Does the shunt opening pressure influence the effect of shunt surgery in normal pressure hydrocephalus?

Summary Thirteen patients with normal pressure hydrocephalus were operated upon with an externally manoeuvrable shunt system (Sophy SU8) in order to investigate its influence on clinical outcome, intracranial pressure and cranial CT parameters. The opening pressure was set at high at surgery and lowered stepwise at intervals of three months to medium and low. The clinical condition, intracranial pressure and cranial CT parameters were examined at the end of the 3 months interval on each pressure level.The patients improved within the first 3 months inspite of an unchanged mean intracranial pressure and remained in a stable clinical condition during the rest of the study period. The intracranial pressure was significantly reduced at 9 months. The ventricular index, Evans index, temporal horn and third ventricle width were reduced 3 months post-operatively and did not change significantly during the rest of the study. The pre-operative third ventricle width was correlated to high psychometric test results after shunt surgery. Reduction in ventricular index, Evans index and third ventricle width after surgery correlated to improvement in psychometric scoring.The clinical improvement after shunt surgery for normal pressure hydrocephalus is seen within 3 months and is independent of the adjusted valve pressure.     

电解可脱式微弹簧圈栓塞治疗颅内动脉瘤

目的　探讨电解可脱式微弹簧圈 (GDC)栓塞治疗颅内动脉瘤的方法。方法　采用美国波士顿公司GDC栓塞治疗 1 7例患者中 1 8个颅内动脉瘤 ,其中 1 5例蛛网膜下腔出血 (SAH)发病者 ,术前Hunt和Hess分级 :Ⅰ～Ⅱ级1 0例 ;Ⅲ级 3例 ;Ⅳ级 2例。结果　 1例死亡 ,3例轻度短期神经功能障碍 ,1 3例痊愈。结论　GDC栓塞治疗颅内动脉瘤较为理想 ,但还需随访观察     

Rebound intracranial hypertension after treatment of spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and the cause is usually cerebrospinal fluid leaks in spine level. Most patients with SIH have a benign course. Epidural blood patch (EBP) is the treatment of choice when initial conservative managements are ineffective. We reported a patient with SIH diagnosed by using magnetic resonance imaging and radionuclide cisternography. Acute rebound intracranial hypertension developed after EBP and was successfully treated with intravenous osmotic agent.     

脑动脉瘤破裂伴发急性硬膜下血肿的诊治

目的 探讨脑动脉瘤(AN)破裂所致的急性硬膜下血肿(ASDH)的临床、影像学特点和诊治方案。方法 回顾288例破裂AN，发现10例伴有ASDH。Huni Hess分级，Ⅱ级3人，Ⅲ级1人，Ⅳ级3人，Ⅴ级3人，均经CTA诊断为AN破裂，除2例外均被脑血管造影或手术所证实。保守治疗2例，血肿清除加AN夹闭术4例，电解脱弹簧圈(GDC)栓塞后加血肿清除2例，栓塞加脑室外引流1例，单纯栓塞l例。结果 疗效优者2例，中残者l例，7例死亡。结论 AN性ASDH的预后极差，同术前分级相关；CTA检查后立即行血肿清除加动脉瘤夹闭有助于提高预后，合适患者可联合栓塞和血肿清除术。     

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。     

慢性夹层动脉瘤的磁共振检查

本文对6例慢性夹层动脉瘤的MR所见进行分析。对真腔、假腔、“双腔主动脉”、左室形态和信号对比进行了描述。强调MR非侵袭性检查的重要意义。     

颅内破裂动脉瘤手术时机的探讨(附237例分析)

目的探讨颅内破裂动脉瘤手术时机与临床预后的关系。方法回顾性分析2005年我院收治的237例颅内破裂动脉瘤，其中196例行手术治疗。按入院时Hunt—Hess分级将手术病人分为A组（Ⅰ～Ⅲ级）162例，B组（Ⅳ、Ⅴ级）34例；根据手术时间分为早期手术组（SAH3d内手术）19例，延期手术组（SAH4～10d手术）82例，晚期手术组（SAH11d之后手术）95例。比较不同手术期别动脉瘤术中破裂率、术后1个月GOS评分及术后主要并发症（脑血管痉挛、脑积水）发生率，并进行统计学分析。结果24例（10．1％）因再出血丧失治疗机会。术中动脉瘤破裂早期手术组3例（15，8％），延期手术组8例（9．8％），晚期手术组6例（613％）。术后脑血管痉挛发生率早期手术组为15，8％，延期手术组为19，5％，晚期手术组为17，9％。脑积水发生率以晚期手术组最高（14，7％）。对术后1个月GOS评分Ridit分析结果显示：A、B两组中均以早期手术组治疗效果最佳．延期手术次之．晚期手术最差。结论早期手术可规避颅内破裂动脉瘤再出血的风险，降低主要并发症发生率。对于各个级别（包括Ⅳ、Ⅴ级）的SAH病人，均应根据治疗者的手术经验与技巧和所在医院的条件，及早诊断，尽早手术。     

Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease

BACKGROUND: Although some laboratory findings are known to be indicators of the risk of giant coronary aneurysm formation among Kawasaki disease patients, an appropriate cut-off point to predict aneurysm formation is not clear. METHODS: One hundred and five patients with giant coronary aneurysms were selected from the 15th and 16th nationwide surveys of Kawasaki disease in Japan. A total of 2936 patients without Kawasaki disease were recruited from a single hospital as a control group. Odds ratios were calculated for six laboratory data with specific values as cut-off points. Receiver operating characteristic (ROC) curves were observed to determine the most appropriate laboratory tests and cut-off points. RESULTS: Hematocrit, leukocyte count, neutrophil proportion, and hemoglobin had one or more peaks of odds ratio for specific cut-off points, but they did not have a clear cut-off point for the predictor according to the receiver operating characteristic curves. Alanine aminotransferase (ALT) increased the risk of giant coronary aneurysms continuously so no clearly appropriate cut-off point was identified. Serum sodium concentration of 135 mEq/L had a peak of odds ratio, and those with <135 mEq/L had the highest odds ratio (4.78). This value seemed appropriate with a sensitivity of 78% and specificity of 57%, although the predictive positive value was as small as 5%. CONCLUSION: The author's propose that a serum sodium concentration of <135 mEq/L at the patient's first visit to hospital may be a predictor of giant coronary aneurysms due to Kawasaki disease.     

红外热像图在神经外科疾病中应用价值的评价

目的 评价红外热像图在神经外科疾病中应用的价值。方法 应用红外热像图对39例脊髓损伤患者进行躯体温度监测，对31例颅内肿瘤、76例脑梗死、2480例头痛、21例头面部血管瘤进行头部温度监测。结果 红外热像图监测脊髓损伤39例，测出脊髓损伤平面上下无温差14例，平面以下温度增高1-3℃ 13例，下降1-3℃ 12例。经大网膜脊髓移植手术13例，术前脊髓损伤平面以下34℃，术后1个月复查皮肤温度，上升至35℃并伴有麻胀和皮肤湿润感7例，皮肤温度下降0．6℃者6例。热像图可显示血管性头痛颞部高温区，眶上神经痛同侧前额部皮肤低温区，枕大神经痛同侧枕颈部热区；热像图可显示梗死侧有低温区；显示颅内肿瘤颈外血管供血情况；基本上能反映头面部血管瘤血管侵及范围。结论 红外热像图在神经外科有其独特的价值，本技术具有无创、可重复、价廉和检查的非接触性等优点，反映组织代谢活跃状态与程度，是CT等形态学诊断方法的补充，在医学科学的研究和临床应用中具有很大的潜力。     

颅内动脉瘤破裂出血患者血清PRL、GH的动态变化

目的　测定颅内动脉瘤破裂出血患者血清泌乳素 (PRL)、生长激素 (GH)的含量变化 ,探讨其与病情演变的关系。方法　对 3 5例颅内动脉瘤破裂出血患者发病后 1～ 3d ,发病后 7～ 9d ,发病后 13～ 15d血清PRL、GH进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　颅内动脉瘤破裂出血患者血清PRL、GH发病后 1～ 3d、发病后 7～ 9d各均值明显高于对照组 (P <0 .0 5 ) ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛组和非脑血管痉挛组也有明显差异 (P <0 .0 5 )。结论　血清GH、PRL含量与蛛网膜下腔出血 (SAH)的病情演变、脑血管痉挛 (CVS)有关