听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

骶部先天性藏毛窦瘘并发脑脊髓膜炎脑积水1例

男孩，2岁4个月。生后7月发现骶部中线处有一针尖大小的皮肤瘘口，少量乳样分泌物溢出，伴发热，曾经抗炎及局部药物帖敷，体温正常。但此后瘘口时有分泌物溢出，量少，偶伴有毛发。1个半月前，瘘口突然漏出水样液，量多，伴有高热、呕吐，经多次腰穿检查，CSF细胞数达1630个／μl，虽予抗炎治疗、但病情渐加重，出现高热，意识朦胧而人我院。CT及     

成人髓母细胞瘤的临床特点与治疗

目的研究成人髓母细胞瘤的临床特点及治疗措施。方法20例成人髓母细胞瘤，其中男性13例，女性7例，平均年龄26．6岁，平均病程5．5月。所有病人接受显微神经外科手术治疗，15例病人术后接受放疗，4例行术后化疗。结果肿瘤全切除15例，近全切除2例，部分切除3例，无手术死亡。术后复发6例，中枢神经系统种植转移2例，术后2年生存率90％，术后5年生存率75％。结论通过手术全切除肿瘤和术后全中枢轴放疗可使成人髓母细胞瘤患者得到较好的治疗效果。     

颅咽管瘤全切除术中垂体柄的保护

目的 探讨颅咽管瘤全切除术中垂体柄的保护方法。方法 对63例颅咽管瘤患者的影像学及手术资料进行分析，重点描述影像学及术中垂体柄的辨认与保护方法。结果 63例中23例可在影像学上初步判断垂体柄与肿瘤的位置关系，均得到术中证实；术中明确发现垂体柄33例，可位于肿瘤瘤体后方(70％)、上方(15％)、侧方(9％)、前方(6％)。结论 垂体柄的辨认与保护对提高肿瘤全切除率、改善预后至关重要，MRI扫描可以为术中主动寻找及保护垂体柄提供帮助。     

原发性松果体区混合性生殖细胞肿瘤病理特点及其起源探讨

目的通过影像学表现、术中所见及病理成分探讨松果体区混合性生殖细胞肿瘤的起源。方法回顾分析我院2000年1月致2010年9月间经术后病理证实的15例松果体区混合性生殖细胞肿瘤的术前影像学表现和病理标本。结果影像学表现,12例存在钙化,10例含有囊变,5例含有脂质。矢状位类圆或类椭圆状6例,边缘均较光滑,不规则形状9例,边缘多突起;术中所见,所有肿瘤均位于大脑大静脉蛛网膜袖套包绕形成的松果体隐窝内;病理成分,13例含有生殖细胞成分,9例含有畸胎瘤成分,4例含有胚胎性癌成分,3例含有绒癌成分,7例含有卵黄囊瘤成分,3例含有横纹肌瘤成分。在7例标本边缘发现生殖细胞瘤,10例患者生殖细胞瘤成分与其余成分相互穿插或被其它成分包绕。结论松果体区混合性生殖细胞肿瘤起源于松果体周围残余生殖细胞,其极有可能来自单一的原始生殖细胞。     

颅咽管瘤组织炎症的研究及意义

目的研究不同病理类型颅咽管瘤组织炎症的差异、机制及意义。方法收集30例颅咽管瘤临床病例标本，采用免疫组化S—P法检测白细胞共同抗原CD45以标记炎症细胞，并检测细胞间黏附分子ICAM-1的表达。结果CD45标记的炎症反应在颅咽管瘤组织广泛存在，ICAM-1在肿瘤细胞、炎症细胞及血管内皮细胞都有表达。造釉细胞型颅咽管瘤组织炎症反应及ICAM-1的阳性表达显著高于鳞状乳头型颅咽管瘤（P〈0．05），肿瘤炎症与ICAM-1表达显著相关（P〈0．05）。结论不同病理类型颅咽管瘤组织炎症存在显著差异，颅咽管瘤组织炎症的差异与ICAM-1蛋白表达有关，颅咽管瘤细胞可产生ICAM-1参与炎症反应，不同病理类型颅咽管瘤组织炎症差异可能影响其预后。     

三脑室脑膜瘤

原发性脑室内脑膜瘤少见,其发生率占颅内脑膜瘤的0.5%～3%.脑室内脑膜瘤的好发部位以侧脑室三角部为主,起源于三脑室的脑膜瘤非常罕见,国外文献中报道很少,且均为个案报道,我科自200O年至今共收治三脑室脑膜瘤3例,为提高对此类脑膜瘤的认识,现总结报道如下.     

松果体区非肿瘤性囊肿性病变的外科治疗

目的总结松果体区非肿瘤性囊肿性病变的外科治疗经验。方法回顾性分析7例有症状的松果体区非肿瘤性囊肿病人的临床资料、手术方法和预后。采用显微手术切除4例，神经内镜囊肿部分切除1例，神经内镜三脑室底造瘘术2例。结果术后临床症状均改善或消失，术后随访6个月～3年。随访期间影像学复查松果体区囊肿性病变消失或显著缩小。结论松果体区非肿瘤性囊肿性病变的外科治疗。应根据囊肿的性质选择合理的手术方法；本病术后预后好。     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

松果体区肿瘤的MRI表现与其病理学对照研究

目的探讨不同病理性质的松果体区肿瘤MRI表现,评价其临床诊断价值。方法回顾性分析1999年1月至2009年1月经开颅手术治疗的131例松果体区肿瘤患者的MRI及病理学资料,并进行对比分析。结果这131例松果体区肿瘤中,纯生殖细胞瘤21例,畸胎瘤18例,混合性生殖细胞肿瘤12例,绒毛膜癌6例,胚胎性癌2例,内胚窦瘤1例,神经上皮肿瘤27例,松果体实质肿瘤17例,脑膜瘤14例和其它肿瘤13例。本组生殖细胞肿瘤60例,MRI增强后均有不同程度的强化,含有小囊状改变39例;其中生殖细胞瘤21例,5例MRI有较典型蝶形征;畸胎瘤18例,13例MRI有较典型的峰窝状改变;绒毛膜癌6例,5例MRI示出血。脑膜瘤14例,MRI示边界清楚,增强扫描均明显均匀强化,局部硬膜增厚6例;松果体实质肿瘤17例、神经上皮肿瘤27例及其他肿瘤13例,MRI表现各式各样。结论松果体区肿瘤的MRI表现与病理类型有关,部分MRI征象对一些肿瘤的诊断有较大特异性,但敏感度不高,依据MRI仍不能完全鉴别出松果体区肿瘤的病理性质。