经迷路进路听神经瘤术后脑脊液漏的预防及处理

目的　探讨经迷路进路听神经瘤切除术后脑脊液漏发生的影响因素及处理方法。方法1999年以来采用迷路进路或扩大迷路进路听神经瘤切除术 85例 ,前 4 1例采用传统关闭术腔技术 ,后4 4例对关闭技术进行改良 ,分析其脑脊液漏的发生率。发生脑脊液漏者行保守或手术治疗。结果传统关闭技术组中脑脊液漏的发生率为 19 5 % ( 8 4 1) ,改良关闭技术组中脑脊液漏的发生率为 2 3%( 1 4 4 ) ,两组差异有显著性意义 (P =0 0 13)。传统关闭技术组中脑脊液漏多数发生在大型听神经瘤中 ,其发生率随肿瘤增大有上升的趋势。 9例脑脊液漏的患者中 ,3例经保守治疗 ;6例经手术修补成功 ,其中 5例 1次修补成功。结论　改良关闭术腔技术可显著降低经迷路进路听神经瘤切除术后脑脊液漏的发生率 ,手术修补为终止脑脊液漏的有效措施     

GM(1,1)灰色模型在尘肺患病人数预测的应用与评价

目的 探讨验证灰色模型在尘肺患病人数预测的应用效果。方法 利用该煤矿1996～1986年尘肺患病人数进行建模，并建立了数学模型X(I)=583e^0.038(T-II)-452，作外推预测验证。结果 该灰色预测模型的拟合程度较高，取得了较好的效果。结论 灰色模型可应用于尘肺患病人数的预测。     

经口咽入路显微手术治疗颅颈区畸形

目的 总结经口咽入路颅颈区畸形的显微手术治疗体会。方法 回顾30例颅颈区畸形病例的临床表现、术前准备、手术方法、术后效果及并发症，并结合文献进行分析。结果 本组30例颅颈区畸形，经行口咽入路显微手术后，随访3个月～4年，痊愈21例(70％)，好转6例(20％)。结论 采用经口咽入路显微外科手术是治疗颅颈区畸形的有效手段，术中良好的显露及镜下细心操作是降低并发症的关键。     

GLOMUS TUMORS──A REVIEW OF 8 CASES WITH INTRODUCTION OF A MODIFIED COMBINED INTRA-AND EXTRACRANIAL APPROACH

Eight cases of glomus tumors hospitalized in our department from 1982 through 1995 were reviewed. It comprised of five glomus tympanic tumors and three glomus jugular tumors. Discussion was centered on it’s contemporary diagnosis, classification and surgical treatment with introduction of a modified combined intra-and extracranial surgical approach to resect the extensive glomus tumors.     

咽旁间隙肿瘤及手术入路

为探讨咽旁间隙肿瘤的手术方法及入路的选择。报告６６例经各种手术入路治疗的良、恶性肿瘤。结果表明，经颈或经颈合并下颌及正中裂开外旋入路较之其他几种手术入路具有手术适应证广、安全、术后并发症少等优点。认为经颈或经颈合并下颌正中裂开外旋入路是一种安全、彻底切除咽旁间隙原发肿瘤效果最好的入路。     

A limited-sampling method for evaluation of the area under the curve of ultrafilterable carboplatin in children

Carboplatin is a widely used cytotoxic agent in numerous solid tumors of children. Since there is a large degree of interpatient variability in the area under the curve of free carboplatin for a given dose of the drug, the current tendency is to adjust the carboplatin dose so as to reach a target area under the curve rather than to determine a carboplatin dose on the basis of the body surface area. A limited-sampling method was developed for estimation of the ultrafilterable carboplatin area under the curve and for adjustment of the carboplatin dose on subsequent treatments. Population parameters were obtained from 16 children (reference group). We used the maximum a posteriori (MAP) Bayesian approach on 15 children with complete carboplatin pharmacokinetic data (test group). Two blood samples were sufficient to obtain reliable prediction of the area under the curve. The best sampling times were: (a) 30 min after the end of the infusion and (b) 5 h after the end of the infusion. On the basis of these data it is possible to prescribe prospectively a target area under the curve for free carboplatin given in a fractionated daily infusion and to adapt the carboplatin dose directly to ultrafilterable carboplatin measurements. Received: 8 June 1997 / Accepted: 9 January 1998     

一期前路病灶清除植骨内固定治疗脊柱结核

目的总结一期前路病灶清除植骨内固定治疗脊柱结核的临床效果。方法对13例平均年龄42·3岁,平均病程5·6个月的脊柱结核患者,采用一期病灶清除结合植骨内固定,手术前后配合正规化疗,根据X线片观察脊柱融合时间,手术前后后凸角度变化以及按照Frankel分级的神经功能变化。结果全部病例伤口均一期愈合,未出现严重并发症。平均随访时间17·3个月,植骨界面骨性融合时间平均5·6个月。后凸平均矫正度数为11·7°,7例术前伴有神经损害症状者Frankel分级平均提高1·1级。结论一期病灶清除植骨内固定治疗脊柱结核,骨结构重建可靠,治疗过程相对简化,住院周期缩短,效果肯定。     

视神经鞘脑膜瘤的显微外科治疗(附13例报道)

目的探讨视神经鞘脑膜瘤的显微神经外科手术方法。方法收治13例视神经鞘脑膜瘤，根据肿瘤位置采用3种不同经颅入路：单侧额部入路、经额经眶上缘入路及经额颧经眶上缘入路，利用显微外科技术安全显露眶上裂外侧部、眶上裂中央部切除肿瘤。结果肿瘤全切11例，部分切除2例。术后13例患者的眼球突出均恢复正常，11例其它症状和体征也恢复或改善。术后动眼神经麻痹1例，患侧眼失明2例。结论熟悉显微神经外科解剖学，利用显微外科技术选择合适的经颅入路，可以提高视神经鞘脑膜瘤的全切除率，并使颅眶区的正常结构得到最大程度的保护。     

Cytoarchitectonic Basis for Safe Entry Into the Brainstem

This work is a continuation of the anatomical study in which safe approach zones through the floor of the fourth ventricle--infrafacial and suprafacial--were morphologically and morphometrically defined (Acta Neurochir (1997) 139: 1014-1019). The purpose of cytoarchitectonic study was to analyze correlation between morphometry of the facial colliculus and hypoglossal triangle and localization of the corresponding cranial nerves nuclei in the brainstem tegmentum in order to verify morphometrical borders of the previously defined zones. Morphometrical evaluation of the fourth ventricle floor of 10 examined brainstems was initially performed. Distances from obex to the rostral portion of hypoglossal triangle and facial colliculus were determined. Then a series of axial sections of each specimen, stained for Nissl substance, were analyzed to define the distance from obex to the rostral portion of the hypoglossal and abducens nuclei. Distances of motor trigeminal and facial nuclei from the midline sagittal plane were also measured. The obtained results allowed morphometrical determination of the infra-abducental and supra-abducental region of safe entry into the brainstem tegmentum. Infra-abducental region corresponds to infrafacial safe approach zone and supra-abducental to suprafacial zone. The distance of the rostral portion of facial colliculus from obex was longer than the distance of the rostral pole of abducens nucleus from obex in every examined specimen (by 0.7 mm on average). A very similar correlation between the distance of the rostral margin of hypoglossal triangle and localization of the rostral pole of hypoglossal nucleus was found. The rostral portion of hypoglossal triangle was longer by 1.5 mm on average. The obtained results show that previously defined infrafacial and suprafacial safe approach zones via the fourth ventricle floor correspond morphometrically to tegmental regions of safe entry--infra-abducental and supra-abducental respectively. It suggests that morphometrical evaluation of the fourth ventricle floor proposed by the authors could be useful in the intra-operative determination of safe entry via the rhomboid fossa into the brainstem tegmentum.     

Tentorial Meningiomas. Report on Twenty-Seven Cases

Summary ? Objective. Report our experience with 27 tentorial meningiomas (TM) surgically treated between 1985 and 1998.  Methods. The records of 27 patients with TMs were retrospectively reviewed for clinical presentation, neuroradiological evaluation, surgical treatment and long-term outcome. The extent of tumor resection was scored according to the Simpson's grading for tumor removal. Long-term results were evaluated according to the Glasgow Outcome Score (GOS).  Results. The average age was 53 years. Female predominance was 74%. The most common complaints at presentation were headaches (51%), gait ataxia (33%), memory disturbances (30%) and hypo-acousia (30%). A classification of TMs into 5 subgroups according to tumor site is proposed on the basis of imaging studies. A cerebrospinal fluid shunt was established prior to direct approach in 7 patients and as the sole procedure in one inoperable patient. Twenty-seven direct approaches were undertaken in 26 patients, including 17 infratentorial and 10 supratentorial approaches. Total tumor removal was achieved in 20 patients (77%) and subtotal removal in 6 (23%). Fifteen patients (55%) experienced 22 postoperative complications. One patient died three months after a subtotal resection (mortality=3,7%). With a mean follow-up of 54 months, all 26 survivors are currently alive with 23 having resumed their normal activities and 3 needing assistance. Five of 6 patients with subtotal resection survived and were followed for a period ranging from 72 to 132 months: none showed residual tumor progression and no re-operation was considered. An additional patient experienced a ?true? recurrence 6 years after total removal, with no tumor progression 2 years after his recurrence was recognized.  Discussion. The best surgical approach to TMs is still a controversial matter. The advantages and drawbacks of conventional versus transbasal approaches are reviewed. Our experience suggests that subtotal removal can be associated with long recurrence-free intervals and preserved quality of life. TMs located at the tentorial edge carried a definitely worse prognosis than peripheral forms.