Treatment for severe craniocerebral trauma combined with transtentorial hernia in children

Objective:To explore the treating method for severe craniocerebral trauma combined with transtentorial hernia in children. Methods: We treated 58 children with severe craniocerebral trauma combined with transtentorial hernia through evacuating the hematomas, incising the tentorium but preserving the floating bone flap between January 1996 and January 2002. Results .- GCS was 3-5 in 17 cases and 6-8 in 41 cases. After treatment, 46 patients (79.30%) recovered well, 6 (10.30%) suffered from mild disability, 1 (1.72%)suffered from severe disability, 1 (1.72%) was in vegetative state, and 4 ( 6.90 % ) died. Conclusions: Evacuating hematomas and incising tentorium can effectively treat the child patients with severe craniocerebral trauma combined with transtentorial hernia, which can decrease the disability and mortality rates greatly, preserve the skull, exempt reoperation for cranioplasty and relieve the psychologic and physiologic burden of the child patients.     

个体化治疗幕上临界量高血压脑出血的临床疗效观察

目的对比分析个体化治疗临界量高血压脑出血的疗效。方法分析2016年1月‐2017年12月72例临界量高血压脑出血(30±5)ml患者,随机分为个体化治疗组37例,传统保守治疗组35例,比较并发症发生率、血肿吸收时间、住院费用、1个月后的近期疗效及6个月以上的远期预后情况。结果个体化治疗组在住院费用不明显增加情况下,缩短血肿吸收时间(P 0.05),明显改善1个月后的近期疗效(P 0.01);6个月以上远期预后有一定的改善,但无统计学意义(P0.05)。结论个体化治疗临界量高血压脑出血综合并量化患者年龄、意识状态、出血部位及肌力损害等指标并制定相应评分表,能减少患者的住院时间及降低致残率,改善患者的预后,为临床治疗方案的选择提供一定的参考。     

立体定向术与经外侧裂小骨窗开颅术治疗高血压脑出血的临床研究

目的探讨经立体定向血肿清除术(简称立体定向)与经外侧裂小骨窗开颅血肿清除术(简称小骨窗)治疗高血压脑出血患者的疗效。方法随机抽取67例高血压脑出血患者,分别采用立体定向血肿清除术和经外侧裂小骨窗开颅血肿清除术治疗。结果立体定向组与小骨窗组患者术后偏瘫开始恢复时间分别为(18±4.5)d、(12±3.2)d,两组数据比较有显著性差异(P<0.05);术后上消化道出血和感染的发生率无明显差异(P>0.05);预后:小骨窗组优于立体定向组(P<0.05)。结论两组结果相比较,经外侧裂小骨窗开颅血肿清除术有效且及时的清除了脑内血肿,是治疗高血压脑出血的良好方法。     

X-刀治疗颅内疾病44例疗效分析

Objective to investigate therapeutic methods and effect of X-knife for on intracranial diseases. Method Recent effect of 44pqtients with cranial diseases by X-knife was observed. Radiological follow-up was performed on 40 cases with mean 5.65 months of followup time. Result 92.5% of tumors were controlled locally, stability and recovery rate was 90.0%. The local control of metastatic tumors of brain was higher, but most patients with metastatic tumors died of primary lesion. New metastatic lesions appeared in patients without panencephalic radiotherapy in 1～5months. Tumors of pineal region were sensitive to X-knife. Conclusion X-knife has a definite effect on intracranial diseases. For patients with tumors of pineal region complicated by serious hydrocephalus, shunting should be conducted before X-knife treatment. For patients with mild or morderate hydrocephalus, X-knife chould be utilized only under correct interventions such as dehydration. The local control rate of intracranial metastatic tumors was high, but survival time postoperation depended on panencephalic radiotherapy or control of primafry lision. For tumors with diameter＞ 3cm, pituitary tumors, brains stem tumors and tumors in cerebellopontine angle region repeated X-knife were suggested, which could improve cure rate and decrease complications.     

Analysis of Therapeutic Effect of X-knife on Intracranial Tumors in 44 Cases

By linear electron accelerator KD II of Siemens M evatron and RSA X－knife of the fourth generation produced by Radionics company, 44 patient with intracranial diseases were intervened through 1999,6－2000,4. The results are as following.1 Materials and Methods1.1 Mateials In the group,25 male,19 female aging from 8～74 years, meanly 43 years.Total 50 lesions were radiated.Of all the patients, 12 patients with metastatic tumors of brain (7 with solitary tumors,5 with multiple tumors);3 w…     

癫痫病的外科治疗探讨

2000年3月至2004年3月，我院对30例顽固性癫痫病人进行了外科治疗，疗效良好，现报告如下。     

颅脑损伤后脑脊液中白介素含量的变化

目的:研究颅脑损伤后1 wk脑脊液中IL-1β,IL-6和IL-8含量的变化,并探讨其水平变化与损伤程度关系.方法:32例急性颅脑损伤患者以GCS评分分组,轻度颅脑损伤组GCS>8分,中、重型颅脑损伤组GCS≤8分,分别在损伤后第1,3,7日测定脑脊液中IL-1β,IL-6和IL-8浓度.结果:损伤后第1日IL-1β,IL-6和IL-8含量显著升高,随后在第3日降低,在第7日又显著升高.中、重度颅脑损伤组脑脊液中IL-1β及IL-6含量与轻度颅脑损伤组相比无显著差异(均P>0.05).中、重度颅脑损伤组脑脊液中IL-8含量显著高于轻度颅脑损伤组(P<0.01).结论:颅脑损伤后脑脊液中IL-1β,IL-6和IL-8含量显著上升,中、重度颅脑损伤患者脑脊液中IL-8含量显著高于轻度颅脑损伤患者.     

锁孔手术治疗前部颅底和脑深部肿瘤25例

目的：探讨锁孔神经外科手术治疗前部颅底及脑深部肿瘤的手术技巧和适应证。方法：对25例前部颅底及脑深部肿瘤行锁孔开颅显微神经外科切除术，其中部分使用内窥镜及术时超声辅助技术。结果：20例实体瘤中17例全(或等体积)切除，3例次全切除，其余5例囊实性肿瘤全切除，无手术死亡、致残及相关并发症。结论：锁孔手术是治疗前部颅底和脑深部肿瘤的微创治疗技术，恰当选择适应证尤其重要，神经内镜及术时超声的应用可帮助提高手术疗效。     

小儿松果体区肿瘤的治疗

目的探讨小儿松果体区肿瘤的治疗策略。方法对43例患松果体区肿瘤病例施以立体定向放射外科、全脑放疗为主,化疗、Ⅴ-P术、手术切除为辅助的治疗方略,以探讨疗效。结果随访3～44个月,平均22.6个月,肿瘤消失25例,缩小11例,不变5例,增大2例,无死亡病例。肿瘤控制率95.3%。结论采取以立体定向放射外科、全脑放疗为主,化疗、手术切除为辅助的治疗策略,可以极大限度地降低手术造成的损伤,提高小儿松果体区肿瘤患者生存质量,延长生存期。     

小儿重型颅脑外伤并天幕裂孔疝的临床救治

目的 探讨小儿重型颅脑外伤并天幕裂孔疝的处理方法。方法 对58例重型颅脑外伤合并天幕裂孔疝的病儿在开颅清除血肿后行天幕裂孔切开，并保留漂浮骨瓣。结果 恢复良好46例(79.3％)，中残6例(10.3％)，重残1例(1．7％)，植物生存1例(1．7％)，死亡4例(6．9％)。结论 小儿重型颅脑外伤并天幕裂孔疝在清除血肿后行天幕裂孔切开术能有效地使脑疝复位，减少脑疝所致的继发性脑干损伤，降低病残率和病死率。保留漂浮骨瓣，使得自身颅骨能完全生长愈合，避免了再次行颅骨修补术，减少了小儿因颅骨缺损带来的心理及生理问题。