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耳源性脑疝25例,抢救成功者19例。采用单纯脑脓肿穿刺抽脓抢救脑疝6例,仅1例成功;开颅减压术抢救脑疝20例,18例抢救成功。本组临床实践和文献报道都说明耳源性脑疝一旦发生应即刻行开颅减压术,能卓有成效地抢救生命 相似文献
3.
Sigmund Jenssen Michael R. Sperling Joseph I. Tracy Maromi Nei Liporace Joyce Glosser David Michael OConnor 《Seizure》2006,15(8):621-629
RATIONALE: A small percentage of patients with idiopathic generalized epilepsy (IGE) do not respond to medical therapy. Generalized tonic-clonic (GTC) seizures are especially debilitating and can be associated with severe injuries. The benefit, safety and effect of corpus callosotomy (CC) in patients with IGE have not been studied. METHODS: We reviewed patients with presumed IGE who underwent CC between 1991 and 2000. Criteria for selection included history, examination, brain imagining, interictal and ictal EEG. All patients had refractory and debilitating tonic-clonic seizures (GTCS) and had failed four or more antiepileptic drugs. Seizure frequency was calculated per month over the last year and pre-operative baseline was compared to last follow-up using paired t-tests. IQ, executive function, language and verbal, non-verbal memory and quality of life (QOL) was compared before and after surgery. Serial EEGs after surgery were reviewed. RESULTS: There were nine patients (seven men), mean age 37.9 (range: 22-49), mean IQ 87.3 (range: 75-107). All had anterior CC. Mean follow-up time was 5.4 years (range: 0.6-10.3 years). One patient died from sudden death in epilepsy 9 months after surgery. There was a significant reduction of GTC seizures from 6.3 to 1.1 (p<0.005). Four patients had more than 80% and eight more than 50% reduction. Of five patients with absence seizures, two became seizure free and one had more than 80% reduction and two worsened slightly, and of three with myoclonic seizures one had more than 90% reduction. One patient had completion of the CC with improvement of myoclonus and absence seizures, but not of GTC seizures and suffered a disconnection syndrome. Another had right frontal focal resection without improvement after new seizures of focal onset. Cognitive testing showed a good outcome (improved or no change) in all cognitive domains. Post-surgical EEG showed new focal slowing and sharp waves. There was no change in QOL. CONCLUSION: CC can be effective in reducing GTC, absence and myoclonic seizures in patients with refractory IGE. These findings suggest that interhemispheric communication of the cerebral cortices plays an important role in the generation of seizures in IGE. Anterior CC appears safe while complete callosotomy has a risk of disconnection syndrome. 相似文献
4.
报告33例高血压性脑出血施行外科手术治疗的临床体会。结合术前病情分级、血肿类型、血肿量、中线结构移位程度等,对手术治疗的适应症选择、手术方式及入路、提高治疗效果、减少术后并发症等作了讨论。提出了手术治疗重要性。 相似文献
5.
Summary: A 6.5-year-old boy developed seizures at age 2.8 years consisting of episodes of unconsciousness and laughing attacks. By age 6 years, multiple seizure types, including generalized tonic-clonic (GTC), complex partial (CPS) and akinetic seizures, and drop attacks were occurring several times daily. EEG showed multifocal epileptic discharges. Antiepileptic drugs (AEDs) did not control the seizures. With progression of the epilepsy, cognitive deterioration developed. There were no manifestations of precocious puberty. Neuroimaging disclosed a suprasellar mass in continuity with the hypothalamus, and a diagnosis of hypothalamic hamartoma was made. After surgical resection of the hamartoma, the seizures were completely alleviated, and the epileptic EEG discharges disappeared. Improvement of mental function was also noted. 相似文献
6.
Scalp and Limbic P3 Event-Related Potentials in the Assessment of Patients with Temporal Lobe Epilepsy 总被引:1,自引:1,他引:0
Auditory oddball scalp and limbic P3s were recorded from 18 patients with unilateral temporal lobe epilepsy (TLE) prior to seizure surgery. Limbic P3s were unilaterally absent ipsilateral to the seizure focus and were present in the nonepileptogenic temporal lobe in all 18 cases studied. Scalp P3s, recorded from C3 and C4, on the other hand, were elicited bilaterally and there was no significant difference in amplitude or latency between the epileptogenic and nonepileptogenic sides. These data concur with studies of scalp P3 performed following surgery and suggest that the assessment of the contribution of limbic P3 to scalp P3 may be masked by volume conduction effects and other generators of P3. We conclude that the P3 recorded from central scalp sites, unlike its limbic counterpart, offers little clinical information in the presurgical assessment of patients with TLE. 相似文献
7.
Neurosurgery has traditionally been at the forefront of advancing technologies, adapting new techniques and devices successfully
in an effort to increase the safety and efficacy of brain and spine surgery. Among these adaptations are surgical robotics.
This paper reviews some of the more promising systems in neurosurgical robotics, including brain and spine applications in
use and in development. The purpose of the discussion is twofold—to discuss the most promising models for neurosurgical applications,
and to discuss some of the pitfalls of robotic neurosurgery given the unique anatomy of the brain and spine. 相似文献
8.
目的 探讨采用上颌骨翻转面部移位入路手术切除侵及颅底放疗后复发鼻咽癌的疗效及临床意义。方法 11例侵及颅底放疗后复发鼻咽癌,均采用上颌骨翻转面部移位入路手术切除。结果 11例患者均达到显微镜下肿瘤全切除。全部患者随访10-46个月,因肿瘤复发死亡2例,带瘤生存1例,其余患者均无肿瘤复发,生活质量良好。手术并发症包括:创腔感染1例:患侧听力下降、耳鸣各1例;张口受限1例。结论 上颌骨翻转面部移位入路手术切除侵及颅底复发鼻咽癌具有显露充分、肿瘤切除彻底的优点,其疗效满意,可作为放疗术后复发广泛侵及颅底的鼻咽癌的一种治疗选择。 相似文献
9.
Jennifer A. Ruskey Lior Greenbaum Léanne Roncière Armaghan Alam Dan Spiegelman Christopher Liong Oren A. Levy Cheryl Waters Stanley Fahn Karen S. Marder Wendy Chung Gilad Yahalom Simon Israeli-Korn Vered Livneh Tsvia Fay-Karmon Roy N. Alcalay Sharon Hassin-Baer Ziv Gan-Or 《European journal of medical genetics》2019,62(1):65-69
Background
Variants in GBA are the most common genetic risk factor for Parkinson's disease (PD), and are especially prevalent in the Ashkenazi Jewish (AJ) population. However, most studies on GBA in AJ genotype only seven selected Gaucher-associated pathogenic variants rather than sequencing the whole gene, which may leave carriers of PD-associated GBA variants undiscovered.Methods
GBA was fully sequenced using molecular inversion probes (MIPs) and Sanger sequencing in 735 AJ PD patients and 662 AJ controls, from Israel and New York. Additional AJ control data (n?=?3044) from the Inflammatory Bowel Disease Exome Portal was used.Results
Full GBA sequencing increased the number of variants discovered by 17.4%, compared to targeted genotyping. An additional 17 PD patients were identified with GBA-associated PD. The p.E326K variant was found in 1.6% of AJ PD patients, making it the second most common PD-associated GBA variant in AJ. GBA variants were found in 18% of PD patients and 7.5% of controls (OR?=?2.7, 95%CI?=?1.9–3.8, p?<?0.0001).Conclusion
Without full sequencing of GBA, or at minimum including p.E326K in the genotyping panel, a significant proportion of variant carriers go undiscovered and may be incorrectly assigned as non-carriers in studies or clinical trials. 相似文献10.
Regional cerebral blood flow was measured by the 133Xe inhalation method in 20 young patients with moyamoya disease and five young healthy volunteers. Most patients showed low values of mean hemispheric blood flow in both hemispheres. Regional cerebral blood flow was at a low value in the upper frontal region and at an almost average value in the posterotemporal and occipital regions, which was different from the "hyperfrontal" pattern in healthy volunteers. Regional cerebral blood flow was reduced evenly by hyperventilation. By 5% CO2 inhalation, regional cerebral blood flow was increased in the temporooccipital regions and was nearly unchanged or decreased in the frontal region. 相似文献