扩大经蝶入路进入海绵窦内侧腔的应用显微解剖

目的为临床开展扩大经蝶入路进入海绵窦内侧腔手术提供解剖学依据。方法用50例成人头颅标本．在显微镜下对蝶窦外侧壁、蝶鞍、海绵窦及周围结构进行解剖学观察并测量。模拟扩大经蝶入路磨除海绵窦腹侧骨质，切开海绵窦内侧壁，显露海绵窦内侧腔。结果颈内动脉（ICA）明显隆起于蝶窦侧壁的占58％，蝶窦内隆起呈管型占3％。鞍底硬膜分为2层，海绵窦内侧壁的上部南垂体硬膜构成，无骨性结构支撑；下部由骨周硬膜构成，有蝶窦侧壁骨质支撑。两侧海绵窦内侧壁的距离为（14．8±2．7）mm。海绵窦内侧腔位于C4段ICA与垂体之间，腔内为丰富的静脉丛，最宽可达7mm，但常因ICA扭曲而闭塞。无颅神经穿越海绵窦内侧腔，ICA是扩大经蝶入路探查海绵窦遇到的第一个主要结构。结论扩大经蝶入路进入海绵窦内侧腔是安全可行的。     

Skull base surgery for malignancy: when not to operate

The purpose of this paper is to detail the contraindications for surgery, with curative intent for those patients who suffer from a head and neck malignancy that invades the intracranial space. This is based on a 30-year experience of over 250 patients. The most important contraindications are anatomical. Surgery is not done if the following structures are invaded: brain stem, eloquent portions of the cerebrum, superior sagittal sinus, both internal carotid arteries, both cavernous sinuses and certain vital bridging veins. Certain tumor factors are absolute but are occasionally relative contraindications: such as distant metastatic disease especially if multiple and at multiple anatomic sites. Some tumors that behave in a particularly virulent fashion that defy complete resection but are often difficult to predict preoperatively. Lack of patient medical fitness or absence of patient commitment to the operative procedure is make-up two serious contraindications to surgery. Presented at the 77th Annual Meeting of the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery, 24–28 May 2006, Mannheim, Germany.     

简易定向锥颅脑内血肿碎吸术治疗高血压脑出血——介绍一种简易脑内血肿碎吸器的研制及临床应用

本文介绍一种高血压脑出血外科治疗的新方法,即简易定向锥颅脑内血肿碎吸术。截至1988年10月临床应用19例,年龄41～79岁,出血量平均为48.1ml,一次吸除量为总量的79％(38ml),术后立即清醒者8/19例,偏瘫好转者4/19例,死亡4例。实践证明本法简单,安全有效,病人负担轻。     

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Abstract – Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.     

老年患者静脉穿刺常见困难及对策

静脉穿刺是临床常用的护理操作技术。老年人由于各器官生理性老化 ,经常合并多种疾病 ,患病率高 ,患病时间长 ,致使静脉穿刺次数多 ,因此静脉穿刺比较困难。对临床上常遇到的静脉穿刺困难进行分析并给予相应解决方法 ,经过多年实践 ,遵照这些方法 ,穿刺成功率达 97%以上 ,为患者解除了病痛     

Raymond's syndrome following petrosal sinus sampling

Summary Inferior petrosal sinus sampling (IPSS) is used to evaluate the pituitary-dependency of Cushing's disease, and to predict the laterality of a microadenoma prior to transsphenoidal operation. A serious complication occured in a 14-year-old boy: he suffered brain stem ischaemia with abducens nerve palsy and hemiparesis (Raymond's syndrome). The case prompted us to reconsider the indication for this investigation.     

Convergence of occipital nerve and superior sagittal sinus input in the cervical spinal cord of the cat

Co-existence of facial and occipital pain may occur in occipital neuralgia, migraine and cluster headache; suggesting convergence of trigeminal and cervical afferents. Such convergence has been shown in humans and other animals, but the site and extent of this are uncertain. In anaesthetized adult cats, the superior sagittal sinus and occipital nerve were stimulated electrically, and extracellular recordings made in the dorsolateral area of the upper cervical cord using glass-coated tungsten electrodes. Of 49 units in 10 cats, 33 (67%) had input from the superior sagittal sinus and the occipital nerve. Thirteen (27%) had superior sagittal sinus input and 3 (6%) had occipital nerve input. Convergent receptive fields were identified mechanically in 7 units. These experiments in cats show convergent input from occipital nerve and superior sagittal sinus on dorsolateral area units in two-thirds of cases studied. This experimental site of trigeminocervical convergence may relate to referral of pain in occipital neuralgia and other headaches.     

扩大经额硬膜外入路切除巨大侵袭性垂体瘤

目的:探讨采用扩大的经额硬膜外入路切除巨大侵袭性垂体瘤的临床应用.方法:1997年6月至2002年3月采用该入路显微外科切除巨大侵袭性垂体瘤10例,肿瘤主要累及于鞍上、蝶筛窦及上斜坡区.结果:本组10例中,肿瘤全切6例,次全切除3例,大部分切除1例.术后发生颅神经麻痹4例,其中动眼神经障碍3例,外展神经障碍1例.全组无手术死亡.术后影像学随访6～24个月,全切除肿瘤病例未见肿瘤复发,次全切除者无明显增大.结论:该入路可充分显露鞍区肿瘤,术野开阔,对脑组织损伤小,适用于已侵犯蝶筛窦区及上斜坡的侵袭性垂体瘤.     

Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia

To examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post–dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively. Three groups were identified: Group I (n = 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n=17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only for the duration of caesarean delivery; Group III (n= 13) patients had an immediate conversion to spinal anaesthesia and received post–caesarean section continuous intrathecal patient–controlled analgesia consisting of fentanyl 5 (ig'ml^-1 with bupivacaine 0.25 mg·ml^-1 and epinephrine 2 μg·ml^-1 with catheterization lasting >24 h. No parturient in group III developed a PDPH. This was substantially lower ( P < 0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization > 24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.     

Persistent left superior vena cava draining to left atrium with normal coronary sinus

In embryology, a persistent connection of the left superior vena cava to the left atrium rarely coexists with a coronary sinus. We herein report an unusual case of persistent left superior vena cava terminating in a left atrium with normal coronary sinus, which was revealed at the time of permanent pacemaker implantation after a second operation for recurrent left atrioventricular valve regurgitation. Because this anomaly had gone undiagnosed at the first operation, we were unable to diagnose it prior to the second operation, because the preoperative coronary angiogram clearly demonstrated a coronary sinus that was not dilated. We would have repaired the anomaly using a patch or other procedure had it been diagnosed before the second operation in order to prevent cyanosis or brain complications secondary to right-to-left shunting. One should always be on guard for this rare condition.