线锯穿过眶下裂行额颞眶颧开颅技术

目的额颞眶颧开颅应用广泛且有诸多变异。其中，由颧结节指向眶下裂方向的这一重要而必不可少切割已引起神经外科医师的关注。许多学者对颧面孔在精确定位眶下裂方面的实用价值也有若干评价，最近其可靠性又受到质疑。本研究的目的即是对用线锯代替摆锯完成切割这一新的技术要点的可行性进行评价。方法颅骨标本19个（38侧）用以模拟术中线锯从眶内经眶下裂穿出，并沿眶下裂-颧上颌缝方向切割的技术动作，而后将这一简捷有效的操作技术用于5例患者。其中三叉神经鞘瘤1例，同时累及前中颅底的（蝶骨嵴）脑膜瘤3例，累及左侧蝶骨大小翼、蝶骨体和翼突的骨纤维结构不良1例。结果临床实践证实，眶下裂可以在眶内充分暴露，而眶筋膜可基本完整或轻度撕裂仅需缝合数针；线锯穿过眶下裂基本无困难，切割效果满意。三叉神经鞘瘤、骨纤维结构不良和3例中的2例脑膜瘤予以全切除，另1例脑膜瘤予以近全切除。结论用线锯完成颧结节与眶下裂之间的切割过程是眶颧开颅中一种非常简捷实用的技术改良。     

小骨窗开颅术与骨瓣开颅术治疗高血压脑出血疗效比较

目的对小骨窗开颅术与骨瓣开颅术治疗高血压脑出血的疗效进行比较。 方法将从化市中心医院自2008年6月至2010年6月收治的56例高血压脑出血患者按随机数字表法分人观察组（行小骨窗开颅术,28例）与对照组（行骨瓣开颅术，28例），比较两组患者手术时间、住院时间、住院期间病死率、再出血发生率、并发症发生率及治疗后半年GOS评分。 结果观察组手术时间及住院时间明显短于对照组，差异有统计学意义(P＜0.05)；观察组与对照组住院期间病死率分别为14.3％、25.0％，差异无统计学意义(P＜0.05)；观察组与对照组并发症发生率分别为25.0％、46.4％,差异无统计学意义(P＜0.05)；观察组治疗半年后GOS评估预后明显优于对照组，差异有统计学意义(P＜0.05)；观察组与对照组再出血发生率分别为10.7％、14.3％，差异无统计学意义（P＞0.05）。结论与骨瓣开颅术相比，小骨窗开颅术治疗高血压脑出血能明显降低病死率及并发症发生率，改善患者预后。     

去大骨瓣开颅术的临床应用

目的探讨去大骨瓣开颅术治疗重型颅脑损伤的效果。方法对37例重型颅脑损伤合并脑疝患者采用去大骨瓣开颅术进行治疗,按格拉斯哥预后评分法观察手术疗效。结果恢复良好18例,中残4例,重残6例,植物样生存3例,死亡6例。结论去大骨瓣开颅术是治疗重型颅脑损伤的有效方法。     

微创和开颅减压术后"脑减压性损害"的CT表现与发病机制探讨

目的 探讨微创和开颅减压术后脑减压性损害的CT表现.方法 回顾分析经微创和开颅减压术治疗颅内血肿56例,其中术后并发脑减压性损害6例,分析其CT表现.结果 6例病人CT表现为血肿再发2例,硬膜下积气6例,硬膜下出血3例,脑水肿2例.结论 CT是诊断脑减压性损害的首选方法.     

标准大骨瓣减压并颞肌贴敷术防治重型颅脑外伤术后脑梗死

目的:探讨外伤标准大骨瓣减压并脑组织表面颞肌贴敷术防治重型颅脑外伤术后脑梗死患者的效果。方法:32例重型颅脑外伤患者采用外伤标准大骨瓣减压并脑组织表面颞肌贴敷术治疗,25例行常规区域性开颅手术并比较其效果。结果:在中线回复、患者死亡率、致残率三方面,标准手术组优于常规手术组,但痊愈率差异无显著性。结论:标准大骨瓣减压并颞肌贴敷术可减轻术后脑梗死,降低重型颅脑外伤患者的死亡率及致残率,改善预后。     

重症高血压脑出血治疗方法的探讨

目的探讨对重症高血压性基底节区脑出血更合适的手术方式。方法对出血量50ml以上的高血压性基底节区脑出血患者126例,随机分为3组,分别用穿刺引流术﹙A组﹚、开颅血肿清除术﹙B组﹚及穿刺引流加开颅血肿清除术﹙C组﹚三种手术方式进行治疗,对比3组疗效。结果总有效率A、B、C3组分别为41.46﹪、55.81﹪、85.71﹪,A、B2组之间差异无显著性(P>0.05),C组与A组、C组与B组之间差异均有显著性(P<0.01);病死率A、B、C3组分别为36.59﹪、18.60﹪、9.52﹪,A组与B组、B组与C组、A组与C组之间差异均有显著性﹙P<0.01)。结论重症高血压性基底节区脑出血更适合于用穿刺引流加开颅血肿清除术治疗。     

标准大骨瓣减压术治疗大面积脑梗死临床体会

目的 探讨标准大骨瓣减压术治疗大面积脑梗死两种不同方法的疗效以及影响其疗效的因素。方法 对大面积脑梗死患者随机分组部分行标准大骨瓣减压颞肌黏覆术，另一部分行标准大骨瓣减压硬膜扩大减张缝合术，术后分析其疗效，并分析GCS评分和梗死面积同患者疗效的关系。结果 35例中是否行颞肌黏覆术对其疗效无明显差别，GCS评分低，梗死面积大的患者疗效差。结论 标准大骨瓣减压术是治疗大面积脑梗死的有效方法，硬膜扩大减张缝合术优于颞肌黏覆术，判断大面积脑梗死术后疗效基本因素为患者术前GCS评分和梗死范围。     

神经外科颅内感染危险因素的病例对照研究

目的回顾分析神经外科颅脑手术后发生颅内感染的危险因素，为临床预防和控制颅内感染提供依据。方法对2006年1-8月神经外科颅脑手术后38例发生颅内感染和68例未发生颅内感染病例的一般资料、基础疾病、主要诊断、手术情况、抗菌药物应用情况、侵入性操作、住院时间及手术人员等因素进行统计分析。结果单因素分析结果显示，两组病例在主要诊断、手术入路方式、入住重症监护室、手术持续时间、住院时间、留置导尿、H2受体阻滞剂（包括质子泵抑制剂）应用、手术人员等方面有统计学差异（均P＜0.05）；进一步通过多因素Logistic回归分析发现，手术持续时间和手术人员是颅脑手术后发生颅内感染的独立危险因素。结论颅脑手术后发生颅内感染与手术持续时间和手术人员的手术技巧及其无菌观念有关。     

Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy

Background. Levobupivacaine is an effective local anaestheticagent for nerve blockade with less systemic toxicity than racemicbupivacaine. The safety and efficacy of levobupivacaine forscalp blockade during awake craniotomy have not been addressedpreviously. Methods. Serial arterial plasma levobupivacaine concentrationsfollowing scalp blockade were measured to 2 h in 10 patientsbooked for awake craniotomy for epilepsy or tumour surgery.Bilateral scalp blockade providing surgical anaesthesia wasachieved with a mean dose of 177 mg (2.5 mg kg^–1, range1.6–3.2 mg kg^–1) of levobupivacaine (0.5%, 5 mgml^–1) with epinephrine (5 µg ml^–1) added immediatelybefore the block insertion. Results. The maximum measured plasma levobupivacaine concentrationwas 1.58 (0.44) µg ml^–1 [mean (SD)] with a meantime to peak plasma concentration of 12 (4) min. There wereno episodes in any of the 10 patients of symptoms or signs suggestiveof either CNS or CVS toxicity. Conclusions. This study demonstrated a relatively rapid riseof plasma levobupivacaine concentration without evidence ofcardiovascular or central nervous system sequelae in a samplepopulation of patients who may be particularly prone to perioperativeseizures.     

Comparison of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery

Background. Propofol and sevoflurane are suitable agents formaintenance of anaesthesia during neurosurgical procedures.We have prospectively compared these agents in combination withthe short-acting opioid, remifentanil. Methods. Fifty unpremedicated patients undergoing elective craniotomyreceived remifentanil 1 µg kg^–1 followed by an infusioncommencing at 0.5 µg kg^–1 min^–1 reducing to0.25 µg kg^–1 min^–1 after craniotomy. Anaesthesiawas induced with propofol, and maintained with either a target-controlledinfusion of propofol, minimum target 2 µg ml^–1 orsevoflurane, initial concentration 2%_ET. Episodes of mean arterialpressure (MAP) more than 100 mm Hg or less than 60 mm Hg formore than 1 min were defined as hypertensive or hypotensiveevents, respectively. A surgical assessment of operating conditionsand times to spontaneous respiration, extubation, obey commandsand eye opening were recorded. Drug acquisition costs were calculated. Results. Twenty-four and twenty-six patients were assigned topropofol (Group P) and sevoflurane anaesthesia (Group S), respectively.The number of hypertensive events was comparable, whilst morehypotensive events were observed in Group S than in Group P(P=0.053, chi-squared test). As rescue therapy, more labetolol[45 (33) vs 76 (58) mg, P=0.073] and ephedrine [4.80 (2.21)vs 9.78 (5.59) mg, P=0.020] were used in Group S. Between groupdifferences in recovery times were small and clinically unimportant.The combined hourly acquisition costs of hypnotic, analgesic,and vasoactive drugs appeared to be lower in patients maintainedwith sevoflurane than with propofol. Conclusion. Propofol/remifentanil and sevoflurane/remifentanilboth provided satisfactory anaesthesia for intracranial surgery.