Chiari畸形手术方法的改良

目的探讨小脑扁桃体下疝畸形(Chiari畸形)的手术方法，提高治疗效果，减少并发症方法本院自1993年12月至2003年12月对收治的86例Chiari畸形及部分合并脊髓空洞症患者实施了改良的枕大孔区小骨窗骨性减压、局部硬膜外层剥脱术。术后82例得到随访，平均随访5．5年(1～9年)，其中50例MRI复查头颈部？结果患者症状明显改善59例，部分改善10例，无变化13例，有效率占随访者84．15％，无手术并发症。结论改良的手术方式，在枕颈交界区骨性减压后，保留枕大孔区内层硬膜结构的情况下，可改善局部蛛网膜下腔脑脊液循环，缓解小脑扁桃体对延颈髓的压迫，效果较显著，同时减少了并发症。     

A dumbbell thrombus entrapped in patent foramen ovale

A 75-year-old lady came to emergency room due to dizziness andpresyncopal attacks during exertion since two days prior toadmission. Transesophageal echocardiography revealed a thrombuslike mass in right atrium traversing patent foramen ovale andextending to left atrium. Spiral chest CT scan showed bilateralpulmonary thromboemboli. Operative and pathological findingsconfirmed the diagnosis.     

Endodermal cyst of the foramen magnum Case report and review of the literature

The majority of endodermal cysts occur in the cervicothoracic spine, ventral to the cord. Intracranial locations are rare. We report a case involving the foramen magnum in a 14-year-old child, which was an incidental finding following a traumatic head injury. A review of the literature revealed six other cases involving this same location. These lesions are asymptomatic for a long time, and may cause brain stem medullary compression. Treatment is surgical. Effective simple removal can be achieved by a posterior approach. Received: 11 September 1997     

CT、MRI配准对圆孔、卵圆孔、棘孔的显示

目的:分析CT、MRI圆孔、卵圆孔及棘孔的显像及特征表现,探讨CT、MRI显示的圆孔、卵圆孔及棘孔在鼻咽癌放射治疗靶区勾画的意义。材料和方法:20例未经治疗的无脑神经侵犯鼻咽癌患者行CT、MRI扫描,在Pinnacle37.0工作站上采用互信息法配准后分析、评价圆孔、卵圆孔及棘孔在CT、MRI图像上显示特点。结果:在CT骨窗上圆孔显示为低密度的管状结构,卵圆孔及棘孔显示为低密度的孔状结构。7例(35%)圆孔在CT上为双侧显示,5例(25%)为单侧显示,8例(40%)未见显示。全部患者卵圆孔、棘孔在CT上均为双侧显示,卵圆孔两侧对称者13例(65%),不对称者7例(35%)。卵圆孔呈圆形8侧(20%),呈椭圆形32侧(80%)。棘孔两侧对称3例(15%),两侧不对称者17例(85%)。全部病例圆孔在MRI各个序列上均未见显示,卵圆孔及棘孔在T1WI、T2WI上均未见显示,在增强T1WI上表现为高信号血管影。全部患者卵圆孔及棘孔在增强T1WI上为双侧显示,卵圆孔两侧对称13例(65%),两侧不对称7例(35%);呈圆形8侧(20%),呈椭圆形32侧(80%)。增强CT未见圆孔、卵圆孔及棘孔内血管显示。结论:在MRI上对圆孔的识别还有很大困难,但是MRI可以显示正常卵圆孔及棘孔,为今后直接在MRI勾画鼻咽癌靶区(卵圆孔)制定放疗计划提供了影像解剖及靶区确定的依据。R     

Syringomyelia associated with a foramen magnum meningioma

In a 14-year-old boy with a meningioma at the foramen magnum extending to C-2, cervical syringomyelia was found on metrizamide computed tomographic myelography. The mechanism of syrinx enhancement on delayed computed tomographic scanning was considered to be due to transneural passage of metrizamide into the spinal cord. Long-standing spinal block may be responsible for development of syringomyelia. Syringomyelia associated with spinal extramedullary tumors was reviewed in the literature.     

颅骨卵圆孔—颞骨关节结节间径回归方程测定与临床应用

山西省太原地区出土老年颅骨120例(男80、女40),测量两侧颞骨关节结节间径及卵圆孔—颞骨关节结节间径,利用两个间径中度正相关的特点,经计算求得卵圆孔—颞骨关节结节间径回归方程式: 男性:Y=31.33+0.03X 女性:Y=16.36+0.14X临床运用只需测量出两侧颞骨关节结节间径,减去两侧A点处软组织厚度2L(2×3.34±0.21mm),代入此方程式,即可计算出颞骨关节结节—卵圆孔的距离。此距离加上一侧A点处软组织厚度L(3.34±0.21mm),为临床采用射频电流经皮选择性热凝半月神经节及传统的酒精注射至半月神经节的深度。     

Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia

Platypnea-orthodeoxia is a rare syndrome characterized by the occurrence of dyspnea and hypoxemia on adoption of an upright posture (i.e., orthodeoxia) and by the absence of symptoms and hypoxemia in decubitus. This syndrome is frequently related to patent foramen ovale and right-to-left shunting. We describe two patients in whom patent foramen ovale with right-to-left shunting was observed on transthoracic and transesophageal echocardiography and who had platypnea-orthodeoxia in the absence of pulmonary disease. They underwent transcatheter closure using an Amplatz device. The echocardiographic diagnosis and closure procedure are discussed. These case reports demonstrate that closure of patent foramen ovale is an effective treatment for platypnea-orthodeoxia.     

Accessory oval foramen

We describe an opening with smooth walls in front and medial to foramen ovale which leads to an oblique canal directed towards the fossa pterygoidea. The canal was up to 2.3 mm long and opened near the root of the pterygoid process. We called this opening "foramen ovale accessorium", and found it in 48 of 124 anatomical specimens. The foramen was present in newborns and in those aged over 80 years old on one side but rarely on both sides of the sphenoid bone. Only in a single specimen were there two foramina side by side in front of the foramen ovale. In another case, the foramen ovale accessorium was present in the anterior wall of the canalis ovalis and pointed to the fossa pterygoidea. The localization and direction of the foramen ovale accessorium led us to the conclusion that it housed some of the separate rootlets for the chewing muscles, in this case for mm pterygoidei, mm tensor veli palatini and tensor tympani. The existence and contents of the foramen ovale accessorium is important in surgical interventions on the trigeminal nerve and/or ganglion Gasseri.     

Low sensitivity of the echocardiograph compared with contrast transcranial Doppler in right-to-left shunt

Background

Contrast transcranial Doppler (c-TCD) has a high sensitivity for detecting right-to-left shunt (RLS), and is probably higher than transthoracic echocardiography (TTE) and comparable with transesophageal echocardiography (TEE).

Objective

To evaluate the accuracy of echocardiography (TTE and TEE) to detect RLS compared to c-TCD.

Material and methods

Observational study of patients <55 years old with cerebral ischaemia of undetermined origin (2007-2009). All underwent c-TCD monitoring to detect RLS, at rest and after Valsalva manoeuvre (VM). The TTE and TEE were performed when indicated by our cerebrovascular protocol. The accuracy of TTE and TEE for detecting RLS was calculated by comparing them with c-TCD.

Results

A total of 115 patients with c-TCD, mean age 43.3 (SD 10.3) years, 51.3% male. The TTE was performed in 102, and TEE in 81, patients. RLS detection was higher with c-TCD than with TTE (67.6% vs. 22.5%, P = .001) or TEE (77.8% vs. 53.1%, P = .001). The TTE, compared with c-TCD after MV showed: sensitivity 31.8%, specificity 96.9%, positive predictive value (PPV) 95.6%, negative predictive value (NPV) 40.5% and accuracy 52.9% to detect RLS. TEE, compared with c-TCD after MV showed: sensitivity 63.4%, specificity 83.3%, PPV 93%, NPV 39.4% and accuracy 67.9%. The accuracy of TTE and TEE improved when they were compared with c-TCD at rest.

Conclusions

TTE and TEE show a considerable number of false negatives for RLS detection. Clinical studies should consider the c-TCD as the best technique to diagnose RLS when a paradoxical embolism is suspected.     

远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术探讨(附11例报告)

目的探讨经远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术技巧。方法自2003年5月至2010年5月经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤11例,其中,经枕髁后入路5例,经部分枕髁入路4例,经C_1～2关节面侧方联合部分枕髁入路2例。结果肿瘤全切除（SimpsonⅠ、Ⅱ级）7例,次全切除（SimpsonⅢ级）3例,大部切除（SimpsonⅣ级）1例,无手术死亡病例。结论经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤的关键在于:①合理设计磨除枕骨大孔侧方骨质的范围以充分暴露肿瘤;②术中注意保护脑干、上颈髓、后组颅神经及椎动脉等重要结构。