血管内介入治疗椎动脉颅内段夹层动脉瘤

目的 探讨血管内介入治疗椎动脉颅内段夹层动脉瘤(IVADA)的疗效.方法 回顾性分析2015年1月至2018年12月采用血管内介入技术治疗的24例IVADA的临床资料.结果 23例为单侧椎动脉夹层动脉瘤,1例为双侧椎动脉夹层动脉瘤.25枚夹层动脉瘤中,支架辅助弹簧圈栓塞18枚,单纯双支架治疗2枚,闭塞夹层动脉瘤及载瘤动...     

急性破裂性颅内动脉瘤血管内治疗的围手术期处理

目的：探讨急性破裂性颅内动脉瘤血管内治疗的围手术期处理。方法：对72例行血管内治疗的急性破裂性动脉瘤患者的围手术期处理进行回顾性分析。结果：动脉瘤腔闭塞100％的30个，闭塞95％的36个，90％的10个；1例栓塞术后早期再出血，再行开颅动脉瘤夹闭术；患者出院时按格拉斯哥预后评分分级：I级15例，Ⅱ级48例，Ⅲ级4例，V级3例。结论：术前主要防止要出血及严重脑血管痉挛，术后主要防治继发的神经功能损伤及改善症状，正确合理的围手术期处理是降低动脉瘤围手术期严重并发症、提高手术治愈率的关键。     

Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Objective To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS). Design Clinical, controlled, prospective study. Setting Department of intensive care of a tertiary care academic hospital. Patients Forty acute neurological patients with hyponatremia suggesting SIADH or CSWS (20) or with normonatremia (20). Interventions None. Measurements and main results Measurement of clinical and biological variables. Measurement of blood, plasma, and red blood cell volumes to discriminate SIADH and CSWS. Renal, adrenal and thyroid functions were normal in all patients. Average blood, plasma, and red blood cell volumes were 54, 37 and 17 ml/kg in control patients and 54, 37 and 18 ml/kg in hyponatremic patients, respectively. Conclusions The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

持续颅内压监测在神经外科ICU的应用与护理

目的总结神经外科ICU 10例行持续颅内压监测患者的护理方法;方法10例患者均在术中在测脑室放置专用的脑室外引流管,连接压力转换器,接监护仪进行动态持续监测颅内压;结果经过持续监测颅内压,能准确及时为医疗提供诊治依据及减轻护士工作压力,在病人病情变化前作出相应处理,对提高医护质量起到重要作用;结论持续监测颅内压的同时需结合患者的意识、瞳孔、四肢肌力及生命体征变化进行综合判断。     

Mixed germ cell tumor of the pineal gland in a pediatric patient

Tumors of the pineal region are a rare clinical entity, comprising approximately 3%-8% of pediatric tumors. Based on their histopathological features, they are typically classified as pineal parenchymal tumors and germ cell tumors, with the latter being more prevalent. Clinical presentation is heterogeneous, with symptoms arising either due to tumor invasion or compression of adjacent neurovascular structures and increased intracranial pressure. Imaging studies are paramount in evaluating pineal region lesions and establishing an accurate diagnosis, with MRI representing the gold standard. Herein, we present the case of a 16-year-old boy presented with recurrent headaches. A head MRI revealed a pineal gland lesion. Histopathological examination confirmed the diagnosis, and the patient underwent a successful gross total resection (GTR) of the tumor. This case report seeks to draw attention to the elusive clinical presentation and management of this infrequently encountered tumor, as well as emphasize the importance of considering pineal gland tumors in the differential diagnosis of recurrent, chronic headaches in pediatric patients.     

新生儿颅内出血90例观察与护理

目的:探讨新生儿颅内出血(ICH)患儿的护理方法及其效果.方法:对90例新生儿颅内出血患儿进行回顾性分析,总结其护理方法及效果.结果:本组90例,治愈78例(86.7%),死亡12例(13.3%).对治愈的78例随访3个月,70例(89.7%)精神、发育、运动、智力正常.结论:认真观察新生儿颅内出血患儿的生命体征、有无惊厥、意识和精神状态、囟门、摄入情况,采取吸氧并保持呼吸道通畅、降低颅内压、保持正常体温、营养支持、并发症的治疗等治疗护理措施,可提高ICH的治愈率,降低后遗症的发生率与病死率.     

尼莫地平合用生脉注射液治疗早产儿颅内出血的临床疗效观察

目的：探讨尼莫地平合用生脉注射液治疗早产儿颅内出血的临床疗效。 方法： 138例患儿随机分为对照组（n=60）和治疗组（n=78）, 治疗组在治疗早产儿各项并发症的基础上加用尼莫地平和生脉注射液,动态观察其有效率、存活率,脑积水、脑室旁白质软化、智力低下和脑瘫的发生率。结果：①对照组显效25.0%、有效30％、有效率55％,治疗组显效33.3%、有效44.8％、有效率78.1％(χ²=14.6,P<0.01);②存活率对照组为75.5%、治疗组为88.5%（χ²=4.7,P<0.05）;③脑积水的发生率,对照组为37.7%,治疗组为8.7%（χ² =14.3,P<0.01）;④脑室旁白质软化的发生率,对照组为37.8%,治疗组为18.5%（χ²=5.0,P<0.05）;⑤智力低下的发生率,对照组为33.0%,治疗组为8.7%（χ²=11.0,P<0.01）;⑥脑瘫的发生率,对照组为17.0%,治疗组为4.3%（χ²=5.4,P<0.05）。结论：尼莫地平、生脉注射液联合应用治疗早产儿颅内出血,可以提高存活率、减少并发症和后遗症,改善预后。     

早期微创穿刺治疗高血压脑出血临床分析

目的:探讨早期微创穿刺术治疗高血压脑出血的疗效。方法:回顾性分析早期微创穿刺治疗高血压脑出血87例,在CT引导下采用颅内血肿微创清除术,对血肿进行抽吸、液化和引流,并对存活病人进行临床神经功能缺损程度评分和日常生活能力评分。结果:87例患者中治愈68例,好转15例,死亡4例。临床神经功能缺损程度评分在治疗前后比较差异具有显著性(P<0.01)。存活出院病人日常生活能力评分1~3级者达72人(82.76%)。结论:早期微创穿刺血肿清除术是一种有效治疗高血压脑出血的方法。     

未破裂脑动脉瘤血管内治疗的安全性及影像学结果

目的　观察未破裂脑动脉瘤血管内治疗后的安全性及影像学结果。方法　将可解脱弹簧圈栓塞未破裂脑动脉瘤 (必要时支架或球囊辅助 ) ,去除可能的出血因素。结果　 5 7例共 6 5个未破裂动脉瘤 ,5 2个致密栓塞 ,12个栓塞程度大于 90 % ,1个栓塞程度少于 90 %。血管造影随访 (6～ 36个月 ) ,30个致密栓塞 2 9个仍稳定 ,1个动脉瘤再生长 ;11个栓塞程度大于 90 %中 1个完全消失 ,7个稳定 ,3个再生长 ;1个栓塞程度少于 90 %的再生长。结论　未破裂脑动脉瘤血管内治疗是必要的也是安全的方法 ,致密栓塞的影像学结果更好 ,长期疗效需进一步的随访观察。     

Intracranial synovial sarcoma: A clinical,radiological and pathological study of 16 cases

IntroductionSynovial sarcoma (SS) is a tumor of unknown origin and is extremely rare in the central nervous system. Most studies on intracranial SS included only one or two cases. To better understand the disease, we review a series of primary intracranial SS.Method and materials16 primary intracranial SS in Tiantan Hospital during 2008–2017 were included. The clinical characteristics, including radiological and histological examination, operative records, and prognoses were reviewed.ResultThe case series included nine male and seven female patients with an average age of 23.8 years. Radiological results showed that the supratentorial region (81.25%) was the most common site of the brain involved. All patients were misdiagnosed as non-SS tumors. Gross total resection (GTR) was achieved in 12 cases (75.0%), and subtotal resection (STR) was achieved in 4 cases. All cases showed the characteristic SYT-SSX fusion gene, as detected by RT-PCR. The mean progression-free survival time (PFS) was 10.0 months and the mean overall survival time (OS) was 15.5 months. Multivariate analysis revealed that GTR and postoperative adjuvant radiotherapy were independent factors for PFS (HR = 6.143, 95% CI = 1.491–25.312; P = 0.012, HR = 6.143, 95% CI = 1.491–25.312; P = 0.012 respectively) and OS (HR = 9.000, 95% CI = 1.627–49.773; P = 0.012, HR = 0.017, 95% CI = 0.001–0.213; P = 0.002 respectively).ConclusionIntracranial SS were more frequently observed in the supratentorial region and in young patients without sex predilection. We recommend adjuvant radiation regardless of the extent of resection. More patients and longer follow-up periods were needed to further elucidate the biological features of intracranial SS.