垂体窝及其毗邻结构手术相关显微解剖学研究

目的为临床神经外科提供鞍区,尤其是垂体窝边界及其毗邻结构的解剖参数与观察研究。方法用20例汉族成人尸头湿标本、漂白干颅骨15例进行精确显微解剖测量、观察及拍照。结果两前床突间距为(25.2±0.58)mm(20.3～30.0mm);前后床突间距(12.5±1.21)mm(8.1～17.5mm);两后床突间距(12.8±0.87)mm(8.0～17.0mm)。颈内动脉内侧缘与垂体外侧缘间距为(3.8±1.25)mm(2.3～7.1mm)。海绵窦内侧壁为垂体硬膜囊袋的一部分。正常情况下约有20%的垂体侧面向其外侧的海绵窦膨出。结论该显微解剖学研究提供了垂体区的重要解剖参数及其重要毗邻间隙与结构,为临床鞍区肿瘤、尤其是垂体瘤及海绵窦肿瘤的术前诊断、入路选择提供参考。     

Delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan

OBJECTIVE: To evaluate delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan. BACKGROUND: The safety of the use of drugs for migraine during pregnancy is not established. Design and METHODS: Using the Swedish Medical Birth Registry which contains information on drug use reported by women at the first antenatal visit, 912 infants (born in 905 deliveries) whose mothers had used drugs for migraine were identified, the majority of whom (n = 658) had used sumatriptan. RESULTS: These women differed from the general population of women who had delivered by being older and more often of first parity, but they had similar smoking habits. Slightly more often, the infants were preterm, and they had a birth weight less than 2500 g; neither of these effects were statistically significant. There seemed to be no difference between infants exposed to sumatriptan and those exposed to other drugs used for migraine. No increase in the rate of congenital malformations was seen. CONCLUSIONS: The data indicate that use of sumatriptan in early pregnancy does not result in a large increase in teratogenic risk, but do not rule out the possibility of a moderate increase in risk for a specific birth defect.     

液氮冷冻治疗婴幼儿唇黏膜静脉畸形的效果观察

目的 探讨液氮冷冻治疗婴幼儿唇黏膜静脉畸形的效果. 方法 57例唇黏膜静脉畸形患儿采用液氮冷冻治疗. 男35例,女22例,平均年龄7. 4个月. 术前、术后及每次复诊拍照记录,对治疗结果进行评估. 结果 随访2~16个月,71. 9%(41/57)完全有效,19. 3%(11/57)明显有效,8. 8%(5/57)部分有效. 所有病例均未出现严重并发症. 结论 液氮冷冻治疗唇黏膜静脉畸形安全、有效.     

Hybrid operation for arteriovenous malformations with associated multiple intracranial aneurysms and subarachnoid hemorrhage: Case report

Rationale:The hybrid surgical concept for the treatment of brain arteriovenous malformations (AVMs) with associated intracranial aneurysms (IAs) is still not widely practiced. Concomitant occurrence of AVMs with IAs is common. Subarachnoid hemorrhage (SAH) as a result of AVM or IA rupture is often associated with these dual pathological phenomena. We present a case of concomitant occurrence of AVMs and IAs that was successfully treated using the hybrid operation concept.Patient concerns:A 62-year-old man presented with sudden onset of severe headache, dizziness, nausea, and vomiting for 4 hours.Diagnosis:Computed tomography revealed SAH and a hematoma in the right frontal lobe. A computed tomographic angiogram also revealed a right frontal AVM with 3 IAs.Interventions:We used a hybrid operating room to successfully treat both AVMs and IAs.Outcomes:Two years of follow-up showed that the patients were well and performed their daily duties.Lessons:The hybrid operating room is an innovative, safe, and effective method for the treatment of AVMs with associated IAs, particularly high-grade AVMs and IAs with hemorrhage or SAH. Patients with concomitant AVMs and IAs have the highest chance of hemorrhage compared with those with AVM or IAs alone.     

垂体腺瘤侵袭海绵窦的MRI判定标准

目的:探讨垂体腺瘤侵袭海绵窦的MRI影像学判定标准.方法:以140例垂体腺瘤为研究对象,根据手术中判定的垂体腺瘤对海绵窦的侵袭结果为金标准,对比分析它们的MRI影像学表现,通过计算各项观测指标的灵敏度(Sen),特异度(Spe),阳性预报值(PPV)和阴性预报值(NPV),来确定侵袭性垂体腺瘤侵袭海绵窦的MRI影像学判定标准.结果:①肿瘤和海绵窦之间存在正常垂体者NPV为100%;②肿瘤未超过ICA内侧壁切线者NPV为100%,而肿瘤超过ICA外侧壁切线者PPV为100%;③海绵窦内侧静脉丛间隙存在者NPV为100%,而海绵窦外侧静脉丛间隙消失和≥3个海绵窦静脉丛间隙消失者PPV均为100%;④海绵窦内颈内动脉被肿瘤包绕在25% 以下者NPV为100%,而包绕在50% 以上者PPV为100%.结论:垂体腺瘤侵袭海绵窦的MRI影像学表现为:①肿瘤超过ICA外侧壁切线;②海绵窦外侧静脉丛间隙消失;③≥3个海绵窦静脉丛间隙消失;④窦内ICA被包绕≥50%.     

肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

目的 探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的疗效和安全性.方法 前瞻性研究9例少血供性肝海绵状血管瘤患者经肝动脉栓塞结合经皮经肝瘤体内药物注射治疗情况.对于CT/MRI明确诊断的肝海绵状血管瘤(直径＞5 cm),且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此表现的9例患者,先行肝动脉插管栓塞术,栓塞剂为超液化碘油(10 m1)与博莱霉素(8 mg)混悬剂,实际用量为5～10 ml.栓塞后4 d开始行经皮经肝瘤体内穿刺多点注射博莱霉素8～16 mg,间隔3～4 d再次注射,连续2～3次,1个月后复查CT,以后3、6个月及1年不定期复查CT.结果 9例患者DSA上所见血管瘤染色与CT增强扫描表现一致,碘油沉积呈散在点状分布,治疗后1个月瘤体均明显缩小,以后继续缩小,1年后复查基本稳定不再缩小.2例患者出现急性胆囊炎,对症处理后痊愈.1例出现栓塞后胆汁瘤,随访观察未进一步进展,未作特殊处理.结论 经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法 .     

Proton magnetic resonance spectroscopy in disturbances of cortical development

Proton magnetic resonance spectroscopy(¹H-MRS) can be used for looking at cerebral metabolites in vivo. However, measurement of concentrations of cerebral metabolites in patients with disturbances of cerebral development have not been successful. Our purpose was to measure the concentrations of cerebral metabolites in such patients. We carried out quantitative ¹H-MRS in eight patients with cortical dysplasia, four with lissencephaly and three with heterotopic grey matter and six age-matched normal controls. Regions of interest for ¹H-MRS were set over the affected cortex in the patients and the occipital cortex in controls. The calculated concentration of N-acetylaspartate ([NAA]) was significantly lower in the affected cortex in patients with cortical dysplasia (P < 0.05), lissencephaly (P < 0.01), and heterotopia (P < 0.05) than in controls, idnicating a decreased number and/or immaturity or dysfunction of neurones in the affected cortex. The concentration of choline ([Cho]) was significantly lower in patients with lissencephaly (P < 0.01) than in controls, indicating glial proliferation and/or membrane abnormality. Received: 19 April 2000 Accepted: 30 May 2000     

门静脉海绵样变的手术治疗

目的 探讨门静脉海绵样变的手术治疗方式。方法 对9例门静脉海绵样变患者的14次手术方式进行回顾分析。结果 1例患者剖腹探查无法手术，其余13次手术中，分流手术5次，断流手术8次，对于再出血时间的对比分析，断流手术发生再出血时间长，并与断流的彻底性有关。结论 对于门静脉海绵样变的手术方式以彻底的断流术为佳，最好行贲门周围血管离断 食道下段 胃底切除再吻合术。     

MR引导下经皮硬化治疗低流速血管畸形

低流速血管畸形治疗非常困难,经皮硬化治疗是目前推荐度较高的治疗方法。由于软组织MRI分辨率高,能进行多平面成像,使得MRI作为引导手段的硬化治疗应用于低流速血管畸形,更加具有优势。     

Primary amenorrhea secondary to imperforate hymen

Hymen imperforation is uncommon. Symptoms include primary amenorrhea, cyclical lower abdominal pain, and rarely a pelvic mass syndrome. Delayed discovery may lead to endometriosis and infertility. Pelvic ultrasound and nuclear magnetic resonance detect associated genito‐urinary malformations. Hymenectomy is the standard surgical treatment.