Objective To investigate the accuracy of preoperative three-dimensional reconstruction of tumor in craniotomy for supratentorial convex brain tumors, and to provide an accurate and safe auxiliary method for craniotomy. Methods Patients with supratentorial convexity brain tumors who were admitted to the Department of Neurosurgery, West China Hospital, Yibin Hospital, Sichuan University between April 2018 and November 2020 were prospectively enrolled and randomly divided into reconstruction group and control group. In the reconstruction group, preoperative three-dimensional reconstruction of the tumor was used for craniotomy positioning, while in the control group, traditional two-dimensional tomographic imaging was used. The basic conditions, intraoperative localization and tumor exposure satisfaction rate, maximum diameter of bone window, operation time, cerebral draining vein injury, and postoperative subcutaneous effusion or intracranial infection were compared between the two groups. Results A total of 43 patients were included, 22 in the reconstruction group and 21 in the control group. There was no significant differences in age, gender composition, incidence of midline shift, tumor growth site and tumor size between the two groups (P>0.05). There was no significant difference in the incidence of cerebral drainage vein injury and postoperative subcutaneous effusion or intracranial infection between the two groups (P>0.05). The satisfaction rate of intraoperative positioning and tumor exposure in the reconstruction group (95.5% vs. 66.7%) was higher than that in the control group, the maximum diameter of the bone window [(6.26±1.32) vs. (7.31±1.13) cm] and the operation time [(194.00±22.76) vs. (214.57±26.53) min] were lower than the control group, and the differences were statistically significant (P<0.05). Conclusions Preoperative three-dimensional reconstruction helps to locate the tumor more accurately, improves the satisfaction rate of tumor exposure, reduces the diameter of the craniotomy window, and shortens the operation time. Compared with traditional two-dimensional tomographic positioning, it has more advantages.
目的 探讨脑胶质瘤术后不同时期的MRI增强表现，客观分析其术后的手术切除程度。 方法 2009年2月－2012年10月32例脑胶质瘤患者均在术后1 d～2周进行第1次MRI平扫及增强扫描（其中21例在术后3 d内进行检查），术后1～3个月随访复查21例，术后6～12个月随访复查18例，术后1～3年MRI随访16例。分析不同时期的MRI平扫及增强表现，以期发现正确评价手术切除程度的指标。 结果 术后3 d内行MRI增强检查仅有4例出现反应性强化，肿瘤残余有7例，结合其影像学表现可较准确地区分术后反应性强化及肿瘤残余。 结论 胶质瘤术后早期（3 d内）进行MRI增强检查可准确评价肿瘤术后切除程度，便于制订下一步治疗计划。
【摘要】 目的 探讨中型和重型颅脑损伤后患者血小板（platelet，Plt）参数的变化特点及临床意义。 方法 选取2009年3月-2010年3月脑外伤后24 h内入院的颅脑损伤患者75例作为观察组，于伤后1、3、7、14 d采血测定Plt数量、血小板平均体积（mean platelet volume，MPV）、血小板体积分布宽度（platelet distribution width，PDW），并同时进行格拉斯哥昏迷评分（Glasgow coma scale，GCS）。同时选取60例健康体检者，测定Plt、MPV和PDW作为对照组。 结果 观察组伤后1、3、7 d Plt计数分别为（106.21±36.31）、（102.76±35.23）、（108.37±31.32）×109/L，较对照组[（210.41±68.56）×109/L]明显降低（Plt;0.05）；观察组伤后1、3、7 d MPV分别为（12.34±1.34）、（11.21±1.52）、（10.78±1.36） fL，PDW分别为（15.78±1.26）、（17.67±1.16）、（16.72±1.21） fL，均较对照组[MPV：（8.24±1.76） fL，PDW：（12.86±1.42） fL]明显升高（Plt;0.05）；伤后14 d Plt、MPV和PDW均较对照组差异无统计学意义（Pgt;0.05）。GCS≤8分组伤后1 d Plt计数为（96.85±36.52）×109/L，明显低于GCSgt;8分组[（123.85±35.78）×109/L]，而GCS≤8分组MPV为（12.14±1.32） fL，PDW为（18.63±1.21） fL，均明显高于GCSgt;8分组[MPV：（9.78±1.34） fL，PDW：（16.72±1.34） fL]，差异均有统计学意义（Plt;0.05）。伤后第1天Plt与随访6个月GOS评分呈正相关（r=0.625，Plt;0.05）。 结论 中型和重型颅脑损伤后Plt计数明显降低，MPV和PDW值明显升高，且与伤情及预后有关。Plt及其参数的检测有助于对伤情、预后的判断。【Abstract】 Objective To investigate the platelet parameters changes and its clinical significance in medium and severe head injury patients. Methods From March 2009 to March 2010, 75 brain injury patients hospitalized within 24 h after injury were included in this study. The platelet number (Plt), mean platelet volume (MPV), platelet volume distribution width (PDW) and Glasgow coma scale were measured on the first, third, seventh and fourteenth day after injury respectively. We also measured the Plt, MPV and PDW of 60 healthy volunteers to make comparisons. Results The Plt counts were (106.21±36.31), (102.76±35.23), and (108.37±31.32)×109/L in the head injury patients on the first, third, and 7th day respectively, which were significantly lower than those in the control group [(210.41±68.56)×109/L] (Plt;0.05); the MPV and PDW values measured on the first day [MPV: (12.34±1.34) fL, PDW: (15.78±1.26) fL] and the third day [MPV: (11.21±1.52) fL, PDW: (17.67±1.16)fL] were both significantly lower than those of the control group (Plt;0.05); There was no evidence of a difference in Plt, MPV and PDW between the two groups fourteen day after injury (P＞0.05); The Plt count was (96.85±36.52)×109/L in GCS≤8 group on the first day, which was significantly lower than that of GCSgt;8 group [(123.85±35.78) fL, Plt;0.05]; However, the MPV and PDW values in GCS≤8 group [(MPV: (12.14±1.32) fL, PDW: (18.63±1.21) fL] were both significantly higher than those of GCSgt;8 group [MPV: (9.78±1.34) fL, PDW: (16.72±1.34) fL, Plt;0.05]; The Plt count was correlated with GOS score positively (r=0.625,Plt;0.05). Conclusions Medium and severe head injury patients are significantly associated with a lower Plt count and increased MPV and PDW values. The Plt parameters changes are correlated with the prognosis of patients. Therefore, the measurement of Plt parameters may contribute to the valuation of severity and prognosis, and provide new ideas for treatment of head injury patients.