Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

急性淋巴细胞性白血病患儿的护理

目的让护士增加急性淋巴细胞性白血病的知识，能敏锐观察到患儿的病情变化环节，及时救治，安全护理，预防差错，减轻患儿的痛苦，促进患儿的健康。方法描述患儿的病临床症状、体征，介绍一般护理与特殊治疗过程的护理，用一些关键性化验指标提示、提醒护理人员要注意观察患儿的病情变化及预防措施，强调个人卫生及心理护理和亲属的陪护，注意营养及无菌概念，预防院内感染。结果患儿在住院期间身心快乐，得到优质护理，减轻痛苦，减少并发症，缩短治疗时间，有效地配合医生治疗，促使疾病好转。结论护士通过有计划，系统地配合医生治疗，提供优质护理，保证了医疗护理的安全，促进了患儿早日康复，促进了医疗卫生事业的健康、有序的发展，维护了社会的稳定。     

经颅多普勒超声观察芬舒雅吸入剂对颅内动脉的扩张作用

自1994年11～12月，我们用中药芬舒雅吸入剂治疗33例脑动脉痉挛或脑动脉狭窄的患者，并应用经颅多普勒超声（TCD）在用药前后进行检测，现报告如下。资料与方法一、观察对象经TCD发现有脑动脉痉挛或脑动脉狭窄者共33例，其中男ZO例，女13例；年龄32～76岁，平均54岁。其痉挛或狭窄动脉的血流速度明显高于正常范围。TCD形态分析：14例为正常频谱，男8例，女6例，平均44．6岁；19例为异常频谱，男12例，女7例；平均60．9岁，特点为波峰圆钝，峰时后移；其中6例伴有湍流波形。三、检测方法采用美国TRANSPECTTCD超声诊断仪，用ZM探头…     

脑室腹腔分流术后颅低压及其防治

脑室腹腔分流术是治疗高压性脑积水的一种常用而有效的手术。我院近年来开展此手术，绝大部分取得良好效果，但也遇到术后颅低压的问题。经过处理，均治愈，现报告如下。1临床资料例1男性，9岁，因头痛，呕吐1年，加重伴视力障碍1月入院，经腰穿证实为高压性脑积水，行脑室腹腔分流术后，患儿次日晨即诉头痛，坐位明显而卧位减轻，经大量饮水及静脉补液后缓解。例2女性，8岁，头痛，呕吐3月入院，诊断为中脑导水管梗阻性脑积水，分流术后长期颅低压，经抗颅低压处理仍无缓解，考虑分流泵原因，更换泵后，依低压消失。2讨论脑室腹腔分流术后…     

颅内静脉窦血栓形成的CT诊断

颅内静脉窦血栓形成是一种特殊的脑血管疾病,常发生于感染后,分娩期和消耗疾病中,临床表现复杂多样而无特异性,常病情危重,病死率高,早期对病人局部溶栓等治疗效果明显。本文收集14例颅内静脉窦血栓形成的CT表现作回顾性分析,用以提高对颅内静脉窦血栓形成的CT影像特征的认识。1 临床资料 女性11例,男性3例,年龄19～52岁,平均32岁。其中10例为上矢状窦血栓,4例为乙状窦血栓。临床表现轻重不一,单纯头痛1例,其它所有患者起病时均表现头疼、呕吐,视乳头水肿的颅内高压症状,同时伴意识不清4例,单侧肢瘫5例,癫痫4例,14例中,1例经手术证实,5例DSA血管造影证实,8例经影像和临床随访证实。     

影响外伤性颅内血肿治疗方法选择的相关因素

目的 :探讨外伤性颅内血肿治疗方法选择的影响因素。方法 :总结外伤性颅内血肿 2 13例不同治疗方法的治疗结果 ,分析影响治疗结果的因素。结果 :治愈好转 171例 ,中残 9例 ,死亡 33例。结论 :对颅内血肿的意识和血肿量、中线移位和脑池变化的相关因素综合判断和预见性评估 ,对颅内血肿治疗方法及预后有一定意义     

开放性颅脑损伤的临床处理体会(附225例报告)

目的：探讨近１０年来开放性颅脑损伤治疗处理的临床经验．方法：对１２６０例颅脑损伤的诊断治疗的回顾，其中对开放性颅脑损伤２２５例进行回顾性总结：对颅内无异物、无继发颅内血肿和无严重脑水肿的１２７例行健脑、抗感染、脱水降颅压、止血、激素、头皮清创术．对９８ 例因颅内异物、粉碎性凹陷性颅骨骨折伴颅内血肿及严重脑挫裂伤患者除上述处理外行手术治疗．结果：治愈２１３例（９５.１％）效果满意，死亡１２例（４．９％）．结论：开放性颅脑损伤伤情复杂，合理适时的诊断治疗，可提高其治愈率，降低死亡率与致残率．     

载瘤动脉闭塞术治疗颅内巨大动脉瘤的探讨

目的总结和探讨脑血管造影和载瘤动脉闭塞在治疗颅内巨大动脉瘤上的作用及特点。方法60例颅内巨大动脉瘤患者,根据其脑血管造影的特点采取血管内介入方法[可脱式球囊和(或)弹簧圈]闭塞载瘤动脉近端53例、闭塞载瘤动脉两端后孤立动脉瘤7例;其中23例闭塞前先行颅内-外血管搭桥术。结果出院时Rankin评分分级:单纯血管内介入治疗组37例中轻残3例,合并颅内-外血管搭桥术组23例中死亡1例、重残2例。1-6年的影像学随访动脉瘤无复发。结论血管内介入结合颅内-外血管搭桥术闭塞载瘤动脉是治疗颅内巨大动脉瘤的方法之一。     

重型颅脑疾病合并上消化道出血56例分析

重型颅脑疾病包括颅脑损伤、高血压脑出血、颅内占位性疾病等各种导致电解质紊乱、意识障碍、生命体征不稳定的颅脑疾患。这些疾患极易引起上消化道出血并危及生命。