Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
Objective To explore the effectiveness of cyanoacrylates (Fuaile) for spinal subdural benign tumorectomy to prevent the cerebrospinal fluid leakage. Methods Between January 2009 and March 2013, 35 patients underwent spinal subdural benign tumorectomy. Of 35 patients, Fuaile and gelatin sponge were used after stitch suture for a watertight closure of the dura in 19 cases (trial group), and only gelatin sponge was used after stitch suture in 16 cases (control group). There was no significant difference in gender, age, disease duration, types of tumors, and sites of tumors between 2 groups (P gt; 0.05). The ratio of watertight closure, incision healing, and relative complications were compared between 2 groups. Results All patients in 2 groups achieved watertight closure of the dura intraoperatively. There was no significant difference in operation time, intraoperative blood loss, length of dura incision, hospitalization time, total drainage volume, and drainage time between 2 groups (P gt; 0.05). Primary incision healing was obtained; no delayed healing, infection, or nerve compression occurred in all patients. At last follow-up, the ratios of successful watertight closure of trial and control groups were 89.5% (17/19) and 50.0% (8/16) respectively, showing significant difference (P=0.02). No delayed cerebrospinal fluid leakage or incision infection was found at 1 and 3 months after operation. Conclusion The application of cyanoacrylates for watertight closure of dura in spinal subdural benign tumorectomy is safe and effective.
【Abstract】 Objective To investigate the surgical management of dural injuries and postoperative cerebrospinal fluid(CSF) fistulas in spinal surgeries and to observe cl inical outcomes, since intraoperative injury of dura mater and postoperative CSF fistulas are common compl ications of spinal surgeries. Methods A retrospective research was designed and 405 patients with complete data who underwent spinal surgeries between June 2002 and March 2006 were acquired, including 298 cases of male and 107 cases of female, with the mean age of 46.2 years (ranging from 11 years to 78 years). The course of disease lasted from 3 months to 5 years. A total of 28 cases of intraoperative dural injuries and durotomies (28/405, 6.91%) were recorded, including 3 cases of cervical spinal surgery (3/152, 1.97%), 19 cases of thoracic and lumbar spinal surgery (19/239, 7.95%) and 6 cases of sacral surgery (6/14, 42.86%). CSF fistulas occurred in 6 cases of 28 patients. There were 2 cases in which no intraoperative dural injury was detected but CSF fistulas occurred after operation. The incidence of postoperative CSF fistula was 1.98% (8/405). Surgical management included closure of breach in the dura mater, oversewing every layer of the wound, bed rest and compression dressing and so on. Cl inical outcomes of surgical management were recorded. Results The average followup lasted for 1 year and 5 months (ranging from 3 months to 4 years). Preoperative symptoms remitted to different extents There were 8 cases of postoperative CSF fistula which were cured ultimately. A total of 6 cases of CSF fistulas from dorsal injuries of dura mater were treated mainly by bed rest, compression dressing and reoperations, while 2 cases of fistulas from ventral and lateral injuries of dura mater were treated by additional continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter. One case of central nervous system infection occurred and was treated successfully by multi-discipl inary disposal. Conclusion Timely and correct surgical intervention and postoperative management can help to heal dural injuries in spinal surgeries and can prevent occurrence of postoperative CSF fistulas.
From January, 1994 through March, 1995, 20 cases of CSF rhinorrhea happened during operation. The ages ranged from 20 to 76 years old. The types of tumors were: communicating craniofacial malignant tumors in 3 and pituitary adenoma in 17.The CSF fistulas were all repaired with autogeneous free muscle flaps, fat grains and gel foam, "threeinone" method. The defects of sphenoid and ethmoid bones and the dura mater ranged from 1.5 to 3.5cm and the filling materials used were 2 to 3 grams of fat grains and a muscle flap of 24cm in length, 1.82.5cm in width and 0.50.8cm in thickness. The survival rate from the implantation was 100 per cent, with satisfactory results. The patients were followed up for 1 to 14 months without any ill effect and recurrence of CSF rhinorrhea. The selection of the implanted material and its preparation were discussed. The main points in the surgical technique were introduced, and the mechanism of the implanted tissue was discussed preliminarily.
方法 2008年9月-2009年11月，将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例，外引流组进行持续腰池置管脑脊液外引流，定期取引流脑脊液进行常规和生化检查；抗生素组采用静脉抗生素治疗。对两组颅内感染情况进行对比分析。 结果 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
目的：研究脑脊液置换术治疗蛛网膜下腔出血的效果。方法：蛛网膜下腔出血79例为治疗组及30例对照组，给予常规药物治疗，治疗组在此基础上增加脑脊液置换疗法。结果：治疗组疗效优于对照组、治疗有效率及死亡率上差异均有显著。 结论：脑脊液置换术对蛛网膜下腔出血具有较好的疗效，值得进一步推广。
ObjectiveTo explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. MethodsA retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging (44.3±15.9) years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging (40.2±10.7) years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in one-stage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. ResultsIn the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was (43.4±4.5) days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was (22.7±2.7) days. None of the 13 patients suffered intracranial infection. ConclusionMaxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for moderate craniocerebral injury