脑血管母细胞瘤的外科治疗(附38例报告)

目的总结、探讨脑血管母细胞瘤的外科治疗。方法对38例脑血管母细胞瘤的临床表现、手术治疗进行回顾分析。结果30例囊性肿瘤均行瘤结节全切除术;随防3～20年,未复发29例。8例实体性肿瘤中,4例先行血管内栓塞后行全切除术,另4例因术中大出血行大部分和部分切除;随访3～12年,全切除的4例未复发,非全切除者1例无变化,1例增大,2例死亡。结论囊性血管母细胞瘤外科治疗易做到全切除,疗效好。实体性血管网状细胞瘤外科治疗因血管丰富,可先行血管内栓塞,减少术中出血量,提高切除率。     

Whole-brain 3D perfusion MRI at 3.0 T using CASL with a separate labeling coil.

A variety of continuous and pulsed arterial spin labeling (ASL) perfusion MRI techniques have been demonstrated in recent years. One of the reasons these methods are still not routinely used is the limited extent of the imaging region. Of the ASL methods proposed to date, continuous ASL (CASL) with a separate labeling coil is particularly attractive for whole-brain studies at high fields. This approach can provide an increased signal-to-noise ratio (SNR) in perfusion images because there are no magnetization transfer (MT) effects, and lessen concerns regarding RF power deposition at high field because it uses a local labeling coil. In this work, we demonstrate CASL whole-brain quantitative perfusion imaging at 3.0 T using a combination of strategies: 3D volume acquisition, background tissue signal suppression, and a separate labeling coil. The results show that this approach can be used to acquire perfusion images in all brain regions with good sensitivity. Further, it is shown that the method can be performed safely on humans without exceeding the current RF power deposition limits. The current method can be extended to higher fields, and further improved by the use of multiple receiver coils and parallel imaging techniques to reduce scan time or provide increased resolution.     

术前选择性血管栓塞减少脊柱转移瘤术中出血

目的:改变脊柱转移瘤治疗长期以来采用的姑息、保守的治疗方法。手术切除脊柱肿瘤后,给予坚强的内固定,辅以术后放化疗,可延长病人的生命,使病人无痛生存,提高了病人的生活质量。但由于脊柱转移瘤切除术中出血异常多,使手术切除肿瘤椎管减压内固定较难进行,为解决这一问题我们于1991年始用下述方法治疗脊柱转移瘤。方法:应用术前选择性脊柱血管栓塞,肿瘤切除椎管减压,内固定器材固定治疗脊柱转移瘤16例,取得了满意的效果。16例病人均为胸腰段转移瘤,均在术前48h行相应脊柱血管,胸段选择相应肋间动脉,腰段选择相应腰动脉进行栓塞,然后行胸段、胸腰段、腰段前路或后路肿瘤切除,椎管减压、内固定术。结果:16例病人术中出血平均900ml,出血量最少者仅600ml,出血量较未行血管栓塞病例明显减少,术野更为清晰、使术者更易操作;术后病人脊髓及神经根受压症状明显减轻,16例脊髓及脊神经根受压症状明显减轻,16例病人中8例脊髓及脊神经受压症状完全解除。结论:术前脊柱血管栓塞,手术切除肿瘤椎管减压内固定明显减少了术中出血、降低了手术风险、缩短了手术时间,是治疗脊柱转移瘤的安全有效的方法。     

经皮血管内栓塞颅内动静脉畸形（附38例治疗效果观察）

经皮血管内采用氰基丙烯酸异丁脂（ＩＢＣＡ）栓塞治疗３８例颅内动静脉畸形（ＡＶＭ）病人。其中８例达到１００％完全栓塞，栓塞面积大于７５％的１０例，大于５０％者１１例；余下９例栓塞面积小于５０％，１９例以出血为首发症状，１１例以癫痫为首发症状，６例神经功能障碍，２例以头痛为主要症状。栓塞术后发生并发症５例，占１３％，无死亡病例。本文讨论了超选插管技术问题、Ａｍｙｔａｌ试验假阴性、导管粘连及正常灌注压突破。     

介入神经放射治疗43例

１９８５～１９９３年对４３例脑血管病及脑肿瘤患者应用介入神经放射治疗方法进行了５１次治疗，包括外伤性颈内动脉海绵窦瘘的球囊栓塞治疗８例；脑、脊髓血管畸形的栓塞治疗１７例；各种脑肿瘤术前栓塞７例；经皮穿刺血管内成型治疗脑供血动脉狭窄３例和脑胶质瘤超选择化疗８例，效果良好，介入神经放射治疗已成为重要的临床治疗手段，是某些脑血管疾病的首选治疗方法。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

眶骨的改变在眶部疾病HR-MRI诊断中的作用

目的:探讨眶骨的影像学所见及其在眶部疾病诊断中的作用。方法:回顾性分析诊断明确的眶部疾病80例的HR-MRI影像表现。80例中良性囊肿18例，外伤6例，炎性疾病6例，蝶骨嵴脑膜瘤9例，其他肿瘤41例。磁共振扫描采用1．5T GE Signa及Siemens Magnetom Sp63磁共振扫描机，用眶部表面线圈，SE系列常规轴位、冠状位及矢状位扫描，部分病例行脂肪抑制及增强扫描。结果：正常眶骨的HR-MRI表现为结构完整，边缘光整，皮质骨在T1WI及。T2WI上均为无信号区。15例眶骨受压迫性改变全见于良性囊肿的病例，骨质增生改变主要见于蝶骨脑膜瘤，2例骨折见于外伤病例，21例骨质破坏大多见于不同的恶性肿瘤病变中。结论：不同的眶部病变对眶骨的影响有差异，良性囊肿主要表现为眶骨受压迫性改变，蝶骨脑膜瘤多表现为骨质增生，外伤病例伴有眶骨骨折，恶性肿瘤病例常伴有眶骨的破坏。眶骨的改变对眶部疾病HR-MRI的诊断和鉴别诊断有重要作用。     

颅内后循环远端动脉瘤的介入治疗

目的回顾性分析20例以电熔断解脱弹簧圈栓塞的后循环远端动脉瘤的治疗结果,探讨颅内动脉后循环远端动脉瘤的介入治疗方法与安全性。方法20例患者(其中18例以自发性蛛网膜下腔出血起病,2例以头痛起病)经造影证实大脑后动脉、小脑上动脉、小脑前下动脉、小脑后下动脉之远端动脉瘤分别为2例、4例、4例、10例。其中小脑上动脉供血之动静脉畸形1例,伴有血流相关破裂动脉瘤。小脑后下动脉远端多发动脉瘤1例。所有动脉瘤均采用GDC、EDC或Matrix弹簧圈栓塞。其中单纯栓塞动脉瘤2例;栓塞动脉瘤同时栓塞载瘤动脉18例。结果所有病例栓塞操作均顺利完成,无手术相关的死亡,术后出现一过性功能障碍2例;载瘤动脉栓塞后多数可见侧支供血,未见叫显的小脑供血减少。结论后循环远端动脉瘤由于动脉瘤特性、载瘤动脉细小、动脉瘤与载瘤动脉比例等因素,多需要闭塞载瘤动脉。为避免可能造成的侧支血管的闭塞,建议用弹簧圈栓塞。     

部分性脾栓塞术的临床应用：——附37例报告

应用部分脾栓塞术(PSE)治疗难治性原发性血小板减少性紫癜27例,血栓性血小板减少性紫癜1例;难治性再生障碍性贫血2例;Evan's 综合症2例;系统性红斑狼疮合并血小板减少性紫癜2例;继发性脾亢3例.获完全缓解者24例(64.9%);部分缓解者8例(21.6%),总有效率为86.S%.24例获完全缓解者18例追踪1年,6例复发,复发率为33.3%.与25例切脾对照组及文献报道比较,差异无显著性(P>0.05).本文对 PSE 术后外周血小板的变化进行讨论,并与脾切除作了对比。本文还对血小板破坏场、栓塞范围和方法等影响疗效的因素进行了探讨.作者认为 PSE 术可作为脾切除的替代术.     

微导管真丝线段血管内栓塞治疗脑动静脉畸形（附7例报告）

应用国产真丝线段行血管内栓塞治疗７例脑动静脉畸形（ＡＶＭ）。结果：１例术中畸形血管破裂出血死亡，１例出现半身麻木，肢体轻瘫，经治疗短期内恢复。余病例症状明显缓解或消失。此栓塞材料为永久性，较安全，效果好，并发症少。