经远外侧入路切除颈静脉孔区肿瘤14例

目的 颈静脉孔区肿瘤位于颅底深部，临近主要动静脉及颅神经，手术显露困难。介绍选用远极外侧入路能良好暴露该区。方法 经切除14例颅底颈静脉孔区肿瘤，三维CTA模拟手术入路9例。结果 肿瘤全切除8例，大部切除6例。术后病人临床症状均较术前明显改善。结论 笔者就诊断特点、分型和手术入路选择等进行讨论，提出了选用远外侧入路对该肿瘤的手术优点。     

大脑中动脉夹层动脉瘤临床特点及治疗的荟萃分析

目的 综合分析有关大脑中动脉夹层动脉瘤临床报道病例的临床表现、治疗特点以及预后情况。方法 用关键词途径对1990年1月～2003年5月MEDLINE数据库进行光盘检索。对34例临床确诊为大脑中动脉夹层动脉瘤的病例报道资料进行综合分析，并进行统计学处理。结果 大脑中动脉夹层动脉瘤无明显性别和临床表现上的差异，其好发于中动脉M1段和M2段。破裂或未破裂的中动脉夹层动脉瘤的手术组预后均明显优于保守组，两者统计学差异明显。结论 大脑中动脉夹层动脉瘤是一种较为罕见的脑血管疾病。对于破裂或未破裂(尤其是M1段)的大脑中动脉夹层动脉瘤应于诊断后早期进行手术干预，改善患者预后。     

S-100B and neuron specific enolase in outcome prediction of severe head injury

Objective: To elucidate the role of S-100B and neuron specific enolase (NSE) in predicting the outcomes of patients with severe head injury. Methods：Forty patients with severe head injury were included in this study. The serum concentrations of S-100B and NSE were measured within 12 hours after head injury to investigate the correlation between serum levels of S-100B and NSE and outcome. Validity of both S-100B and NSE in outcome prediction was assessed with Receiver Operator Characteristic (ROC) curve. Results: The serum concentrations of S-100B and NSE of both groups, with favorable or unfavorable outcomes, were significantly higher than those of the normal group. The serum concentrations within 12 hours after head injury were closely correlated with the prognosis. Furthermore, according to the ROC curves of S-100B and NSE, S-100B was found better in predicting outcomes than NSE. Conclusions： S-100B and NSE may play importantroles in outcome prediction after severe head injury. Moreover, S-100B is clearly superior to NSE in terms of predictive value and appears to be a more promising serum marker in outcome prediction after severe head injury.