87例神经外科术后颅内感染的临床分析

目的探讨神经外科术后颅内感染的防治方法。方法回顾性分析我科术后发生颅内感染的87例临床资料。结果 87例患者经治疗后83例（95.4%）治愈,2例（2.3%）死亡,2例（2.3%）自动出院。结论及时有效的预防和治疗是减少后遗症、提高患者生活质量的关键。     

术中CT在脑血管疾病手术中的应用

目的 探讨术中CT在脑血管疾病手术中的应用价值.方法 收集2012年3月至8月收治的脑血管疾病患者38例.在手术前后行CT灌注成像(PCT)及CT血管造影(CTA)扫描,根据PCT及CTA情况,指导手术操作.结果 术中扫描总时间19～ 21 min.共行PCT77次、CTA 36次,图像质量良好109次(96.46％),差4次.11例颈动脉狭窄,PCT提示rCBF、rCBV增加,rTTP缩短；CTA提示狭窄消失.25例动脉瘤共处理28个动脉瘤,1例脑灌注异常,调整动脉瘤夹位置后恢复.CT平扫均未见颅内出血.术后随访3～8个月,恢复良好37例(97.4％)、中残1例.结论 术中CT是一种安全、操作简单、成像时间短、能提供高质量图像的技术.术中CT有助于及时发现动脉瘤及脑动静脉畸形残留、载瘤动脉及穿支动脉闭塞,是脑血管疾病外科手术中一种新型辅助技术.     

三维数字减影血管造影在颅内动脉瘤诊断和治疗中的作用

目的探讨三维数字减影血管造影(3D-DSA)在颅内动脉瘤的诊断及制定治疗策略中的价值。方法选择急性蛛网膜下腔出血并疑似颅内动脉瘤的患者53例,在常规数字减影血管造影(2D-DSA)的基础上行3D-DSA检查,根据造影结果制定相关治疗策略。结果53例患者中经3D-DSA证实共检出45例57个动脉瘤,3D-DSA较2D-DSA能更好地显示动脉瘤立体形态、载瘤动脉与毗邻血管的关系、瘤颈及其与载瘤血管关系,准确判断动脉瘤血管内治疗和外科手术夹闭的可行性,并为栓塞或支架置入提供最佳工作角度。结论3D-DSA可提高颅内动脉瘤特别是<2mm动脉瘤的检出率,为制定颅内动脉瘤的治疗策略提供准确、有效的信息,从而进一步提高动脉瘤血管内治疗和手术的安全性。     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

目的 评价高场强术中磁共振(iMRI)对脑胶质瘤手术切除程度及手术策略的影响.方法 解放军总医院神经外科自2009年10月至2010年6月将高场强iMRI系统应用于胶质瘤切除术患者106例,术前了解术者的切除意图(全切、次全切、大部切除),术前1 d患者常规行MRI扫描,应用影像数据和软件计算术前肿瘤体积,术中常规使用神经导航手术,依据术者的需求采集影像.必要时行iMRI扫描计算术中残余肿瘤体积和肿瘤体积切除百分比,分析使用iMRI对肿瘤切除程度、手术策略的影响.结果 术前计划全切48例,次全切41例,大部切除17例.术中第一次扫描示42例(39.6%)完全切除,64例(60.4%)仍有残留,其中25例由于肿瘤与重要功能区或重要传导束紧邻而未作进一步切除,其余39例(36.8%)改进手术策略,标记出残留肿瘤后进一步手术,25例(23.6%)胶质瘤最终全切除,肿瘤体积切除百分比由(76.5±20.5)%提高到(94.2±8.7)%,差异有统计学意义(U=2.000,P=0.000);最终实际全切67例,次全切25例,大部切除14例,全切率有所提高.106例患者平均肿瘤体积切除百分比由第一次扫描时的(86.3±20.2)%提高到最终扫描时的(93.6±12.4)%,差异有统计学意义(U=4.000,p=0.000).结论 高场强iMRI的应用可显著提高脑胶质瘤的切除程度,改进手术策略.

Abstract：

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

神经导航在夹闭大脑前动脉远端动脉瘤手术中的应用

目的:评价神经导航系统在大脑前动脉远端动脉瘤夹闭术中的作用.方法:2010年5月～2011年11月间,我科在神经导航系统辅助下夹闭大脑前动脉远端动脉瘤4例,其中动脉瘤位于A2段者2例,位于A3段者2例.结果:导航的精度为0.6～2.0mm(平均1.3mm),4例动脉瘤均成功定位,未出现术中动脉瘤破裂,动脉瘤均成功夹闭,未出见手术并发症.患者术后均恢复良好.结论:大脑前动脉远端动脉瘤是使用神经导航系统的适应证,可减少手术创伤、提高手术成功率、降低并发症的发生.     

大脑中动脉瘤的显微手术治疗体会(附35例报告)

目的 探讨显微外科手术处理大脑中动脉瘤(MCAA)的临床经验.方法 回顾性分析2004-2008年行显微手术治疗的35例MCAA患者的临床资料,其中男20例,女15例,年龄18～72岁,平均40岁.35例中22例曾有蛛网膜下隙出血,11例伴颅内血肿,1例伴硬膜下血肿;动脉瘤发生部位:MCA主干10例,分叉部20例,远端5例,其中1例分叉部有两个动脉瘤;左侧13例,右侧22例;巨型7例,大型11例,小型17例.35例均采用显微手术治疗,根据动脉瘤的位置而采取不同的于术人路,其中3例伴有颅内巨大血肿经颞上回入路行手术,1例巨大动脉瘤行左颞浅动脉大脑中动脉吻合术后行载瘤动脉阻断术,1例巨大动脉瘤行动脉瘤孤立、大隐静脉大脑中动脉架桥术.结果 巨型及大型MCAA占总例数的51.4%.与术前相比较,35例患者中术后症状好转20例,无变化12例,出现术后并发症3例,无一例死亡.结论 LWEAA易形成巨大动脉瘤;正确的手术入路及熟练的操作技术有助于提高手术效果.     

术中磁共振和功能神经导航在语言功能区病变手术的应用

摘要：目的探讨术中磁共振和功能神经导航在语言区病变手术中的应用价值。方法61例右利手患者在术中磁共振和基
于血氧水平依赖和弥散张量成像技术的功能神经导航辅助下实施语言功能区病变手术,按部位分为A组（左额下回后部
附近病变）和B组（左颞上回后部附近病变）,术前及术后2周用西方失语症成套试验对所有患者进行语言评估,获得失语
指数（AQ）。结果AQ术前正常者（AQ≥93.8）33例,AQ术后与AQ术前对比无统计学差异（P>0.05）,AQ术前低于正常者28例,AQ
术后较术前对比有所提高（P<0.01）。术后2周时,14例（23.0%）出现语言功能下降,仅有2例（3.2%）在6个月随访时仍存
在语言功能障碍。41例获得全切除,20例获得次全切除,AQ变化值（ΔAQ=AQ术后-AQ术前）与病变切除程度无关,A组ΔAQ
高于B组。结论术中磁共振和功能神经导航技术能够较好显示病变与语言相关皮层及纤维束之间的关系,有助于语言
功能区病变患者术后语言功能的保留。     

三维CT血管造影对动脉瘤性蛛网膜下腔出血诊断的可靠性研究

目的评价三维CT血管造影（3D-CTA）在动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage,aSAH）诊断的可靠性。方法对我科2010年12月-2011年11月间192名急性蛛网膜下腔出血患者行CT血管造影检查（CTA）检查并应用3D Slicer软件进行三维重建,与数字减影血管造影（digital subtraction angiography,DSA）或术中实际情况进行对比,评价CTA在动脉瘤性蛛网膜下腔出血诊断中的可靠性。结果 192例中,CTA检查出动脉瘤162例,脑血管畸形12例;另有假阴性1例,假阳性1例,均通过DSA及手术证实,3D-CTA在aSAH诊断的灵敏性为96.17%,特异性为94.11%。结论3D-CTA是动脉瘤性蛛网膜下腔出血的首选检查方法。