持以上疗效。 结论 :阴茎背深静脉包埋术创伤小 ,几乎无并发症 ,是治疗静脉性ED的有效疗法 相似文献
38.
重视患者知情同意权提高医疗服务质量 总被引:12,自引:0,他引:12
为了提高医院的医疗服务质量,保证医疗安全,避免和减少医疗纠纷,医院必须严格遵守患者知情同意原则。作者着重讨论知情同意的意义,如何规范知情同意书的范围、格式和内容,以及填写注意事项等问题。 相似文献
39.
668颗后牙镍铬合金PFM边缘适合性的临床观察 总被引:4,自引:0,他引:4
目的:观察采用2种边缘形式的后牙烤瓷熔附金属全冠边缘适合性和对牙龈健康的影响.方法:对668颗后牙,分别采用2种边缘形式的后牙烤瓷熔附金属全冠(单冠或桥的基牙)在修复2年后进行复查,检测其边缘适合性及牙龈指数(GI)和牙周探诊深度(PD),用统计学方法分析修复体边缘形式与牙龈病变间的关系.结果:采用羽状边缘360°金属脚边的PFM边缘适合性明显优于凹面肩台型边缘PFM,凹面肩台型边缘的PFM的牙龈病变发生率,明显高于羽状边缘360°金属脚边的PFM,而边缘适合性差者较适合性好者牙龈病变发生率显著增高.结论:后牙PFM的边缘采用羽状边缘360°金属脚边是一种好的选择. 相似文献
40.
按照中国药典1985年版蕲蛇为蝰科动物五步蛇除去内脏的干燥体。近年在河北省的药村商品中,发现有游蛇科动物滑鼠蛇混入其中,充当蕲蛇。作者应用解剖、组织切片的方法,研究了蕲蛇与滑鼠蛇在形态组织上的鉴别特征。它们的主要区别在于:鳞片、体表花纹、牙齿、鼻骨的形态;椎骨的形态与组织特征。据此可以鉴别蕲蛇与滑鼠蛇的真伪。 相似文献