立体定向联合术中皮层电极、神经电生理监测治疗功能区皮层下小肿瘤性癫痫

目的 评价采用立体定向联合术中皮层脑电图(ECoG)、神经电生理监测(IOM)治疗功能区皮层下小肿瘤性癫痫的手术方法及效果、并发症. 方法 解放军第153医院神经外科自2006年6月至2011年6月共收治功能区皮层下小肿瘤引起的癫痫患者15例,均在立体定向仪导向下,开放直视手术准确切除肿瘤,ECoG监测定位致痫灶,IOM判断致痫灶与功能区的重叠程度,分别采取切除术、多处软膜下横切术(MST)或皮层低功率电凝热灼术处理致痫灶.总结分析患者的手术方法及疗效. 结果 本组肿瘤全切13例,次全切2例;瘤周致痫灶切除4例,瘤周致痫灶MST或/和皮层低功率电凝热灼术11例;术毕ECoG监测发现痫样放电消失、基本节律大致恢复正常6例,仍残留少量棘波6例,残存较多棘波且基本节律轻到中度异常3例;无严重永久性并发症;随访1～3年,肿瘤原位复发2例,Engel分级Ⅰ级10例,Ⅱ级3例,Ⅲ级2例,总有效率100％.结论 立体定向联合术中ECoG、IOM治疗功能区皮层下小肿瘤性癫痫,能够精准定位并切除肿瘤及处理致痫灶,避免损伤功能区,是一种微创、安全、有效的手术方法.     

Aqueductal stenosis 9 years after mumps meningoencephalitis: treatment by endoscopic third ventriculostomy

Introduction Hydrocephalus due to aqueductal stenosis following mumps meningoencephalitis is a rare condition, reported only in 16 cases in the literature. The pathogenetic role of the mumps virus in inducing aqueductal stenosis has been demonstrated experimentally in animal models and clinically proven in a few cases. Although obstructive in nature, the post-infectious etiology raises the question as to whether third ventriculostomy is the appropriate treatment.Patient We report a case of hydrocephalus due to pure aqueductal stenosis occurring in an 11-year-old boy who suffered from mumps meningoencephalitis 9 years previously. The boy was successfully treated by endoscopic third ventriculostomy.Conclusions The present case offers further evidence of the purely obstructive nature of the hydrocephalus induced by paramyxovirus meningoencephalitis, even if it did occur several years after the infectious disease. The pathogenesis of mumps-induced hydrocephalus and the rationale of treatment are discussed, and the literature is reviewed.     

Automated classification of neonatal sleep states using EEG

Objective

To develop a method for automated neonatal sleep state classification based on EEG that can be applied over a wide range of age.

术中肌电监测在累及第四脑室底肿瘤手术中的应用

目的探讨术中肌电监测在累及第四脑室底面肿瘤切除术中的应用及影响因素。方法南方医科大学南方医院神经外科自2007年1月至2010年12月在后组颅神经肌电监测下完成累及第四脑室底面肿瘤切除术32例,其中髓母细胞瘤11例,第四脑室室管膜瘤9例,脑干海绵状血管瘤6例,脑干起源外生性胶质瘤4例,脑干背侧血管网状细胞瘤2例。分析术中肌电监测对手术效果的影响及其干扰因素。 结果 本组肿瘤全切除21例,次全切除9例,大部切除2例;无后组脑神经功能障碍9例,轻度后组颅神经损伤18例,中度后组颅神经损伤5例,无严重损伤者。肌电监测结果的干扰因素主要包括双极电凝产生的外泻电流、肌松药物的过多使用、麻醉深度的改变、以及患者体温、冲洗盐水温度、血压急剧变化等。 结论术中肌电监测可以为累及第四脑底面肿瘤切除术中颅神经核团的位置及功能保护提供客观依据。     

同步视频监测侧方扩散反应在面肌痉挛手术中的应用

目的 探讨显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛术中应用同步视频监测侧方扩散反应(lateral spread response,LSR)的意义.方法 回顾性分析105例行MVD且术中实施同步视频LSR监测的面肌痉挛病人的临床资料.分别将依据术中LSR监测及同步视频...     

神经导航和神经电生理辅助下脑功能区肿瘤手术

目的 探讨脑功能区肿瘤治疗的策略和技巧.方法 分析2008年5月至2009年5月手术治疗的脑功能区41例肿瘤.使用神经导航和神经电生理辅助的有23例(辅助组),未使用18例(未辅助组).未辅助组直接行显微手术切除肿瘤.辅助组采用神经导航、皮层神经电刺激(MEP)、体感诱发电位(SEP)、术中唤醒麻醉等技术确定肿瘤和脑功能区,根据肿瘤和功能区的关系切除肿瘤.结果 未辅助组肿瘤全切4例(22%),3例(17%)次全切,11例(61%)大部切除.术后功能良好6例(33%),无变化2例(11%),10例(56%)功能障碍加重.辅助组肿瘤全切12例(52%),4例(17%)次全切,7例(31%)大部切除.术后功能良好16例(70%),无变化3例(13%),4例(17%)功能障碍加重.两组肿瘤全切率及术后功能障碍发生率差异有统计学意义(P<0.05).结论 在神经导航和神经电生理监测的辅助下,可以做到精确的病灶解剖和脑功能区定位,加上运用娴熟的显微手术技巧,脑功能区的肿瘤也能取得良好疗效.     

外伤性急性硬膜下血肿选择性非手术治疗体会

目的探讨急性硬膜下血肿选择性非手术治疗的适应证。方法回顾性分析近5年来保守治疗74例外伤性急性硬膜下血肿患者的临床资料。所有患者入院后即行持续颅内压监护,并根据颅内压的变化随时调整治疗方案。结果62例保守治疗,6例急诊开颅清除血肿,4例亚急性期血肿钻孔冲洗引流,2例慢性硬膜下血肿钻孔引流。结论除急诊手术外,部分急性硬膜下血肿患者在严密监护下,尤其在持续颅内压监护下,保守治疗或延期手术取得良好的效果。     

颅内压监测对重型颅脑创伤患者预后与疾病负担影响的队列研究

目的 了解颅内压(ICP)监测在重型颅脑创伤(TBI)患者中的应用情况及其对预后和经济负担的影响.方法 抽取上海市5家二级以上综合性医院在2009年1月至2011年1月间收治的重型TBI住院患者535例,按是否行ICP监测分为两组(ICP组和非ICP组),对比两组患者的病死率,急性期总住院费用,住院天数,寿命年费用及质量调整寿命年费用.结果 重型TBI患者行ICP监测的比例为28.0％.ICP组患者的住院病死率为16.7％,显著低于非ICP组患者的住院病死率32.2％(P＜0.001).多元Logistic回归分析显示行ICP监测的患者死亡风险仅为非ICP监测患者的0.32倍(95％ CI,0.19,0.54).重型颅脑创伤患者行ICP监测可使病死率下降15.5％,但平均多耗费住院费用69 620元(P＜0.001);行ICP监测的寿命年费用中位数为5 995元,显著高于未行ICP监测的寿命年费用中位数2 236元(P＜0.001);行ICP监测的质量调整寿命年费用中位数为11 558元,显著高于未行ICP监测的寿命年费用中位数3 938元(P＜0.001).结论 我国重型TBI行ICP监测的比例仍较低,重型TBI患者行ICP监测可能会增加经济负担,但却大大降低患者病死率.     

Quantitative evaluation of extracellular glutamate concentration in postischemic glutamate re-uptake, dependent on brain temperature, in the rat following severe global brain ischemia

Changes in brain temperature are known to modulate the marked neuronal damage caused by an approximately 10-min intra-ischemic period. Numerous studies have suggested that the extracellular glutamate concentration ([Glu](e)) in the intra-ischemic period and the initial postischemia period is strongly implicated in such damage. In this study, the effects of intra-ischemic brain temperature (32, 37, 39 degrees C) on [Glu](e) were investigated utilizing a dialysis electrode combined with ferrocene bovine serum albumin (BSA), which allows oxygen-independent real-time measurement of [Glu](e). This system allowed separate quantitative evaluation of intra-ischemic biphasic glutamate release from the neurotransmitter and metabolic pools, and of postischemic glutamate re-uptake in ischemia-reperfusion models. The biphasic [Glu](e) elevation in the intra-ischemic period did not differ markedly among intra-ischemic brain temperatures ranging from 32 to 39 degrees C. Intra-ischemic normothermia (37 degrees C) and mild hyperthermia (39 degrees C) markedly inhibited [Glu](e) re-uptake during the postischemic period, although the intra-ischemic [Glu](e) elevation did not differ from that during intra-ischemic hypothermia (32 degrees C). It was assumed that normothermia or mild hyperthermia in the intra-ischemic period influences intracellular functional abnormalities other than the intra-ischemic [Glu](e) elevation, thereby inhibiting glutamate re-uptake after reperfusion rather than directly modulating intra-ischemic [Glu](e) dynamics.