脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.     

腰骶部长节段神经鞘瘤一例报道

文章报道1例较少见的腰骶部长节段神经鞘瘤.患者以下肢无力伴尿潴留为主要临床表现,术前腰椎MRI表现为不连续的强化,诊断为腰骶部髓外、硬脊膜内多发性神经鞘瘤.肿瘤经显微手术完整切除,肿瘤长约15 cm.术后患者恢复良好.结合文献,对该病例的相关问题进行探讨.     

慢性硬脑膜下血肿钻孔引流术后并发症及其防治

钻孔引流术是目前治疗慢性硬膜下血肿（ＣＳＤＨ）的首选方法，其方法简单有效、损伤小、治愈率高，但仍有一些严重并发症影响其临床病程及预后．笔者复习文献对几种主要并发症的发生机理及防治综述如下．一、继发性颅内出血文献报道发生率为４％～５％，为硬脑膜外血肿（...     

复发性脑转移瘤的再手术

本文报告48例复发性脑转移瘤再手术结果。 男女各24例,年龄17～68岁(平均47.5岁)。原发灶类型:黑色素瘤14例,肺癌11例,乳腺癌10例,肾癌及结肠癌各4例,脊索瘤、生殖细胞瘤各1例,不明者3例。癌肿确诊至首次开颅平均间隔11.5月(0～109月),首次开颅时脑转移灶2个者5例,单发43例;术后全脑放疗31例。首次开颅术后至复发平均为6.7月(1.2～28.8月),复发时单个病灶42例,2个病灶6例;原位复发30例,远隔复发16例。二者均有2例;再手术前平均KPS评分(Karnof-sky performance scale)为80(40～100),有癌肿全身症状者23例。再手术前后4例无症状,有症状的44例术前及术后30天KPS评分比较,好转33例,稳     

应用近红外线频谱仪早期发现迟发性颅内血肿

作者报道了用近红外线频谱仪(NIRS)早期发现167例迟发性颅内血肿病例的结果。 NIRS电极依次置于双侧额、顶、枕、矢状窦旁和枕下区,通过探测反射光强度比较两侧半球不同区域的光吸收(760nm)差(△OD),△OD=log_(10)(I_N÷I_H),I_N正常侧反射光的强度,I_H血肿侧反射光的强度。 男141例,女26例:年龄4个月～101岁:GCS评分9～12分90例,≤8分77例;病人首次CT扫描后行NIRS测定(随后连续测定)。伤后24～48小时内,或神经病学症状加重、ICP升高及NIRS提示有颅内血肿形成时复查CT。     

慢性硬脑膜下血肿钻孔引流术后并发症的诊治

慢性硬脑膜下血肿钻孔引流术后并发症的诊治陈少军，梁玉敏，张光霁，卢亦成我院近１０年来采用钻孔引流治疗慢性硬脑膜下血肿（ＣＳＤＨ）２２８例，现对其中２２例术后并发症进行总结，探讨其发生机理及防治等问题。临床资料一般资料本组根据病史、临床表现、影像学诊断...     

高压氧治疗致颅内积气一例报告

高压氧治疗致颅内积气一例报告梁玉敏，卢亦成，张沉石１．临床资料患者，男性，２５岁，１９９３年１２月２３日因车祸受伤，前额部着力，伤后原发昏迷史不详，呕吐２次，２ｈ后就诊。查体：ＧＣＳ１４分，前额及双眼睑肿胀，左侧鼻孔陈旧性出血。头颅ｘ线平片显示前额粉...     

深低温脑保护的差异蛋白质组学研究

目的应用差异蛋白质组学技术，研究深低温和常温停循环后大鼠海马组织蛋白质的变化。方法采用深低温停循环模型，取大鼠海马组织，通过双向电泳、分离蛋白，然后通过胶内酶切、生物质谱分析差异的蛋白质点，鉴定出变化的蛋白质。结果通过Image Master软件分析报告发现有差异的Ratio值大于1．5的蛋白考染点14个。通过对这些蛋白考染点进行质谱鉴定，鉴定出28个蛋白质，其中4个为同一种蛋白，实际的蛋白数为24个。它们是细胞骨架蛋白、介导代谢的酶类、参与核酸合成、参与氧化应激反应的蛋白质及未知蛋白。结论鉴定出的差异蛋白质可能与深低温脑保护作用有关，某些蛋白质在低温脑保护中的作用尚未报道。     

伴精神症状的外伤性硬脑膜下积液的治疗

1对象与方法 我院自1999年6月～2004年6月．对11例伴精神症状的外伤性硬脑膜下积液病人行钻孔引流结合扩血管药物治疗，其中男9例，女2例；年龄35～71岁，平均47．5岁。受伤原因：交通事故9例，坠落伤2例：均为闭合性损伤。着力部位：枕部6例，顶枕部5例。6例表现为躁动、谵语、秽语、大声喧哗，其中1例表现类似精神分裂症：3例表现为情绪低落、缄默、焦虑和失眠；2例表现为智能障碍、健忘。病人均于伤后2～6h来院就诊。首次头颅CT检查示对冲性额颞部或脑干挫裂伤9例．外伤性蛛网膜下腔出血2例：双额颞部均有少量硬脑膜下积液，经过扩血管药物治疗后．病人神志清楚但精神症状明显。复查CT示硬脑膜下积液增多，位于一侧额颞部8例，双侧额颞部3例；积液厚度〉1cm，量约30～50ml。治疗方法：局麻下经颞肌切口行额颞交界处钻孔引流．切开硬脑膜，采用双极电凝行硬脑膜造瘘，直径0．5mm左右，放置直径2mm硅胶引流管于硬脑膜下腔．从切口旁引出。如果引流液不多，术后第2天拔除引流；如果引流液〉30ml／d，则采用仰卧位，管抬高15cm，引流3～5d后拔除。术后继续应用扩血管药物．根据精神症状决定是否服用抗精神药物。     

慢性扩展性脑内血肿

慢性扩展性脑内血肿（chronic expanding intracerebral hematoma,CEICH）是一种特殊类型的脑内血肿,具有慢性进展性发展的特性,临床上多数以进行性颅内压增高为主要表现.本文复习文献对CEICH的相关问题综述如下.