神经内镜下寰枕部减压手术治疗Chiari畸形

目的 探讨神经内镜下寰枕减压手术治疗Chiari畸形的手术方法和临床疗效.方法 对23例经MRI确诊为Chiari畸形但不伴有寰枢锥脱位和齿突凹陷的患者在神经内镜下进行了寰枕减压手术,并进行疗效观察.结果 23例术后随访0.5-3.0年,原有症状均有不同程度改善,感觉障碍程度减轻,肢体肌力有所增强.无手术后并发症.术前合并脊髓空洞症的16例患者中,术后7例空洞消失,8例范围缩小,1例范围无明显变化.结论 神经内镜下寰枕减压手术治疗Chiari畸形方法可行,手术安全、有效、创伤小、疗效满意.

Abstract：

Objective To investigate the methods and effectiveness to treat Chiari malformation with the surgical decompression of the foramen magnum under endoscope. Method 23 cases with Chiari malformation.(without atlanto- axialdislocation and basilar invagination) diagnosed by magnetic resonance imaging( MRI)were operated with the surgical decompression of the foramen magnum under the endoscope. Results 23 cases were followed- up 0. 5 -3. 0, years after operation, all the symptoms and signs were remarkably relieved after the operation. No complications was found. In 16 cases with spinal cavities,7 cases spinal cavities disappeared and scases deflated,l case no evident change. Conclusions The endoscope -assisted decompression of the foramen magnum is a safe and effective surgical method to treat Chairi malformation.     

Early rebleeding of a foramen magnum dural arteriovenous fistula: A case report and review of the literature

Foramen magnum dural arteriovenous fistula (FM-DAVF) is a subset of craniocervical junction arteriovenous fistulas. We report a rare case of FM-DAVF with early rebleeding and review the literature. A 50-year-old man experienced 3 episodes of intracranial bleeding from a vessel malformation in the acute stage. We identified an FM-DAVF, supplied by multiple feeding arteries (eg, left ascending pharyngeal artery) that drained into the straight sinus and left superior petrosal sinus. The draining vein had venous varices. We performed transarterial feeder embolization and surgical disconnection of the DAVF. Early rebleeding of FM-DAVF is rare. High-risk patients require risk assessment and appropriate treatment as soon as possible in the acute stage.     

枕骨大孔区肿瘤的MRI诊断及显微外科治疗

目的探讨枕骨大孔区肿瘤的MRI诊断、类别和显微外科治疗方法。方法回顾分析MRI诊断和显微手术治疗51例枕骨大孔区肿瘤,根据肿瘤的MRI及类别选择手术入路,经枕下后正中入路手术切除41例,经枕下远外侧入路手术切除10例。结果肿瘤全切除37例(72.5%),次全切除13例,部分切除l例。临床症状改善者40例,保持原有症状者5例,症状较术前加重4例,术后死亡2例。术后随访到45例,随访期内复发3例。结论枕骨大孔区肿瘤种类及表现差异性大,MRI检查可提供准确的定位和诊断;根据MRI成像特点选择恰当的手术入路和采用显微外科手术切除肿瘤可获得良好的临床效果。     

超声检测卵圆孔径在评估胎儿心室发育不良中的临床意义

目的 探讨超声检测卵圆孔径(foramen ovale diameter,FOD)在评估胎儿心室发育不良中的临床意义.方法 应用彩色多普勒超声诊断系统检测430例正常胎儿和12例心室发育不良胎儿的FOD,进行统计学分析比较,并与尸体解剖或产后追踪结果 对照.结果正常胎儿FOD随胎龄增长而逐渐增大,具有良好的显性线形相关性(r=0.936,P<0.001);8例左心发育不良综合征胎儿的FOD均小于同胎龄组正常参考值下限;4例右心发育不良胎儿的FOD均大于同胎龄组正常参考值上限.结论 超声检测胎儿FOD方法简单且易掌握,能够为心室发育不良胎儿的循环生理变化提供有用信息,可作为早期评估胎儿心室发育不良的一项筛查指标.     

枕大孔畸形的影像学表现

目的:探讨枕大孔畸形的影像学表现。方法;对68例枕大孔畸形的传统X线平片及CT图像进行分析、研究。结果：单纯寰枕融合畸形8例,X线平片显示寰枕融合者5例。X线平片测量均误诊为颅底凹陷症。单纯颅底凹陷症29例,X线平片及CT测量均做出正确诊断。颅底凹陷症合并寰枕融合者31例,X线平片显示寰椎融合19例,CT均显示融合。CT、X线平片测量均符合颅底凹陷症。20例行脑池造影CT扫描,全部病例均示枕大池狭小,18例延脑后部显示小脑扁桃体迹,其中延脑与小脑扁桃体间蛛网膜下腔狭窄者6例,消失者12例,小脑扁桃体疝入椎管内者17例,颈髓有小脑扁桃体压迹者14例。结论：传统X线平片可显示枕大孔畸形的部分骨性特征,CT能显示枕大孔畸形的骨及软组织改变,可对枕大孔畸形做出正确诊断。     

Radiographic studies of the ventricles in syringomyelia

Summary Radiographic investigations of 171 patients with communicating syringomyelia have been reviewed. Hydrocephalus was found in onethird of the cases and has occasionally progressed after operation on the posterior fossa, sometimes with accompanying clinical deterioration. The outlets of the fourth ventricle were usually abnormal; tonsillar descent, arachnoiditis and both together were seen. Arachnoiditis correlated strongly with a history of difficult birth. The foramen of Magendie was sometimes patent and sometimes blocked. There was no consistent level of occlusion corresponding to a persistent roof of the fourth ventricle. The cisterna magna was usually small or obliterated but some examples of large cisterns or subarachnoid pouches were found. Radiological demonstration of a communication from the fourth ventricle to the syrinx occurred in only seven patients by positive contrast material and not by air. It is suggested that a sizable communication is rare at the time when patients seek treatment.     

腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床观察

目的观察腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床效果。方法将确诊为腰椎间盘突出症的患者200例随机分为观察组和对照组,观察组行腰椎间孔神经阻滞并椎间孔外口针刀松解,对照组行单纯腰椎间孔神经阻滞治疗,观察治疗后1个月、3个月、6个月的疗效,两组并进行比较。结果1个月后随访观察组优良率（92.2%,95/103例）明显高于对照组（81.4%,79/97例）（P〈0.05）;3个月和6个月后随访观察组优良率（92.2%,94/102例;90.2%,92/102例）也明显高于对照组（78.4%,76/97例;76.3%,74/ 97例）（P〈0.01）。结论腰椎间孔神经阻滞配合椎间孔外口松解,较单纯腰椎间孔神经阻滞治疗腰椎间盘突出症,可明显提高疗效,其远期效果尤为明显。     

经眶下裂至圆孔穿刺入路的应用解剖

目的为经眶一圆孔入路行射频热凝术治疗三叉神经第二支三叉神经痛提供解剖测量数据。方法对80个成人头骨经眶一圆孔穿刺入路及相关结构进行了测量与观察,对20个头颅软标本进行在CT引导下模拟操作与观察。结果在160侧颅骨中,成功穿进圆孔者为122侧,占76．25％;穿刺点位于眶下缘外眦的内侧（0．41±0．11）cm;经穿刺点至圆孔外口的距离为（4．45±0．18）cm,至圆孔内口前缘的距离为（4．99±0．17）cm,至颈动脉沟外侧缘距离为（5．52±0．35）cm。头颅软标本模拟操作穿刺安全有效深度为（5．38±0．25）cm;穿刺针进入圆孔时针与正中矢状面角度为32．2°±2．3°,与冠状面角度为57．2°±2．5°;穿刺针进入眶上裂后端时针与正中矢状面角度为26．0°±1．5°,与冠状面角度为64．5°±1．6°。结论根据解剖测量数据,在CT引导下经眶下裂至圆孔穿刺法行临床治疗第二支三叉神经痛安全可靠,疗效确切。     

CT diagnosis of cecal herniation through the foramen of Winslow

The computed tomographic (CT) appearance of a case of cecal herniation through the foramen of Winslow is described. This is an extremely uncommon type of internal hernia, and, to the best of our knowledge, its CT appearance has not been reported. Its recognition is important to both establish a preoperative diagnosis and to distinguish it from a lesser sac collection or abscess.     

颅底凹陷症合并脊髓空洞症的显微外科治疗

目的分析76例颅底凹陷症合并脊髓空洞症的显微外科手术治疗效果,探讨发病机理与手术方法等.方法采用显微外科手术方法,分别行枕下减压(A)、空洞蛛网膜下腔分流(B)、四脑室闩部疏通术(C),按Tator标准进行评定,观察不同手术方法后的效果.结果76例均有效,其中9例Ⅰ期手术行A后效果不明显,又Ⅱ期手术行B后仅1例症状无改善;52例同时行A+B后,仅2例症状无改善;15例同时行A+B+C后效果均为优.结论仅行A后难以奏效,A+B+C是最有效的手术方法.