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颈椎硬膜外脓肿一例

SKULL BASE RECONSTRUCTION AND PEROPERATIVE TREATMENT FOR CRANIO-ORBITAL TUMORS/

Objective To investigate the peroperative treatment of cranio-orbital tumors and the method of the reconstruction of the skull base. Methods Between April 2008 and April 2011, 35 patients with cranio-orbital tumor were treated. There were 21 males and 14 females, aged 17-73 years (mean, 46.3 years). The first symptoms were orbital pain in 13 cases, hypopsia in 12 cases, exophthalmos or abnormal eye position in 5 cases, headache and dizziness in 2 cases, di plopia in 2cases, and pulsating eyeball in 1 case. Some of the patients needed resecting the zygomatic arch, supercil iary arch, and orbit roof. The autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges were used to reconstruct the skull base. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Postoperative MRI indicated that total removal of tumors was achieved in 30 cases, subtotal in 3 cases, and partial in 2 cases at 3 days. There was no operative death. Cerebrospinal rhinorrhea and infection occurred at 1 week in 1 and 2 cases respectively, and were cured after lumbar drainage and antibiotics. The patients were followed up 6 to 36 months (mean, 18 months). In patients having hypopsia, the visual function was improved in 9 cases at 1 month; in patients having orbital pain, pain rel ief was achieved at 2 weeks after operation; in patients having exophthalmos or abnormal eye position and pulsating eyeball, sympotoms disappeared after operation. In 27 patients with benign tumor, 24 were cured, without recurrence during follow-up; in 8 patients with mal ignant tumor, 6 had recurrence within 18 months and underwent second operation or radiotherapy, 2 relapsed cases died of cerebral hernia and respiratory circulating failure at 24 months after operation. No complication of enophthalmos, pulsating exophthalmos, or collapse of zygomatic region occurred. Conclusion Using the autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges to reconstruct the skull base has rel iable foundation, simple operation, and easy anatomical reconstruction, so it is an effective method after the removal of cranio-orbital tumors; better effectiveness would beobtained when combining with the peroperative nursing.

小儿ChiariⅠ型畸形合并脊髓空洞症研究进展

小儿Chiari Ⅰ型畸形合并脊髓空洞症临床少见，患儿临床症状较少、隐袭且与成年人有很大区别，容易发生误诊、误治。随着MRI的广泛应用，该疾病诊断数量日渐增多，但目前关于小儿Chiari Ⅰ型畸形合并脊髓空洞症的研究存在较多争议，临床工作者对其认识和诊治水平尚待提高。根据国内外文献、专著及最新临床试验研究成果，现就小儿Chiari Ⅰ型畸形合并脊髓空洞症研究进展进行综述。

The Use and Effect of Large Trauma Craniotomy on Severe Traumatic Brain Injury

ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.

小切口小骨窗显微术式治疗Chiari畸形合并脊髓空洞症268例临床分析

目的探讨一种新型的改良小切口小骨窗显微术式治疗Chiari畸形合并脊髓空洞症的疗效。 方法总结2010年1月－2012年9月采用的改良后4 cm小切口、3 cm×2 cm小骨窗减压、小脑扁桃体切除、枕大池扩大重建术治疗的共计268例Chiari畸形合并脊髓空洞症患者的治疗及预后情况，并进行回顾性分析。 结果268例患者中早期症状明显改善221例（82.5%），远期随访245例症状明显改善212例（86.5%）、稳定25例（10.2%）、加重8例（3.3%）。 结论小切口小骨窗显微术式在治疗Chiari畸形合并脊髓空洞症中有着显著的疗效。

经鼻蝶鞍区病变切除术后鞍底重建及围手术期处理

目的 总结经鼻蝶鞍区病变切除术后鞍底重建及围手术期处理的相关经验。 方法 回顾性分析2007 年10 月－ 2008 年12 月收治的132 例经单鼻孔蝶窦入路行鞍区病变切除术患者鞍底重建及围手术期处理方法。男64 例，女68 例；年龄19 ～ 74 岁，平均45.7 岁。病因：垂体无功能腺瘤91 例，生长激素腺瘤22 例，泌乳素腺瘤9 例，促肾上腺素皮质激素腺瘤2 例，促甲状腺素释放激素腺瘤1 例，Rathke 囊肿5 例，鞍内型颅咽管瘤2 例。术中采用由人工硬膜、颅骨和蝶窦黏膜组成的夹心层法重建鞍底。 结果 术后4 例发生少量脑脊液漏，给予腰大池持续引流1 周后治愈。术后再出血2 例，经药物治疗消退；术后高热、感染3 例，经抗生素治疗后2 例好转，1 例配合腰穿持续引流后治愈。患者均获随访，随访时间28 ～ 42 个月，平均35.2 个月。患者术前症状及体征术后不同程度好转。 结论 以人工硬膜加自体骨片等材料为主体的鞍底重建技术具有解剖还原、操作简便、稳固可靠、创伤小、无排斥等特点，辅以周全的围手术期护理，能够取得良好的重建效果。

Analysis of Hypothalamic Reactions Shortly after the Resection of the Third Ventricle Tumor via Transcallosal-interforniceal Approach

目的　探讨经胼胝体-穹窿间入路切除第三脑室肿瘤术后，近期下丘脑反应的发生情况及相关因素，为防治第三脑室肿瘤术后下丘脑反应提供参考。 方法　回顾分析2003年1月－2008年12月经胼胝体-穹窿间入路切除的78例第三脑室肿瘤患者手术后近期（1个月内）下丘脑反应的发生情况，并将其按照肿瘤部位、病理性质、大小、血供、手术切除程度进行分类统计，用SPSS 13.0软件logistic 回归分析影响这些并发症的因素。 结果　78例术后下丘脑反应37例，发生率47.4%；死亡5例，下丘脑反应病死率为13.5%（5/37）。其中电解质糖代谢紊乱33例（42.3%），尿崩症27例（34.6%），激素水平低下16例（20.5%），高热6例（7.7%）。好转痊愈率：激素水平低下43.7%，其余均＞70%。第三脑室前部颅咽管瘤术后最容易发生下丘脑反应（P＜0.05）。 结论　经胼胝体-穹窿间入路切除第三脑室肿瘤术后近期存在程度不同的下丘脑反应，其发生与肿瘤部位、病理性质有密切关系。经积极治疗，大部分下丘脑反应能在术后1个月内好转甚至痊愈。