单鼻孔经蝶内镜下鞍区肿瘤手术效果的临床分析

目的：分析单鼻孔经蝶内镜下鞍区肿瘤手术的临床效果。方法资料随机选取2010年6月-2013年6月本院行择期手术治疗的120例鞍区肿瘤患者,按照随机数字表法分为两组,对照组60例予以开放性手术治疗,研究组60例予以单鼻孔经碟内镜下手术治疗,分析两组患者围术期相关性指标、肿瘤切除及症状改善情况。结果研究组患者手术时间、术中出血量及住院时间均明显少于对照组,患者肿瘤全切除38（63.33%）例明显多于对照组20（33.33%）例,部分切除6（10.00%）例明显少于对照组14（23.33%）例;研究组患者头晕、闭经、阳痿、泌乳及视力恢复等临床症状改善情况均明显多于对照组,比较差异均具有统计学意义（P〈0.05）。结论单鼻孔经蝶内镜下鞍区肿瘤手术的临床效果显著,有效改善患者的临床症状,提高手术治疗有效率。     

脑电图、经颅多普勒超声检查及焦虑量表与难以分类原发性头痛关系

目的探析脑电图（EEG）、经颅多普勒超声（TCD）及焦虑量表（HAMA）与难以分类原发性头痛的关系。方法入选该院2010年6月-2014年6月收治的难以分类的原发性头痛患者141例,发作时进行EEG、TCD及汉密尔顿焦虑量表（HAMA）检查,分析脑电图异常、血流速度异常及HAMA的关系。结果脑血流速度异常率为68.1%（96/141）,脑电活动异常率为32.6%（46/141）,可能焦虑和焦虑患者发生率为62.4%（88/141）;无论TCD检查脑血流速度情况如何,EEG正常和异常患者HAMA量表评分无差异（P〉0.05）;无论EEG检查脑电情况如何,TCD正常和异常患者HAMA量表评分无差异（P〉0.05）。结论难以分类原发性头痛患者中62.4%存在焦虑障碍的精神、心理疾患,故治疗时不应忽视精神和心理疾病的治疗。     

Primary leptomeningeal melanomatosis successfully treated with PD-1 inhibitor pembrolizumab: A case report

Rationale:Primary leptomeningeal melanoma is an extremely rare disease of the central nervous system. There are no standard treatment protocols with a poor prognosis in very few reported cases. Immunotherapy in primary brain melanoma has not been successfully applied so far.Patient concerns:We describe a female patient 72-year-old diagnosed in the Neurosurgery Department which presented with generalized seizures.Diagnoses:Histological examination confirmed atypical melanocytes immunohistochemically positive for melan A, HMB45 and S-100 protein in the meninges, BRAF V600E negative. Dermatological, ophthalmological examinations, and 18-FDG PET/CT were negative.Interventions:The patient was successfully treated with pembrolizumab 2 mg/kg every 3 weeks for 2 years.Outcomes:The disease was stable for 2 years and the patient had no significant toxicity.Lessons:Our report describes durable intracranial tumor response suggesting the efficacy of PD-1 inhibitor pembrolizumab for central nervous system primary leptomeningeal melanoma.