目的 分析和总结采用双靶点伽玛刀治疗三叉神经痛术后疼痛缓解时间规律，为伽玛刀的临床治疗提供参考。 方法 2005年1月－2011年1月，共147例原发性三叉神经痛患者于四川大学华西医院接受Leksell C型伽玛刀治疗。使用4 mm准直器在三叉神经根制作2个等中心靶点，中心剂量80~90 Gy，控制脑桥照射剂量＜20 Gy。术后定期对患者进行随访，对疼痛缓解时间进行统计分析。 结果 130例患者获得随访，随访时间11～64个月，平均28.7个月。术后疼痛完全缓解95例（73.1%），部分缓解29例（22.3%），无效6例（4.6%）。疼痛缓解时间4 h～12个月，平均3.6周，其中疼痛完全缓解患者的疼痛缓解时间明显短于部分缓解患者（P＜0.05）。53例（40.8%）患者于术后出现术侧轻度面部麻木。 结论 患者术后疼痛缓解时间可能是预测伽玛刀治疗效果的重要因素，但疼痛缓解时间个体差异大，应进行长期随访观察。
Objective To systematically evaluate posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for Chiari malformation type I (CM-I). Methods A meta-analysis was performed according to the guideline of the MOOSE statement. Relevant literature and references were electronically searched in CENTRAL, Science Citation Index Expanded, MEDLINE (Ovid), PubMed, CBM, CNKI and WanFang Data from 1993 to September 2011. Two reviewers independently identified literature according to inclusion and exclusion criteria. The included studies were evaluated using the Newcastle-Ottawa Scale. Original data were extracted and analyzed using RevMan 5.1 software. Besides, the level of evidence was assessed using the GRADE system. Results Ten studies involving 829 patients were included. The results of meta-analyses showed that: a) compared with patients undergoing PFD, patients undergoing PFDD had a significantly lower reoperation rate (RR=0.41, 95%CI 0.23 to 0.74, P=0.003), and a higher rate of syringomyelia decrease (RR=1.27, 95%CI 1.03 to 1.56, P=0.02). But there was no significant difference in clinical improvement (RR=1.11, 95%CI 0.95 to 1.28, P=0.18). b) compared with PFD, patients undergoing PFDD had a higher rate of cerebrospinal fluid–related complications (RR=6.3, 95%CI 2.71 to 14.67, Plt;0.000 1). There were no significant differences in the complication of occipital neuralgia and wound infection (Pgt;0.05). Based on GRADE system, the evidence was at Level C and we made a weak recommendation. Conclusion Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation, a better effect of syringomyelia decrease and a greater risk for cerebrospinal fluid–related complications, compared with PFD. Due to the influencing factors of lower-quality included studies, a prudent choice is suggested, and also more high-quality, large-sample studies are need.
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.