目的：探讨和分析巨大听神经瘤手术面神经保留技术。方法:在面神经监护的条件下，57例巨大听神经瘤病人,采用枕下乙状窦后入路,显微外科切除肿瘤。术中观察肿瘤与面神经的病理解剖关系,术后随访时间6个月至5年。结果:肿瘤全切除54例（94.7％）,次全切3例(5.3%)。面神经解剖完整保留52例(91%),面神经解剖部分保留5例(9%)。结论:在有效的术中面神经功能监测条件下，出色的显微外科技术以及对面神经解剖关系的充分认识是面神经解剖保留的基础。识别不与肿瘤粘连的面神经脑干端或内听道端,再沿面神经锐性分离肿瘤,是面神经解剖保留的技术关键。
目的 探讨延髓肿瘤的治疗策略，以达到最佳预后。 方法 回顾分析2007年1月－2010年12月19例延髓肿瘤患者的临床资料，其中18例经外科手术治疗和病理证实，1例通过影像学确诊。 结果 12例血管网状细胞瘤中，11例手术全切，1例手术次全切；2例室管膜瘤均手术全切；2例海绵状血管瘤分别手术全切及伽马刀治疗；3例胶质瘤均手术部分切除。18例手术治疗患者术后神经功能障碍明显好转者13例，无明显变化者3例，2例因术后严重并发症死亡；1例伽马刀治疗患者症状好转。术后随访6～48个月，平均24个月。11例恢复工作，4例生活可自理，2例因肿瘤复发死亡。结论 术前通过MRI检查、术中神经电生理监测及熟练的显微外科技术是外科治疗优势，伽马刀治疗延髓较小肿瘤有着损伤小的优点，因此制定合理的治疗策略有利于提高患者生存质量。
ObjectiveTo study the anatomicopathological relation between facial nerve (FN) and acoustic neuronoma (AN) and summarize the techniques of how to protect facial nerves in microsurgery. MethodsA retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and March 2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. ResultsThe tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. After one-year follow-up, 549 patients had House-Brackmann Ⅰ-Ⅳ function. The location and shape of the FN along the tumor was identified as the follows: FN displaced along the ventral and superior surface of the tumor in 279 patients (47.7%), the ventral and central in 243 (41.5%), the ventral and inferior in 33 (5.6%), the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. ConclusionGood understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
In recent years, the system of standardized resident training has been set up and improved gradually in our country.However, the medical specialist training system for neurosurgeons is still at the stage of exploration.It is important to cultivate and select the best neurologic surgery specialists in China.Mayo Clinic is one of the best teaching hospitals in the United States, which has been ranking the second in the United States for the recent 20 years.Analyzing the neurologic surgery specialist training program of the world's top hospital and learning from its advanced experiences are beneficial for the establishment of medical specialist training system and the production of the highest caliber neurosurgeons in the Department of Neurosurgery in West China Hospital of Sichuan University.The Department of Neurosurgery in West China Hospital of Sichuan University is advantageous in its advanced technology and equipment, sufficient operations, rich teaching resources and independent laboratories.Our goal is to establish strict accessing, management and assessment system, perfecting security and feedback system, focusing on the cultivation of humanistic spirit, building neurosurgery specialist personnel, and establishing a unique brand of West China in the field of teaching.
As the intensity of clinical and research work is high, teaching is gradually paid less attention to and the quality of education cannot be ensured. In this context, a full-time teaching position is set up in West China Hospital which is taken responsibility by qualified clinicians, to improve the teaching quality by strict management and omni-directional teaching. We introduce the setting and running of the full-time teaching position in West China Hospital in this paper.
Objective To study the MRI features of intracranial solitary fibrous tumor (ISFT). Methods MRI features of 8 patients with ISFT treated between December 2010 and December 2015 were retrospectively analyzed and relavent literatures about its neuroimaging were reviewed. Results All the 8 cases were single solitary fibrous tumor (SFT), among which 4 arose from and beneath the tentorium, 2 in the left cerebellopontine angle, 1 in jugular foramen region and 1 in saddle area. All tumors had clear boundary, 3 were oval or round, 2 were irregular-shaped, 2 were lobulated and 1 was dumb-bell shaped. Tumor size ranged from 35 to 65 mm. On pre-contrast MRI, 5 cases were mixed with hypo to hyperintense signals on (T1 weighted image) T1WI and heterogeneous on (T2 weighted image) T2WI. The rest 3 cases were featured by solid and cystic components; the solid component was hypo to isotense on T1WI and hypointense on T2WI while the cystic areas, which were not enhanced in the postcontrast images, were hypo and hyperintense on T1WI and T2WI, respectively. All the areas with low T2 signal intensity were strongly enhanced after gadolinium administration. Flow-empty actions, peritumoral edema and “dural tail” sign was found in 6, 3 and 0 cases, respectively. All the 3 cystic cases were confirmed as malignant ISFT while the rest 5 were benign. Conclusions MRI manifestation of ISFT has some characteristics. There may exist some correlations between the intratumoral cyst and malignant potential. However, the diagnosis of ISFT remains dependent on histopathology.