超声骨钻辅助寰椎发育不良型椎弓根置钉的应用效果

颈椎后路钉棒内固定是目前治疗寰枢椎脱位的主要手术策略,手术安全性良好,融合率高。寰椎螺钉的置钉方法主要有侧块螺钉和椎弓根螺钉,与侧块螺钉相比,椎弓根螺钉具有更多优势,如更好的生物力学强度、更少的椎旁静脉丛出血、避免对C2神经根的骚扰导致术后枕部神经痛等。椎动脉沟位于寰椎椎弓根上方,与椎动脉和C1神经根紧邻,当椎动脉沟处椎弓根高度（vertebral artery groove height,VAGH）较低时,使用高速磨钻经椎弓根置钉存在较大的神经和血管损伤风险,尤其当VAGH≤3.5mm时,经椎弓根置入3.5mm的螺钉难度大,对术者的手术技巧和经验要求较高。2021年8月～2023年7月,笔者的手术团队使用超声骨钻完成12例寰枢椎不稳共24枚寰椎椎弓根置钉,效果满意,报道如下。     

侧脑室枕角扩大畸形1例报告并文献复习

侧脑室枕角扩大畸形,又称空洞脑(Colpocephaly),是一种以双侧脑室枕角异常扩大为主要表现,可伴有多种中枢神经系统解剖结构畸形的脑发育异常.国内外已有的报道[1-5]多为婴幼儿或儿童患者,关于成人病例的报道少见,临床上对本病认识广泛不足.因而成人患者极易误诊.现报道1例成人侧脑室枕角扩大畸形患者,并作文献复习.     

辅助栓塞技术治疗颅内复杂动脉瘤的临床应用(附36例报告)

目的 探讨多种辅助栓塞技术治疗颅内复杂动脉瘤的临床应用.方法 共36例患者的41个颅内复杂动脉瘤行辅助栓塞治疗,方法包括球囊、支架辅助栓塞和双微导管栓塞技术.结果 宽颈动脉瘤33个,其中球囊辅助栓塞11例,完全栓塞7例,次全栓塞3例,另外1例因球囊放置困难改用双微导管栓塞技术;支架辅助栓塞15例,完全栓塞10例,次全及部分栓塞各2例,单纯支架植入1例;双微导管技术栓塞8例,完全栓塞6例,次全及部分栓塞各1例.梭形动脉瘤8个,全部行支架辅助栓塞,完全栓塞1例,次全栓塞6例,单纯支架植入1例.3例出现并发症,其中术中血栓形成2例,术后视野缺损1例.结论 球囊、支架辅助和双微导管栓塞技术是治疗颅内复杂动脉瘤安全有效的方法,具体应根据动脉瘤部位、形态和患者临床情况进行选择.

Abstract：

Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms.Methods From Jun.2007 to Aug.2010, 36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods, including balloon, stent-assisted coiling and double microcatheter coiling techniques.Results Among the 33 wide-neck aneurysms, 11cases underwent balloon-assisted coiling, in which 7 were totally occluded, 3 subtotally occluded, 1 diverted to double microcatheter treatment after failure balloon placement 15 cases underwent stent-assisted coiling, in which 10 were totally occluded, 2 subtotally or partially occluded respectively, 1 by single stent placement without coiling.8 cases accepted double microcatheter treatment, 6 were totally occluded, 1 subtotally occluded and 1 partially occluded.All 8 fusiform aneurysms were treated by stent-assisted coiling, one case was totally occluded, 6 subtotally occluded, and another one was treated by single stent placement.The complications were found in 3 patients, including intra-operative thrombosis in 2 cases and dysopia in one case.Conclusion Balloon, stent-assisted coiling and double microcatheter techniques are safe and effective in treating complex intracranial aneurysms, but it should be determined by the position and morphologic characteristics of aneurysms as well as the patients' clinical condition.