松果体区脑膜瘤的诊断和外科治疗

脑膜瘤是生长缓慢的良性肿瘤,多见于大脑凸面,松果体区相对少见.松果体区脑膜瘤占松果体区肿瘤的6%～11%[1-3].由于这些良性、可根治性切除的肿瘤易被误诊为松果体区多见的恶性肿瘤,术前鉴别诊断具有重要意义[1].     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

垂体柄与鞍区肿瘤的形态学关系

目的 总结鞍区肿瘤与垂体柄的形态学关系。方法 对239例鞍区肿瘤患围手术期资料(手术资料中对垂体柄有明确描述和保留程度的记述)进行回顾性分析。结果 垂体柄与鞍区肿瘤的形态学关系大致可分为四种类型。I型：垂体柄完整，与肿瘤有软膜间隔；Ⅱ型：肿瘤位于垂体柄的中下部，并挤压垂体柄或长入垂体柄内，使垂体变形；Ⅲ型：肿瘤位于垂体柄上部或与下丘脑连接；Ⅳ型：垂体柄与肿瘤完全融合或极少残存。结论 探讨了如何针对鞍区肿瘤与垂体柄不同类型的关系采取不同的处理方法。     

内镜下经单鼻孔经蝶窦垂体瘤切除术的并发症及其防治

目的:探讨内镜下经单鼻孔经蝶窦垂体瘤切除术的常见并发症及其预防措施.方法:回顾性分析32例内镜下经单鼻孔经蝶窦垂体瘤切除术患者的临床资料.结果:肿瘤全切除24例,近全切除6例,部分切除2例.无手术死亡病例.术后并发蝶窦炎3例,脑脊液鼻漏2例,鼻黏膜迟发性出血2例,暂时性尿崩症15例,暂时性高热和水、电解质平衡失调1例,均治愈.无发生鼻中隔穿孔,亦无鼻撕裂伤及鼻部变形,无唇部麻木.术后随诊3～16个月,原垂体瘤术前症状消失、术后并发症痊愈.结论:内镜下经单鼻孔经蝶窦切除垂体瘤术后并发症较少、较轻,术前认真阅读影像学检查结果,熟悉解剖特点和操作技巧是减少并发症的关键.     

神经内镜下脉络丛烧灼术的并发症研究

目的探讨神经内镜下脉络丛烧灼术的并发症及其防治措施。方法回顾性分析14例行神经内镜下脉络丛烧灼术的脑积水患者的术后资料。结果术后并发症包括术后高热4例，短暂性的动作性震颤2例，癫痫发作1例。结论该术式容易出现术后的发热反应，脑室置管外引流可减轻发热反应。烧灼脉络丛根部时应注意避免持续电凝，以保护毗邻的神经血管结构，防止脉络丛与电凝器粘连出血。     

松果体区畸胎瘤的诊断和治疗

目的 探讨松果体区畸胎瘤的临床特征和治疗方法.方法 对16例开颅手术的松果体区畸胎瘤的临床资料及其随访结果进行回顾性分析.结果 以颅高压起病16例,CT扫描钙化14例,MRI囊变7例,血清学甲胎蛋白(AFP)增高2例.行枕部经小脑幕入路手术,成熟畸胎瘤6例,未成熟畸胎瘤10例,无手术死亡,术后并发视野缺损3例,随访6个月至5年,复发5例,死亡3例.结论 松果体区畸胎瘤多见于儿童男性,常见临床表现是颅高压和共济失调,影像学有形态不规则、钙化、囊变、不均一增强等表现,影像学和血清学检查有助于区分成熟和未成熟畸胎瘤,初次放射治疗无效,应积极手术治疗,术后根据病理结果辅助放疗,可取得较满意的疗效.     

神经内镜辅助经单鼻孔切除垂体腺瘤(附23例报告)

1 对象与方法 我科2002年7月～2004年1月采用神经内镜辅助单鼻孔经蝶入路手术切除垂体腺瘤23例，疗效较好；其中男9例，女14例；年龄20～62岁，平均31岁。病程3个月～5年。以视力障碍、内分泌功能紊乱及头痛为主要临床表现。     

132例松果体区肿瘤的临床研究

Objective To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors. Methods The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.Results A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88. 6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases.Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 ～ 132 months. Recurrence developed in 23 cases and 12 cases died.The 5-year survival rate was 89. 3%. Conclusion Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas.Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.     

髓外硬膜下型枕大孔区肿瘤31例的诊断与治疗

目的 探讨髓外硬膜下型枕大孔区肿瘤的诊断和治疗.方法 对31例髓外硬膜下型枕大孔区肿瘤患者的临床资料进行了回顾性分析,包括其临床表现、影像学、病理学及手术入路的分析.结果 脑膜瘤最多见,占54.8%(17/31),其中颅脊型多位于枕大孔前方和前外侧(9/11),脊颅型多位于枕大孔侧方和后方(4/6).31例均接受手术治疗,全切除26例,大部切除5例,肿瘤位于枕大孔后方、后外侧者采用枕后正中人路(8/31),位于前方、前外侧者采用枕下外侧入路(13/31)或远外侧经髁入路(10/31),并依据术中肿瘤与后组颅神经的位置关系分为后组颅神经前型(Ⅰ型)、跨后组颅神经型(Ⅱ型)和后组颅神经后型(Ⅲ型).结论 外硬膜下型枕大孔区肿瘤多属良性,手术切除可取得满意疗效.     

Effect of estradiol on vessel neointimal proliferation in ovariectomized female rabbits

In intent yealS, sighficant improVements have beenmade in pemitanoous tnmslthenal colD~ ~asty(WhA), and owing to itS reduction in subseqUent complications, this tecboqUe has gained extensive aPPlicationin the treabot of coronary diseases. But to the concernof many caliliologistS, restenosis, occurring in 20% 50% patients following even a successal PIDCedure['],gives the major setback in the use of ~oplasty. By farno single agent has clearly been demonshated to be ableto face restenosis.E…