Suboccipital bony decompression combined with removal of the dural band as treatment for Chiari I malformation

Chiari I malformation (CMI) is a disorder involving hindbrain maldevelopments characterized by herniation of the cerebellar tonsils through the foramen magnum. The clinical presentations of CMI are related to the direct compression of the brainstem and cerebellum and to disturbances to cerebral spinal fluid (CSF) circulation. Surgical intervention is indicated in symptomatic patients with neuroradiological abnormalities. Though many different surgical options are available, suboccipital decompression has been widely accepted as a preferred procedure with or without additional manipulations. Nevertheless, any intradural procedures will risk related complications, including meningitis or arachnoiditis, CSF leakage, pseudomeningoceles, vascular injuries, brainstem dysfunction, as well as delayed neurological deterioration. Since the main benefit of surgery for CMI is to arrest the progression of the disease and stabilize the patient‘s neurological state, additional procedures seem to be unnecessary. To achieve acceptable therapeutic results for CMI, it is beneficial to perform a simple and effective procedure involving a minimal extent of surgery. The purpose of this article is to present an extradural technique for the modification of suboccipital decompression and to evaluate its efficacy based on clinical and neuroradiological results.     

脑脓肿的微创手术治疗

目的：分析脑脓肿的手术疗效，探讨脑脓肿的微创外科治疗方法。方法：根据术前评估和术中情况选择（1）脓肿抽吸和（或）引流；（2）脓肿完整切除或脓壁切开＋刮除脓苔＋脓壁全部／部分切除。结果：手术死亡率为4．76%（3／63）。无1例因脓壁切开手术引起感染扩散，所有患者术后CT复查显示病变均有不同程度地缩小和消失。45例获得随访术后神经功能良好。结论：脓壁切开十刮除脓苔＋脓壁全部／部分切除的方法能有效保留神经功能，符合微创手术理念。     

增殖细胞核抗原及其在脑胶质瘤中的研究进展

增殖细胞核抗原(PCNA)是DNA多聚酶δ的辅助因子,是DNA合成过程中的必需物质。作为细胞增殖期标志物可评价肿瘤的恶性程度和增殖潜能。本文就PCNA的分子生物学特点、功能和在脑胶质瘤中的研究进展作一综述。     

神经外科术中超声--历史回顾、应用实践和技术展望

1术中超声的历史回顾在外科领域内,术中超声(IntraoperativeUltra-sound,IOUS)作为一项相对较新的术中影像技术,主要经历了三个主要阶段:第一阶段是20世纪60年代——A型超声和非实时的B型超声开始应用;第二阶段是70年代末期和80年代——实时的B型超声使术中超声技术迅速发展;第     

儿童幕上原始神经外胚层肿瘤

目的 探讨儿童幕上原始神经外胚层肿瘤(ST-PNET)的临床特征、治疗策略和预后.方法 回顾性分析2001年6月至2006年12月问12例经组织病理学证实的儿童ST-PNET的临床资料,并进行随访.结果 男性6例,女性6例,平均年龄6.5岁.8例为脑内肿瘤,4例为脑外肿瘤.11例患者获得随访,随访时间11个月至5年,死亡10例的术后平均生存时间:未放化疗(3例)、单独放疗(3例)、放疗或加化疗(7例)分别为5.0,21.7和23.3个月,后者的3年生存率为14.3%.结论 儿童ST-PNET少见,影像学和免疫组织化学分析有助于诊断.治疗应以手术切除加放疗为主,辅助化疗,但预后极差.     

颅内静脉窦损伤的手术治疗(附28例报告)

目的 探讨颅内静脉窦损伤的手术方法及治疗效果。方法 对28例颅内静脉窦损伤采用明胶海绵直接或止血纱布包裹后压迫、间断缝合或窦壁修补等方法，辅以医用耳脑胶粘合、硬膜悬吊加固等方法达到止血目的。结果 27例患者术后无损伤静脉窦的再出血和静脉窦血栓形成。结论 在充分的术前准备下，针对颅内不同类型的静脉窦损伤采用相应的手术方法，静脉窦出血可达到满意的治疗效果。     

改良颞顶部直切口颞下颅中窝底入路切除岩斜区和脑干病变

目的 研究改良颞顶部直切口颞下颅中窝底入路对切除岩斜区和脑干病变的有效性和安全性.方法 回顾性分析36例采用颞顶部直切口替代马蹄形切口的颞下入路的病例资料,记录开关颅时间,病变的病理类型和切除程度,术后并发症.结果 病变全切除29例,近全切除7例.面神经额支功能保存34例(94.4％).术后随访9～24个月,颞肌无明显萎缩,外形美观效果良好.1例病人因术后脑内血肿急诊手术清除,恢复良好.无手术死亡.结论 在安全和有效性方面,颞顶部直切口可替代传统马蹄形切口进行颞下颅中窝底入路切除脑干和岩斜区病变.这一改良可减少对皮肤、肌肉、血管和神经的损伤.     

1267例儿童神经系统肿瘤的流行病学

目的回顾性分析儿童神经系统肿瘤的流行病学特点。方法2001年1月至2005年12月五年间,获得组织病理学诊断的儿童(年龄≤15岁)原发性神经系统肿瘤1267例,按照WHO 2000年新分类,分析患者性别、肿瘤部位和组织学类型、分级与年龄的相关性。结果脑和椎管肿瘤分别为1177例(92.9%)和90例(7.1%),均以低级别肿瘤为主(65.20h,和76.7%),总的男女性别之比为1.6:1。脑肿瘤以幕上居多(60.4%),而750例神经上皮性脑肿瘤以幕下居多(57.3%)。常见的五类脑肿瘤是星形细胞肿瘤(29.9%)、颅咽管瘤(19.8%)、髓母细胞瘤(15.7%)、生殖细胞肿瘤(GCT)(7.5%)和室管膜肿瘤(5.9%),男性比例最高的是GCT和髓母细胞瘤。33.8%的星形细胞肿瘤发生于青春期;颅咽管瘤除婴幼儿组外,各年龄组发病几乎均等;髓母细胞瘤多见于7—9岁(33.0%),而在婴幼儿和青春期发病较低;GCT在2岁内无患病者,10—15岁占71.6%。室管膜肿瘤以幕下为主(77.1%),婴幼儿期的发生比例最高。椎管肿瘤常见的是星形细胞瘤(17.8%)、室管膜肿瘤和脂肪瘤(均为15.6%)。结论本研究基于WHO新分类,反映了国内儿童神经系统肿瘤的流行病学特点。     

延髓海绵状血管畸形临床特征与预后相关因素分析

目的探讨延髓海绵状血管畸形临床特征和预后相关因素。方法回顾性分析16例延髓海绵状血管畸形病人的临床资料,采用枕下后正中入路手术切除病灶,KPS评分对术前、术后及随访状况进行评估,统计分析影响呼吸、吞咽功能和预后KPS评分的相关因素。结果手术全切除16例,术后平均KPS评分(57.5±15.3)。随访16例,时间3～169.3个月,平均45.2个月,随访平均KPS评分(68.8±30.7),均无再次出血。高位延髓病灶较低位延髓病灶者呼吸功能差(P=0.034),而年龄≥40岁者较年龄<40岁者呼吸功能差(P=0.008);病灶偏中线一侧较病灶位于或接近中线者吞咽功能差(P=0.034);年龄≥40岁者较年龄<40岁者随访KPS低(P=0.036)。结论延髓海绵状血管畸形手术预后较好。对于年龄较大、高位延髓或位置偏中线一侧的病灶应加强围手术期治疗。     

Suboccipital bony decompression combined with removal of the dural band as treatment for Chiari I malformation

Chiari I malformation (CMI) is a disorder involving hindbrain maldevelopments characterized by herniation of the cerebellar tonsils through the foramen magnum. The clinical presentations of CMI are related to the direct compression of the brainstem and cerebellum and to disturbances to cerebral spinal fluid (CSF) circulation. Surgical intervention is indicated in symptomatic patients with neuroradiological abnormalities. Though many different surgical options are available, suboccipital decompression has been widely accepted as a preferred procedure with or without additional manipulations.1-11 Nevertheless, any intradural procedures will risk related complications, including meningitis or arachnoiditis, CSF leakage, pseudomeningoceles, vascular injuries, brainstem dysfunction, as well as delayed neurological deterioration. Since the main benefit of surgery for CMI is to arrest the progression of the disease and stabilize the patient's neurological state,2,12 additional procedures seem to be unnecessary. To achieve acceptable therapeutic results for CMI, it is beneficial to perform a simple and effective procedure involving a minimal extent of surgery. The purpose of this article is to present an extradural technique for the modification of suboccipital decompression and to evaluate its efficacy based on clinical and neuroradiological results.