垂体肉芽肿合并出血

目的探讨垂体肉芽肿的临床特点与治疗.方法报道1例病人的临床资料,并复习文献19例.结果患者以头痛和视力障碍起病,头颅MRI提示鞍内占位性病灶,信号不均匀,视交叉明显受压上抬,手术发现病灶有出血,病理证实为垂体肉芽肿.文献19例垂体肉芽肿中,Rathke's囊肿破裂引起12例,胆固醇、浆细胞、巨细胞肉芽肿各1例,分支杆菌感染引起1例,原因不明3例;临床表现不典型,所有病例均行手术并靠病理确诊.结论垂体肉芽肿非常罕见,临床诊断困难,常经病理确诊.术后激素治疗,预后良好.     

经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤

目的：探讨经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤的疗效和并发症。方法：回顾性分析28例经胼胝体-透明隔-穹窿间入路切除的三脑室内颅咽管瘤患者的病例资料。结果：肿瘤全切18例,次全切6例,部分切除4例。术后主要并发症为电解质紊乱、尿崩症、内分泌功能紊乱、缄默、体温调节障碍、癫痫等。结论：经胼胝体-透明隔-穹窿间入路为切除三脑室内颅咽管瘤最佳入路之一;颅咽管瘤术后并发症多且严重,充分的术前准备及良好的围手术管理是手术成功的前提。     

视神经轴索损伤早期郎飞结超微结构研究

目的 观察视神经轴索损伤早期郎飞结超微结构的变化,并探讨其在延迟性轴索中断中的作用。方法 豚鼠右侧视神经受牵拉致伤,分别于于伤１５分钟,２小时和４小时处死动物。电镜下观察郎飞结形态的变化,并进行定量分析。结果 伤后早期郎飞结有明显的轴膜结构和细胞骨架异常。伤后１５分钟近一半郎飞结的轴膜发生局限性疝出,外突轴膜的特征性膜下致密层消失。     

颅脑外伤急性期血中利钠因子和ADH浓度变化及其临床意义

目的：阐明急性颅脑外伤（ＡＣＩ）患者水盐失衡发生机制及寻找治疗新途径。方法：对６８例ＡＣＩ患者血中心钠肽（ＡＮＰ）、脑钠肽（ＢＮＰ）、内源性类洋地黄物质（ＥＤＬＳ）、抗利尿激素（ＡＤＨ）含量及血、尿渗透压，血、尿钠浓度作同步监测，并在ＧＣＳ≤８分的病例中行促甲状腺素释放激素（ＴＲＨ）刺激试验，观察血中ＡＮＰ、ＢＮＰ、ＥＤＬＳ、ＡＤＨ反应。结果：ＡＣＩ患者血ＡＮＰ、ＢＮＰ浓度显著低于对照组，血ＥＤＬＳ、ＡＤＨ浓度显著高于对照组。ＡＮＰ、ＢＮＰ浓度降低不受脑伤程度影响，而ＥＤＬＳ、ＡＤＨ浓度升高与脑伤程度有关。结论：运用ＡＮＰ、ＢＮＰ或ＴＲＨ可以对抗ＡＣＩ患者ＡＤＨ分泌增加所引起的机体水钠潴留；低钠血症多集中出现在重伤或特重伤病员中，与下丘脑垂体功能受损致ＥＤＬＳ、ＡＤＨ分泌增加相关。     

树胶肿型神经梅毒的影像学表现(附三例报告)

目的　探讨树胶肿型神经梅毒的影像学表现。方法　搜集 3例做过头颅手术的树胶肿型神经梅毒 ,全部 3例均有婚外性生活史 ,实验室检查血清和 (或 )脑脊液标本高度提示梅毒 ,术后病理诊断为脑树胶肿型梅毒。结果　头颅影像检查中 ,例 1CT平扫示左侧颞叶大片低密度病灶 ,约5 0cm× 3 5cm大小 ,伴明显的占位效应 ,增强扫描以环状强化为主 ,未行MR检查。例 2CT平扫见右额叶混杂密度病灶 ,增强后病变中心有小点状强化 ,呈轻度占位 ;MR扫描见右额叶、右侧脑室旁分别有一直径为 1 5cm和 1 0cm大小的T1WI呈等信号、T2 WI呈高信号的类圆形病灶 ,增强后病灶呈环状强化 ,右侧脑室前角轻度受压 ;例 3头颅CT平扫示颅内多发低密度占位性病变 ,以双额叶和左颞叶为主 ,未做增强扫描 ,而MR平扫示双侧大脑半球多发性长径 1～ 3cm大小不等的结节和团块状病灶 ,T1WI呈低信号、T2 WI呈高信号 ,注入对比剂后大多为结节样或环状强化。结论　该病的影像学表现缺乏特征性 ,术前诊断须综合分析临床表现、实验室检查及影像学资料     

Ultrastructural observation of effect of moderate hypothermia on axonal damage in an animal model of diffuse axonal injury

OBJECTIVE: To investigate the effect of moderate hypothermia on responses of axonal cytoskeleton to axonal injury in the acute stage of injury. METHODS: Of fifteen adult guinea pigs, twelve animals were subjected to stretch injury to the right optic nerves and divided into the normothermic group (n = 6) in which the animal's core temperature was maintained at 36.0-37.5 degrees C and the hypothermia group (n = 6) in which the core temperature was reduced to 32.0-32.5 degrees C after stretch injury. Remaining three animals sustained no injury to the right optic nerves and served as control group. Half of injured animals (n = 3) of either normothermic group or hypothermic group were killed at either 2 hours or 4 hours after injury. The ultrastructural changes of axonal cytoskeleton of the right optic nerve fibers from the animals were examined under a transmission electron microscope and analyzed by quantitative analysis with a computer image analysis system. RESULTS: At 2 hours after stretch injury, there was a significant reduction in the mean number of microtubules (P < 0.001), and a significant increase in the mean intermicrotubule spacing (P < 0.05 or P < 0.01) in axons of all sizes in normothermic animals. The mean number of neurofilaments also decreased statistically (P < 0.01) in large and medium subgroups of axons in the same experimental group at 2 hours. By 4 hours, the large subgroup of axons in normothermic animals still demonstrated a significant decline in the mean number of microtubules (P < 0.01) and an increase in the mean intermicrotubule spacing (P < 0.05), while the medium and small subgroups of axons displayed a significant increase in the mean number of neurofilaments (P < 0.05) and reduction in the mean interneurofilament spacing (P < 0.05). On the contrary, either the mean number of microtubules and the mean intermicrotubule spacing, or the mean number of neurofilaments and interneurofilament spacing in axons of all sizes in hypothermic stretch-injured animals was not significant different from the mean values of sham-operated animals. CONCLUSIONS: Posttraumatic moderate hypothermia induced immediately after axonal injury results in substantial protection of axonal cytoskeleton and ameliorates axonal damage.     

经蝶显微手术技巧的初步体会

经蝶入路切除垂体肿瘤首先由 Schloffef于1907年介绍,因入路视野狭窄,手术困难且易致严重并发症,因而未能被广泛采用。随着 Guiot 和 Hardy 60年代对该入路的恢复和改进,经口、鼻中隔、蝶窦入路切除垂体肿瘤的显微手术已在全世界普遍推广,并     

外伤性迟发性颅内血肿及其与血凝障碍的关系

本文报告经ＣＴ扫描证实的外伤性迟发性颅内血肿（ＤＴＩＣＨ）１５例，分别于伤后２４小时内、３天和７天检测了凝血酶原时间（ＰＴ）、凝血酶时间（ＴＴ）、白陶土部分凝血活酶时间（ＫＰＴＴ）和血小板计数（ＰＣ）４项凝血指标，并以同期２２例颅脑损伤病人作对比性研究。结果显示颅脑损伤病人４项凝血指标均有一定程度异常。ＤＴＩＣＨ组病人的ＰＴ和ＰＣ异常率明显高于对照组病人，这种差异于伤后２４小时内具有显著统计学意义     

经蝶手术的并发症及其防治

本文报道连续150例经蝶手术的手术并发症。手术病例包括:垂体腺瘤切除139例,颅咽管瘤切除2例、鞍内囊肿切除2例、晚期癌肿行垂体全切除3例及空鞍填塞4例。并发症中以尿崩症最多见,占16％,其次为脑脊液漏,占6％。无手术死亡及术后鞍内血肿。结合文献复习,对经蝶手术并发症的预防和处理进行了讨论。