显微手术治疗颅内蛛网膜囊肿

目的：探讨颅内蛛网膜囊肿的诊断及最佳治疗方案。方法：５０便均根据头颅ＣＴ和ＭＲ 诊蛛网膜囊肿后,行显微手术切除。结果：５０便手术治疗后,恢复良好,临床症状全部消失。结论：充分建立囊腔与周围池之间的 显向手术切除蛛网膜囊肿成功的关键。     

颅颌面联合手术治疗前颅底区肿瘤

目的 探讨前颅底肿瘤手术及术后颅底组织缺损修复方法。方法 对１９９２～１９９９年间我院收治的３５例患者的手术方法、手术效果、并发症、生存率、修复材料和方法等进行了回顾性分析。结果 本组并发症的发生率为１４．２９％（５／３５例）,３５例中良性肿瘤共１１例,１例死于术后脑水肿伴全身,余了０例随访７年皆健在。２４例恶性肿瘤患者的３年和５年生存率（按生命表法计算）分别为５８．０７％和３６．２９％。结论 采     

重型颅脑损伤66例死因分析

回顾分析２３６例重型颅脑损伤患者中６６例死亡病人的临床资料,结果显示,受伤原因中车祸伤占４５．８％,堕落伤占２４．２％,跌伤占１８．１％,ＣＴ扫描见脑挫裂伤并颅内血肿占６３．６％,单纯脑挫裂伤和颅内血肿各占９．０％,２７．３％。采用亚低温加常规综合治疗后死亡率仅为１８．２％,而非亚低温加常规综合治疗死亡率为２９．２％。     

Review of skull base surgery approaches: With special reference to pediatric patients

Summary The techniques of skull base surgery attempt to maximize the exposure of a cranial base lesion while using the least amount of brain retraction. Cranial base surgery is not a new area of neurosurgical or otolaryngologic interest, but instead represents a resurgence of efforts to treat difficult lesions involving the cranial base. This resurgence of interest and effort is a product of recent advances in microanatomical knowledge of the cranial base, advances in microsurgical technique, improved neurophysiologic monitoring, and improved collaborative relationships between neurosurgery, otolaryngology and plastic surgery. Furthermore, improved neuroanesthetic techniques allow the surgeon to proceed with surgery without undue concern about time, and improved neuroimaging techniques provide the surgeon with detailed knowledge of the three dimensional characteristics of the tumor and surrounding structures [1].This review will focus on the surgical management of cranial base tumors primarily affecting the pediatric population.Little has been written on the techniques of skull base surgery as they apply to the pediatric population, since cranially-based tumors are a relatively rare occurrence in this patient population. In most instances, however, many of the 'standard' skull base approaches can be applied to the pediatric patient with few modifications, and in our experience, the pediatric patients have tolerated these approaches as well as their adult counterparts.     

An unusual cause of depressed skull fracture: case report

BACKGROUND: Camel collision accidents are a common occurrence in Saudi Arabia, with a high rate of mortality and morbidity. Isolated injuries are rare because of the nature of impact sustained by the person. CASE DESCRIPTION: A 4-year-old child with an isolated depressed skull fracture resulting from a camel collision is described. The other occupants of the car were crushed to death. The child sustained only an impact to his head, causing a compound depressed skull fracture with localized cortical damage. CONCLUSIONS: Camel collision accidents are a common cause of mortality and morbidity in Saudi Arabia. Isolated skull injuries are rare and result from a localized impact. This is the first report of a compound depressed skull fracture from such an incident. The extent of the problem and efforts toward prevention are described.     

Osteoplastic frontal sinusotomy and extradural microsurgical repair of frontobasal cerebrospinal fluid fistulas

Summary The choice of the surgical approach and operative technique for the management of cerebrospinal fluid (CSF) fistulas of the anterior cranial fossa are still a controversially discussed topic. Although extracranial approaches through the paranasal sinuses are becoming increasingly more popular among otolaryngologists and maxillo-facial surgeons, most neurosurgeons traditionally prefer the intracranial repair of CSF fistulas by a craniotomy.We present an approach through the frontal sinus for the repair of dural defects behind the posterior wall of the frontal sinus and at the floor of the anterior cranial fossa. The operative procedure comprises the following main steps: 1) exposure of the anterior wall of the frontal sinus by a bicoronal incision; 2) excision of the anterior wall without frontal burr holes; 3) bilateral removal of the posterior wall of the fronal sinus; 4) extradural inspection of the dura behind the frontal sinus and above the cribriform plate, ethmoidal roof, and orbital roof bilaterally; 5) closure of dural tears by direct suture and a periosteal graft; 6) reinsertion of the anterior wall of the frontal sinus and fixation with titanium micro plates.Twenty-five patients operated upon using this technique are described. The aetiology of the frontobasal lesion was traumatic in 23, and an ethmoid carcinoma in two. In all patients, the dural fistulas were successfully repaired during the initial procedure. One patient died from sudden circulatory arrest after an uneventful postoperative course of nine days. Otherwise, there were no postoperative complications.This technique affords atraumatic extradural inspection and repair of dural fistulas bilaterally behind the frontal sinus, and above the cribriform plate and the ethmoidal and orbital roofs with none or minimal brain retraction. It therefore allows early repair of CSF fistulas also in patients with severe brain injury. Although we consider the extradural closure of fistulas the method of choice, this approach also allows for a combined extradural-intradural procedure, thus enabling the surgeon to treat associated intradural pathologies, such as traumatic lesions or tumours of the frontal cranial base.     

手十二井穴刺络放血对中风患者意识状态、心率等影响的临床观察

目的：观察手十二井穴刺络放血对中风初期患者意识状态等的影响。方法：以中风发病后3d有意识障碍的患者为观察对象，按病情分为损伤大面积、中面积、小面积3组，每组随机分为刺络组与对照组， 刺络组和对照组均进行正常治疗，仅刺络组增加井穴刺络放血。将意识状态进行量化，观察患者意识状态、血压、心率等的变化。结果：手十二井穴刺络放血可使损伤面积小的患者意识状态好转；收缩期血压上升；可使各组患者的心率加快。结论：手十二井穴刺络放血可使损伤面积小的患者意识状态好转。     

腰穿置管稳压引流治疗蛛网膜下腔出血后脑积水

目的探讨蛛网膜下腔出血(SAH)后脑积水简便、安全、有效的治疗方法。方法所收治的283例SAH病人中有90例发生了急性脑积水,在内科治疗基础上,其中46例进行了腰穿置管稳压引流治疗结果与无脑积水者对照比较。结果上法治疗后32例(32/46,70%)意识水平均有所改善;所有受治病人12d内再出血和脑缺血的发生率与无脑积水的病人组无显著性差异〔5/46(11%),24/193(12%);16/46(35%)60/193(31%)。P>0.05〕。治疗组未发生脑室炎或脑膜炎。结论腰穿置管稳压引流是一种治疗SAH后脑积水简便、安全、有效的方法。     

纤维喉镜下气管食管穿刺术及Provox发音钮植入的体会

目的 探讨采用纤维喉镜监察替代硬管食管镜或颈外径路进行气管食管穿刺及植入Provox发音钮的效果。方法 本文引述2例在纤维喉镜下进行二期气管食管穿刺术，2例分别在全麻及局麻下进行，植入Provox发音钮后，再以纤维喉镜检定位置。结果 2例术后能实时使用Provox发音钮发声，音色响亮清澈，并无不良反应。结论 纤维喉镜监察下进行气管食管穿刺术，准确性高，手术创伤小，对因手术或放疗引起颈项不能后仰的病人特别有利。