高血压基底节脑出血并脑疝的显微手术治疗102例分析

目的：探讨显微条件下高血压基底节区脑出血并脑疝的治疗。方法：102例高血压脑出血并脑疝急诊手术治疗，扩大翼点开颅，显微镜下行脑内血肿清除加止血，并去骨瓣减压。结果：死亡18例，生存84例ADL分级I级8例，Ⅱ级31例，Ⅲ级30例，Ⅳ级15例。结论：显微手术结合大骨瓣减压是一种有效的治疗高血压脑出血并脑疝的方法。     

显微外科技术治疗16例蝶骨棘内侧脑膜瘤体会

目的:探讨内侧型蝶骨脊脑膜瘤显微手术治疗的经验和体会。方法:对16例垂体腺瘤的临床资料进行回顾性分析。结果:本组16例经显微手术,肿瘤全切除11例,次全切除5例。术后本组患者颅高压、视力下降及眼球突出等临床症状均有不同程度的改善和恢复,1例术后大面积脑梗塞。术后无死亡病例。结论:随着显微神经外科的发展,多数内侧型蝶骨嵴脑膜瘤的显微外科治疗均能达到满意疗效。     

神经内镜血肿清除术治疗重型脑室出血患者的临床价值

目的:分析神经内镜血肿清除术在重型脑室出血患者中的应用价值.方法:选取接受治疗的重型脑室出血患者60例,依照手术方案不同分为钻孔组和内镜组,各30例.钻孔组患者采用钻孔外引流术,内镜组患者采用神经内镜血肿清除术,比较两组患者的手术时间、引流管放置时间、住院时间、术后48 h血肿清除率、并发症发生率及术前、术后3个月Barthel指数、爱丁堡-斯堪的纳维亚(MESSS)评分.结果:内镜组患者术后48 h血肿清除率高于钻孔组(P<0.05);术后3个月内镜组Barthel指数评分高于钻孔组,MESSS评分低于钻孔组(P<0.05);内镜组并发症发生率6.67％低于钻孔组的26.67％(P<0.05).结论:神经内镜血肿清除术治疗重型脑室出血患者血肿清除率高于钻孔外引流术,可改善患者神经功能及日常生活能力,且安全性高.     

侧脑室三角区穿刺外引流治疗重症脑室内出血的临床体会

目的 探讨重症脑室内出血经侧脑室三角区外引流的治疗方法.方法 对46例重症脑室内出血患者,颅骨钻孔侧脑室三角区穿刺外引流术,同时辅以单侧或双侧脑室外引流术.结果 46例中死亡8例,其余38例的生存质量按照日常活动生活质量标准(ADL)评定,Ⅰ级13例,Ⅱ级12例,Ⅲ级10例,Ⅳ级3例. 结论 该方法是一种治疗重症脑室内出血效果较好、操作简单、费用低、安全有效的方法.     

微血管减压术治疗原发性三叉神经痛32例临床观察

原发性三叉神经痛(idiopathic trigeminal neuralgia,ITN)是头面部疼痛的常见原因.目前尚无药物能根治三叉神经痛.微血管减压术(microvascular decompression,MVD)能够长期缓解疼痛,保留面部感觉.我院自2005-07～2007-03采用MVD治疗原发性三叉神经痛32例,取得满意疗效,现总结报告如下.     

高血压脑出血手术患者下肢深静脉血栓形成临床观察

目的了解高血压脑出血手术患者深静脉血栓形成（DVT）的发生情况,分析高血压脑出血手术患者并发DVT的临床特点。方法连续调查2007～03～200904收住人我院神经外科手术的215例高血压脑出血患者,男139例,女76例;平均年龄（65．8&#177;13）岁。于手术后4d及14d行双下肢深静脉超声检测,确定下肢DVT的发生率。结果高血压脑出血手术患者DVT的总体检出率为20．5％,男性为18．0％,女性为25．0％,两者差异无统计学意义。血肿清除并去骨瓣减压术DVT发病率31．5％,高于血肿穿刺引流术（14．8％）,两者差异有统计学意义。DVT主要发生在瘫痪侧肢体,80％发生在手术4d后。最常见的局部症状为肿胀（16．0％）,大多DVT患者临床症状不明显。DVT主要累及下肢远端静脉,近端：远端-1．0：2．85。结论高血压脑出血手术患者为DVT高发人群。大多数DVT患者无症状,体征无特异性,不能根据临床表现诊断DVT。DVT主要累及下肢远端深静脉,以充盈缺损为超声主要表现。应用低分子肝素可能使高血压脑出血术后患者DvT发生率减低,而不增加再出血发生率。     

高血压脑出血手术患者下肢深静脉血栓形成的临床观察

高血压脑出血是老年人致死和致残的主要原因.由于病情重,昏迷时间长,加之手术创伤,导致手术后并发下肢深静脉血栓(DVT)危险较脑血栓病可能性更大.     

枕骨大孔区脊膜瘤一例

枕骨大孔区肿瘤位于颅颈交界,发病率约占颅内肿瘤的0.6%,因肿瘤累及脑干、上部颈髓、挤压小脑、后组颅神经,解剖结构复杂。其血供主要来自椎动脉,手术操作空间狭小,手术切除难度大,风险极高,任何血管、神经组织损伤均会导致严重后果,甚至有生命危险。近日,我院神经外科在显微镜下采用极外侧入路成功切除枕骨大孔区脊膜瘤1例,术后患者肢体功能恢复正常。现报道如下。     

脑血管畸形急性出血并脑内血肿的手术治疗

目的 探讨脑动静脉畸形(AVM) 出血并颅内血肿形成的急诊手术问题.方法 37例CT示颅内血肿,怀疑AVM 出血,32例急诊手术前经MRA检查提示脑AVM21例,其中29例行血肿清除加AVM显微切除术,8例行单纯血肿清除术,10例行去骨瓣减压术.结果 死亡4例,存活33例中恢复优良21例,良7例,差5例. 29例术后复查DSA或MRA,20例AVM消失.结论 急诊显微外科手术治疗是AVM破裂出血首选治疗方法,能够提高脑AVM破裂出血的治愈率,降低致残率.MRA适合急诊术前检查,可快捷、安全显示AVM及主要供血动脉,指导制定手术方案.     

钛表面梯度生物活性涂层材料在颅骨修补中的生物性能

BACKGROUND: Titanium mesh has good clinical effect in repairing skull defects, but due to the lack of bone induction ability, the titanium mesh has a poor integration with the bone tissue. OBJECTIVE: To observe the biological properties of the gradient bioactive coating materials on the titanium surface in the skull repair. METHODS: Osteoblasts were co-cultured with the titanium mesh with or without gradient bioactive coatings for 14 days, and then cell proliferation was detected using MTT method. Seventy-one patients with skull defects were enrolled, including 43 males and 28 females, aged 15-60 years, and were subjected to skull repair using the titanium mesh with (observation group, n=3) or without (control group, n=38) gradient bioactive coatings. During the postoperative follow-up of 12 months, the repairing effects and adverse reactions were observed in the two groups. RESULTS AND CONCLUSION: (1) In vitro cell culture: the cell proliferative ability was increased significantly in the observation group as compared with the control group at 8, 10, 12 and 14 days after cell culture. (2) In vivo repair: the hospital stay and wound healing time in the observation group were significantly lower than those in the control group (P < 0.05), and at the final follow-up, the postoperative recovery effect was significantly higher in the observation group than the control group (P < 0.05). The titanium meshes were fixed firmly in the two groups, with no floating, infection and exposure. These results show that the titanium mesh with gradient bioactive coating has good biocompatibility and osteoinduction capacity.