CT引导下立体定向梯度减压术在重度脑出血术中的应用

目的：探讨CT引导下立体定位梯度减压术在重度脑出血手术治疗中的临床疗效。方法：选取重度脑出血患者129例,按收治时间将其分为治疗组(66例)和对照组(63例)。治疗组采用梯度减压法手术;对照组采用标准大骨瓣开颅术。所有患者均在CT引导立体定位下确定手术路径,采用格拉斯哥昏迷评分(GOS)预后评分进行评估,比较两组的GOS评分结果。结果：两组相比治疗组恢复良好率高于对照组,其差异有统计学意义(x2=5.97,P＜0.05);病死率低于对照组,其差异有统计学意义(x2=4.58,P＜0.05);手术并发症,治疗组脑膨出、迟发性血肿发生率均低于对照组,其差异有统计学意义(x2=5.21,4.01;P＜0.05)。结论：CT引导立体定位梯度减压术能有效提高重度脑出血患者的手术疗效,且可降低术中、术后并发症,对改善患者预后具有积极的意义。     

肺癌脑转移颅内放疗联合免疫检查点抑制剂的研究进展CSCD

近年来,免疫治疗不断发展,免疫检查点抑制剂联合颅内放疗治疗黑色素瘤脑转移的安全性和有效性已得到初步认可,但免疫检查点抑制剂联合颅内放疗治疗肺癌脑转移是否产生类似的协同作用尚未达成共识,免疫检查点抑制剂与颅内放疗联合的最佳时机、联合治疗的获益人群等也需进一步探讨。本文主要就肺癌脑转移患者颅内放疗联合免疫检查点抑制剂的研究进展进行综述。     

伽玛刀治疗帕金森病在MRI图像上靶点坐标标定方法的研究

目的：提高伽玛刀治疗帕金森病靶点坐标标定的准确性。材料和方法：在１７例帕金森病患者中测量和比较前连合（ＡＣ）和后连合（ＰＣ）的坐标。推导靶点坐标计算公式。比较在不同情况下公式法和划线法标定靶点坐标的差别。结果：４例ＡＣ和ＰＣ处于同一层面的ＭＲＩ横断面图像上，划线法和公式法标定的靶点坐标值相同；１３例ＡＣ和ＰＣ处于不同层面的ＭＲＩ横断面图像上，前者标定的靶点坐标要比后者标定的靶点坐标偏后、偏高或偏低。结论：在ＡＣ和ＰＣ处于不同层面时，公式法可纠正划线法在标定靶点坐标上的偏差，主要是Ｓｈｏｔ　２的Ｙ值。     

CT引导立体定向神经内窥镜手术治疗高血压脑出血

目的 探讨CT引导立体定向神经内窥镜手术治疗高血压脑出血的方法和疗效.方法 选择我科自2005年至2006年收治的25例高血压脑出血患者,局麻下安装ASA602A型定向仪,CT扫描后导人手术计划系统,选择血肿最大层面,取血肿中心偏后1～1.5 cm处为靶点,测得坐标,设计手术切121及入路,全麻下环钻开颅,颅骨孔直径约3 cm,导入血肿排空针,排出部分血肿后,置入神经内窥镜进行血肿清除并止血. 结果 25例高血压脑出血患者中术后24 h血肿清除率达60%～70%10例;80%～90%11例;达90%以上4例,给予拔除引流管.72 h复查颅脑CT,患者血肿清除率均达90%以上,均拔除引流管.术后3个月日常生活能力评分示显著好转14例:好转9例;死亡2例,分别于术后10d、14 d死于肺部感染. 结论 立体定向神经内窥镜手术治疗高血压脑出血是一种定位精确、微创、血肿清除率较高和疗效较好的治疗方法.     

Clip migration in stereotactic biopsy

BACKGROUND: Needle localization breast biopsy (NLBB) is the standard for removal of breast lesions after vacuum assisted core biopsy (VACB). Disadvantages include a miss rate of 0% to 22%, a positive margin rate of approximately 50%, and vasovagal reactions (approximately 20%). We hypothesized that clip migration after VACB is clinically significant and may contribute to the positive margin rates seen after NLBB. METHODS: We performed a retrospective review of postbiopsy films in patients who had undergone VACB with stereotactic clip placement for abnormal mammograms. We measured the distance between the clip and the biopsy site in standard two view mammograms. The location of the biopsy air pocket was confirmed using the prebiopsy calcification site. The Pythagorean Theorem was used to calculate the distance the clip moved within the breast. Pathology reports on NLBB or intraoperative hematoma-directed ultrasound-guided breast biopsy (HUG, which localizes by US the VACB site) were reviewed to assess margin status. RESULTS: In all, 165 postbiopsy mammograms on patients who had VACB with clip placement were reviewed. In 93 evaluable cases, the mean distance the clip moved was 13.5 mm +/- 1.6 mm, SEM (95% CI = 10.3 mm to 16.7 mm). Range of migration was 0 to 78.3 mm. The median was 9.5 mm. In 21.5% of patients the clip was more than 20 mm from the targeted site. Migration of the clip did not change with the age of the patient, the size of the breast or location within the breast. In the subgroup of patients with cancer, margin positivity (including those with close margins) after NLBB was 60% versus 0% in the HUG group. CONCLUSIONS: Significant clip migration after VACB may contribute to the high positive margin status of standard NLBBs. Surgeons cannot rely on needle localization of the clip alone and must be cognizant of potential clip migration. HUG as an alternative biopsy technique after VACB eliminates operator dependency on clip location and may have superior results in margin status.     

Interactive MR-guided biopsies of the thyroid gland: validation of a new method

The aim of this study was to demonstrate the clinical feasibility and utility of an interactive MR-guidance system to target and biopsy thyroid lesions, and to compare resolution between ultrasound and interventional MR imaging in the evaluation of thyroid lesions. Twenty thyroid lesions of 18 patients were interactively biopsied using a 0.5-T superconducting open magnet system. Stereotactic localization of the needle and imaging was accomplished using T1-weighted gradient-recalled-echo (GRE) images. Representative cytological material was retrieved in 16 of 20 lesions (benign cystic or colloid goiter: n = 14; one de Quervain's thyroiditis and one follicular neoplasia). Lesions smaller than 1.5 cm detected by ultrasound could not be visualized adequately on GRE images. Lesions smaller than 1.5 cm were successfully biopsied by ultrasound (three colloid and haemorrhagic goiters and one adenoma). Magnetic-resonance-guided interactive biopsies and positioning of non-ferromagnetic needles in the thyroid gland are technically feasible and safe. Compared with high-resolution ultrasound, lesions larger than 1.5 cm can be adequately visualized and biopsied. Magnetic-resonance-guided placement of non-ferromagnetic needles is no substitute for high-resolution ultrasound in clinical work-up of thyroid lesions. Received 1 December 1997; Revised 3 February 1998; Accepted 4 February 1998     

Stereotactic Core-Needle Biopsy of Non-Mass Calcifications: Outcome and Accuracy at Long-Term Follow-Up

Objective

To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings.

Materials and Methods

Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23-72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators'' experience, and the retrieval rate for calcifications.

Results

For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%)], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by long-term follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47).

Conclusion

In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. False-negative findings were frequent during the operators'' learning period.     

脑裂头蚴病四例报告及文献复习

目的探讨脑裂头蚴病的临床表现、影像学特点以及治疗方法和效果。方法结合文献复习回顾性分析4例经病理确诊的脑裂头蚴病例特点。结果脑裂头蚴病临床表现以癫痫、轻偏瘫和头痛多见。CT表现特点为低密度灶伴点状钙化，不规则或点状强化。MRI可见病灶区有串珠样增强或扭曲的条索样增强影。本组4例中3例在CT定位行立体定向活检，1例手术开颅取出，预后均良好。结论CT引导下立体定向活检在诊断和处理脑裂头蚴病中起到重要作用。     

海人酸大鼠癫痫模型的建立

目的 应用海人酸注射建立海人酸大鼠癫痫模型,评价其生物学特性.方法 通过立体定位手术,大鼠海马组织微量注射海人酸,术后观察大鼠行为学表现、电生理改变及海马超微形态结构变化.结果 海人酸注射后实验大鼠出现典型的颞叶癫痫发作过程,表现为湿狗样抖动、前肢抽搐、跌倒以及全身强直-阵挛性发作等,皮层脑电图出现多种形式的痫性放电,单神经元放电细胞外记录显示癫痫模型大鼠放电杂乱,形态不规整.电镜显示神经细胞固缩,星形细胞突起肿胀,神经突触水肿,可见兴奋性递质小泡,线粒体水肿崩解,嵴排列紊乱,血管内皮细胞水肿,血脑屏障破坏.结论 大鼠立体定向海人酸药物注射是一种较理想的癫痫模型.     

A hollow sapphire waveguide for stereotactic intraventricular CO2 laser neurosurgery: a rat model

A hollow sapphire waveguide was used for stereotactic delivery of CO₂ laser radiation through the cerebro-spinal fluid to the ventricular surface of rat brains. The tissue was irradiated with single pulses (spot size ≈0.5 mm) ranging from 0.125 to 0.5s in duration and from 1.68 to 5.2 W in power. The radius, depth and variation in histological appearance of the lesions were measured as a function of energy density, and the repair response was evaluated by observing changes in the laser-induced lesions from 1 to 28 days post-injury. A lack of charring and limited size of the lesions were noted, and the lesions were repaired in a normal manner over the course of observation. Our results demonstrate that hollow sapphire waveguides are both safe and effective for the transmission of CO₂ laser light for intraventricular neurosurgical applications.