Iatrogenic Creutzfeldt–Jakob disease subsequent to dural graft: persisting risk after 1987

The first case of Creutzfeldt-Jakob disease (CJD) related to the use of a dura mater graft of cadaveric origin was identified in 1987 and this procedure is now considered as one of the main causes of iatrogenic CJD. Although the decontamination procedure for the preparation of graft material was modified, the product was withdrawn from the market in many countries a few years later and replaced by synthetic material. In this context, two patients treated in our institution developed CJD following a cadaveric dural graft performed after cerebral and lumbar trauma. Their clinical presentation, showing predominant cerebellar symptoms, late deterioration and myoclonic jerks, and a rapid disease course until death, was similar to that of previously reported cases involving the iatrogenic form. As the graft for one of the patients was performed in 1991 (several years after modification of the decontamination procedure), this fourth reported case suggests that the risk of iatrogenic CJD may have persisted in some patients treated after 1987, when grafts of cadaveric origin were totally abandoned.     

硬脊膜动静脉瘘(附1例临床分析)

目的探讨硬脊膜动静脉瘘(SDAVF)的病因、发病机制、临床表现、诊断及治疗。方法回顾性分析了1例患者的相关临床资料。结果本例患者以双下肢渐进性麻木、无力1年余,加重伴大小便障碍9个月为主要临床表现,脊髓MRI显示T9~L1髓内以长T2长T1为主之异常信号,超选择DSA造影可见位于入LT12椎管处一硬脊膜动静脉之瘘口,成功地进行了经单侧椎板开窗夹闭瘘口术。结论SDAVF为一具有直接的动静脉交通性病变,常伴有小型畸形团,多发生于中年男性,误诊率高,主要表现为渐进性的肢体麻木、无力及大小便障碍,MRI有助于诊断,但仍须DSA确诊。阻断连接瘘口与冠状静脉丛的引流静脉是治疗SDAVF的有效方法,显微外科手术效果可靠、复发率低,尽早地确诊和治疗是取得良好疗效的根本前提。     

冻干人硬脑膜用于修补硬脑膜缺损和血管内栓塞治疗的临床观察

目的：探讨用冻干人硬脑膜行硬脑膜成硬脊膜缺损修补和血管内栓塞治疗的效果。方法：用冻干人硬脑膜修补因脑肿瘤、脑外伤、脊髓内肿瘤手术引起的硬脑膜或硬脊膜缺损,并不同规格的的冻干人硬脑膜微粒或微丝行靶血管栓塞。结果：（１）冻干人硬脑膜用于硬脑或硬脊膜缺损修补患者２２９例,无颅仙感染等并发症,用于血管内栓塞靶血管２８例,可明显减少或闭塞颅内肿瘤的血供。结论：冻干人厝脑膜是一种较为理想的硬脑膜缺损修补和血管     

Calcified convexity dura mater and acute epidural haematoma mimicking calcified chronic subdural haematoma

We report a patient with calcification of the convexity dura mater and an acute epidural haematoma. CT revealed a calcified layer between the haematoma and brain parenchyma, which mimicked acute bleeding into a calcified chronic subdural haematoma. The appearance of a calcified haematoma does not always mean a chronic lesion, and that emergency operation should not be foregone, when there is a history of acute head trauma and progressive impairment of consciousness.     

硬脊膜的蠕变率与椎间盘突出症的自然病程

目的　为探讨椎间盘突出症缓慢自愈的机理和治疗方法的选择提供一定的帮助。方法　应用２１ 例新鲜的猪的腰段硬脊膜,分组测量其蠕变率的变化。结果　各组蠕变率均与时间和载荷成正比,控温组发生速度快而大,模拟组发生慢而小。结论　蠕变率是椎间盘突出症症状缓解的力学基础,促进蠕变率发生的治疗,同减压治疗一样,都是病因治疗。     

Intracranial leiomyosarcoma: A neuro-oncological consequence of acquired immunodeficiency syndrome

We describe a case of glioblastoma treated with chemoradiotherapy that spread to the dura mater with direct invasion of the skull base, protrusion into the homolateral nasal fossa, and penetrated of the frontal sinus, the orbital wall and the ethmoidal sinuses. Only eight cases of glioblastoma showing this development have been described in the literature; one of these, however, had a sarcomatous component which was absent in our case.     

鞍旁硬膜间腔岩尖入路治疗三叉神经鞘瘤

目的探讨鞍旁硬膜间腔岩尖入路显微手术治疗三叉神经鞘瘤的疗效。方法利用鞍旁硬膜间腔岩尖入路对中颅窝型、中后颅窝哑铃型三叉神经鞘瘤12例进行了显微手术治疗,对术中解剖、手术技巧及疗效进行分析。结果鞍旁硬膜间腔岩尖入路能充分暴露肿瘤,肿瘤全切除9例,次全切除3例;经病理学检查均为神经鞘瘤。术后颅神经功能障碍较术前改善。结论鞍旁硬膜间腔岩尖入路能安全切除肿瘤,提高手术切除率,减少术后并发症。     

磁共振成像对硬脊膜动静脉瘘的诊断及随访价值

目的：讨论MRI对硬脊膜动静脉瘘（SDAVF）的初步诊断及随访价值。方法：回顾性分析资料完整的13例SDAVF患者的手术前后或栓塞前后MRI资料。结果：13例患者中手术前或栓塞前诊断为椎间盘突出7例,脊髓炎3例,神经根炎1例,正确诊断2例,误诊率高。分析MRI片提示病灶区脊髓呈现平均连续5个椎体节段长T2信号,T1、T2加权像髓外硬膜下可见密集的血管流空影。10例患者在T1增强中见到迂曲扩张的冠状静脉丛,术后或栓塞后3－6个月复查MRI,长T2信号及血管流空影消失。结论：MRI对硬脊膜动静脉瘘（SDAVF）的诊断治疗具有较可靠的初诊及随访意义,脊髓长T2信号及血管流空影对诊断有意义。