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临床神经外科杂志

临床神经外科杂志

CSTPCD

Journal of Clinical Neurosurgery
本刊面向全国的神经内外科医务人员及研究人员，力刊目的是促进神经外科事业的交流和发展
  • 发文量：2138
  • 被引量：854
  • H指数：1
  • 开始收录时间：2004(1)
  • CNKI综合因子：0.629
  • 维普期刊影响因子： 1.22
  • 万方期刊影响因子：1.1
  • 创刊时间：2004
  • 国内刊号/CN：32-1727/R
    国际刊号/ISSN：1672-7770
  • 发行周期：双月刊
    邮发代号：28-316
  • 主管单位：江苏省卫生厅
    主办单位：南京医科大学附属脑科医院
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  • 地址：江苏省南京市广州路264号
  • 邮编：210029
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  • • 2018年江苏省十佳期刊传播奖
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临床神经外科杂志 >2023年第5期

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  • 摘要：Objective To explore the clipping strategy of paraclinoid carotid aneurysms. Methods The clinical data of 11 patients with paraclinoid aneurysms who underwent aneurysm clipping in our department from February 2017 to October 2017 were analyzed retrospectively. According to modified Barami classification,2 aneurysms were type Ⅰa,3 type Ⅰb,3 type Ⅱ,3 type Ⅲa and 1 was type Ⅲb.5 aneurysms were clipped with balloon-assisted retrograde suction decompression in hybrid operation room.Clinical outcome was evaluated by Glasgow outcome scale (GOS).Results All patients received the removal of the anterior clinoid process.5 aneurysms were clipped,and 6 aneurysms were treated with clip reconstruction.Among 4 patients received a double-lumen Merci guiding balloon and retrograde suction decompression,only 2 aneurysms were deflated, whereas the other 2 aneurysms did not collapse.Intraoperative angiography or postoperative CT angiography showed 10 aneurysms were successfully obliterated,and only 1 aneurysm was residue. One patient developed decreased vision,1 patient had oculomotor paralysis.No aphasia or any limb paralysis occurred in all patients.Before discharge,all patients had good prognosis(GOS 4-5). Conclusions Clipping strategy of paraclinoid carotid aneurysms depends on classification and aneurysm size.Straight clips were used in type I,whereas fenestrated clips were used frequently in type II and III.Balloon-assisted retrograde suction decompression in hybrid operating room seems to facilitate clipping of large and giant paraclinoid aneurysms.%目的 探讨床突旁动脉瘤的手术夹闭治疗方法.方法 回顾性分析2017年2~10月经直接手术夹闭的11例床突旁动脉瘤患者的临床资料.其中动脉瘤改良Barami分型Ⅰa型2个,Ⅰb型3个,Ⅱ型3个,Ⅲa型2个,Ⅲb型1个.5例患者在复合手术室应用球囊辅助手术夹闭治疗.根据格拉斯哥预后量表(Glasgow outcome scale,GOS)评分评定临床疗效.结果 本组患者的11个动脉瘤均术中磨除前床突后,成功夹闭动脉瘤;其中5个动脉瘤行直接夹闭,6个动脉瘤行塑形夹闭.1例患者应用Hyperform球囊临时阻断;4例患者应用Merci双腔球囊导引导管逆行抽吸颈内动脉;其中2例患者抽吸成功,瘤体明显塌陷,2例患者仅瘤壁张力减低.术后即刻DSA或CTA检查示,10个动脉瘤完全闭塞,仅1个动脉瘤瘤颈少许残留.患者术后出现视力下降1例,动眼神经麻痹1例;所有患者均无言语或肢体功能障碍发生.出院时11例患者均预后良好(GOS评分4~5分).结论 床突旁动脉瘤的手术夹闭治疗方法取决于动脉瘤的分型和瘤体大小.改良Barami分型Ⅰ型动脉瘤常采用平行于载瘤动脉直接夹闭,Ⅱ、Ⅲ型动脉瘤则使用跨血管夹塑形夹闭.采用复合手术室球囊辅助逆行抽吸技术,有利于床突旁大型或巨大动脉瘤的手术夹闭.
  • 摘要：目的 探讨颅内破裂微小动脉瘤血管内介入治疗的可行性和疗效.方法 回顾性分析39例颅内破裂微小动脉瘤患者的临床资料.所有患者均行血管内介入治疗,术后立刻再行血管造影观察治疗效果.结果 术后即刻血管造影显示,致密栓塞30例(76.9%),不完全栓塞9例(23.1%),其中瘤颈残余5例和部分栓塞4例.39例患者均临床治愈出院,恢复独立生活能力.有34例患者随访时间6~12个月,DSA复查显示,25例致密栓塞患者的动脉瘤无复发;9例不完全栓塞患者中,除2例患者无变化外,其余患者均动脉瘤完全闭塞.所有患者均无动脉瘤再破裂出血.结论 血管内介入栓塞治疗破裂微小动脉瘤的效果满意,是其理想的治疗方式.%Objective To explore the clinical efficacy and safety of endovascular embolization for intracranial ruptured very small aneurysms.Methods The clinical data of 39 patients with intracranial ruptured very small aneurysms were analyzed retrospectively.All patients were treated by endovascular embolization.Angiography was performed immediately after embolization to test the efficacy of treatment.Results Angiography showed that complete occlusion was achieved in 30 cases(76.9%),incomplete occlusionin 9(23.1%)(aneurysm neck residue in 5 and partial occlusion in 4).All patients were clinically cured and discharged,and restored independent living ability.34 cases were followed up for 6-12 months with angiography test.The result showed that no recurrence was found in 25 complete occlusion cases,and in 9 incomplete occlusion cases,except 2 cases without changes,all other cases were occluded.The follow-up showed no re-bleeding occurred. Conclusions The results of follow-up are satisfactory.Endovascular embolization for intracranial ruptured very small aneurysms is safe and effective.
  • 摘要：目的 探讨颅内多发动脉瘤显微手术治疗的策略、手术时机及效果.方法 回顾性分析2014年12月至2017年6月,采用显微手术治疗的30例颅内多发动脉瘤患者的临床资料.其中男6例,女24例;年龄38~79岁,平均年龄56.13岁.手术策略包括一期手术(一次手术处理所有动脉瘤),二期手术(分期手术处理全部动脉瘤)及部分治疗(仅处理责任动脉瘤).全部患者术前均行头颅CT血管成像(CTA)或DSA检查;术后用格拉斯哥预后量表(GOS)评分进行疗效评定.结果 一期手术者20例,二期手术者3例,部分治疗者7例.GOS评分5分(恢复良好)者20例,4分(轻度残疾)3例,3分(重度残疾)4例,2分(植物生存) 1例,1分(死亡)2例.结论 颅内多发动脉瘤的显微手术治疗较复杂;应制订个性化的手术方案,优先处理责任动脉瘤,选择合适的手术时机尽早手术,一期手术与二期手术相结合,可达到最佳的治疗效果.%Objective To discuss the surgical strategy,operation time and the operation effect of multiple intracranial aneurysms(MIA).Methods The clinical data of 30 patients with MIA underwent microsurgery from December 2014 to June 2017 were analyzed retrospectively.Of 30 patients,6 were male and 24 were female.Patients aged from 38 to 79,the average age was 56.13 years old.Surgical strategies included one-stage operation(all aneurysms were treated by one operation),two-stage operation(aneurysms were treated stage by stage)and partial treatment(only ruptured aneurysm was treated).All patients underwent CTA or DSA before surgery.They were evaluated by the Glasgow prognostic scale(GOS)after operation.Results 20 patients underwent one-stage operation,3 underwent two-stage operation and 7 underwent partial treatment.According to GOS,20 patients had good recovery),3 slightly disabled,4 severely disabled,1 vegetative state and 12 died.Conclusions Microsurgical treatment of MIA is very complicated,the individualized treatment protocols should be developed.We should give priority to ruptured aneurysm,choose the right opportunity for surgery as soon as possible,combine the one-stage operation with the two-stage operation.Only in this way can we achieve the best treatment effect.
  • 摘要：目的 探讨血清降钙素原(PCT)水平与重症颅脑疾病所患呼吸机相关性肺炎(VAP)的关系,以及PCT对VAP早期诊断的意义;评价血清PCT及PCT结合临床肺部感染评分(CPIS)早期诊断VAP的特异性、敏感性.方法 2014年8月1日~2016年12月31日NICU收治的60例需有创机械通气的重型颅脑疾病患者;根据病情分为VAP组(40例)和肺部正常组(20例).动态监测两组患者的血清PCT水平及体温、呼吸道分泌物和CPIS评分,检测血白细胞数和C反应蛋白(CRP).比较两组患者的血清PCT水平;并将VAP组患者按预后分为好转组和进展组,分析比较其PCT及CPIS分值.结果 VAP组第1~7 d血清PCT水平均明显高于正常组,差异有统计学意义(均P<0.05);VAP组的血清PCT水平峰值于第6 d出现.治疗7 d后,VAP组患者中病情好转24例,进展16例.VAP进展组患者第1~6 d血清PCT水平高于好转组,但差异无统计学意义;第7 d差异有统计学意义(P<0.05).VAP进展组与好转组患者第1 d、第3 d CPIS评分比较,差异无统计学意义(均P>0.05),第5 d、第7 d进展组高于好转组,差异有统计学意义(均P<0.001).PCT用于诊断重症颅脑疾病VAP的敏感性为92.5%,特异性为85.0%;PCT联合CPIS评分诊断重症颅脑疾病VAP的敏感性为95.0%,特异性为90.0%.结论 PCT检测可提高重症颅脑疾病VAP早期诊断的准确率,其敏感性和特异性较好.动态监测PCT,并结合CPIS评分对重症颅脑疾病患者的VAP诊断及预后具有重要的临床指导意义.%Objective To analyse the relationship between serum procalcitonin(PCT)and ventilator-associated pneumonia(VAP),explore the early diagnostic value of serum PCT in VAP and evaluate the specificity and sensitivity of serum PCT and PCT associated with clinical pulmonary infection score(CPIS)for the early diagnostic value of VAP.At the same time,the early sensitivity and specificity for diagnosis of VAP between single PCT and PCT combining CPIS were observed. Methods 60 patients with severe craniocerebral diseases who used invasive mechanical ventilation in our hospital's NICU from August 1st to December 31st,2014 were selected.According to patients'condition,they were divied into VAP group(n =40)and non VAP group(n=20).Body temperature,respiratory secretions,and CPIS were monitored dynamicly,and the level of white blood cell,PCT and C reactive protein(CRP)were also tested.Differences of serum PCT between two groups were compared.VAP group was divied into improvement group and worsen group according to the prognosis.Differences of serum PCT and CPIS between two groups were compared.Results The level of PCT in VAP group was obviously higher than that in normal group(all P<0.05)from the 1st day to the 7th day,and the peak value of PCT in VAP group appear on the 6th day.After treatment for seven days,24 patients'condition improved,but 16 patients'condition got worse in VAP group.We observed the dynamic changes of PCT between the two groups:the level of PCT in worsen group was higher than that in improvement group from 1st day to 6th day,but there was no statisical difference,but the level of PCT between two groups has statisical difference on 7th day(P<0.05). There was no statisical difference for CPIS on 1st day and 3rd day between the two groups(all P>0. 05),but CPIS of worse group was higher than that of improvement group(all P<0.001)on 5th day and 7th day.The sensitivity of single PCT in the diagnosis of VAP for the patients with severe craniocerebral diseases was 92.5%,and the specificity was 85.0%.The sensitivity of PCT combining CPIS in the diagnosis of VAP for the patients with severe craniocerebral diseases was 95.0%,and the specificity was 90.0%.Conclusions Monitoring of PCT can improve the accuracy of early diagnosis of VAP for the patients with severe craniocerebral diseases,and have good sensitivity and specificity. Dynamic monitoring of PCT and PCT combining CPIS has important clinical value for the diagnosis and prognosis of VAP for the patients with severe craniocerebral diseases.
  • 摘要：目的 探讨同期腰大池腹腔分流及颅骨修补术在去骨瓣减压术后发生交通性脑积水患者治疗中的临床应用价值.方法 回顾性分析2015年1月至2017年1月苏州市相城人民医院神经外科采用同期腰大池腹腔分流及颅骨修补手术,治疗13例去骨瓣减压术后发生交通性脑积水患者的临床资料及疗效.评价此联合手术方式治疗去骨瓣减压术后并发交通性脑积水的优势.结果 本组患者的总有效率为92.3%;术后未出现颅内出血、感染等严重手术相关并发症;只有1例患者出现分流管阀门切口感染,并发症发生率为7.7%.结论 同期腰大池腹腔分流及颅骨修补手术治疗去骨瓣减压术后发生交通性脑积水更安全、简便,能明显降低颅内出血及感染等手术相关并发症,值得临床推广应用.%Objective To assess the clinical value of lumboperitoneal shunt and cranioplasty on one -stage in treatment of communicating hydrocephalus and cranial defect after decompressive craniectomy.Methods The clinical data of 13 patients diagnosed with communicating hydrocephalus after decompressive craniectomy underwent lumboperitoneal shunt and cranioplasty on one-stage from January 2015 to January 2017 were analyzed retrospectively. Therapeutic effect and complications were analyzed postoperatively.Results Good results were achieved after operation which total effective rates were 92.3%.There were no serious complications such as intracranial hemorrhage,intracranial infection after operation.Only one case had shunt valve incision infection.Complications rate was 7.7%.Conclusions Lumboperitoneal shunt and cranioplasty on one-stage is a safe and convenient method for the treatment of patients with communicating hydrocephalus and cranial defect after decompressive craniectomy.
  • 摘要：Objective To investigate the risk factors of subdural effusion in patients with craniocerebral trauma. Methods The clinical data of 1126 patients with craniocerebral trauma from September 2008 to January 2016 were analyzed retrospectively.The relevant factors of age,gender,GCS score,injury type,decompressive craniectomy, dehydrated drug,therapeutic time of dehydrated drug and dura sutured tightly were analyzed to evaluate the risk factors of subdural effusion in craniocerebral trauma patients.Results 49 patients(4.4%)complicated with subdural effusion.Univariate analysis showed that age,GCS score,decompressive craniectomy,dehydrated drug and therapeutic time of dehydrated drug were the risk factors of subdural effusion in craniocerebral trauma patients. Multivariate logistic regression analysis showed that age(OR 1.923,95% CI 1.436 -4.215,P =0.037), decompressive craniectomy(OR 2.176,95%CI 1.557-6.049,P=0.010)and dehydrated drug(OR 1.874,95%CI 1.209 -6.572,P =0.041)were the risk factors of subdural effusion in craniocerebral trauma patients. Conclusion The traumatic subdural effusion(TSE)may be associated with age,decompressive craniectomy and dehydrated drug.%目的 探讨颅脑创伤患者发生硬脑膜下积液的危险因素.方法 回顾性分析盐城市第三人民医院神经外科2008年9月至2016年1月收治的1126例颅脑创伤患者的临床资料.对患者的年龄、性别、格拉斯哥昏迷量表(GCS)评分、颅脑创伤类型、去骨瓣减压、使用脱水药、脱水药使用的时间和硬脑膜严密修补进行单因素分析;对有统计学意义的指标进行多因素Logistic回归分析,确定颅脑创伤后发生硬脑膜下积液的危险因素.结果 49例患者(4.4%)并发硬脑膜下积液.单因素分析显示,年龄、GCS评分、去骨瓣减压、脱水药使用、脱水药使用时间与颅脑创伤并发硬脑膜下积液有关.多因素Logistic回归分析显示,年龄(OR值1.923,95%CI 1.436~4.215,P=0.037)、去骨瓣减压(OR值2.176,95%CI 1.557~6.049,P=0.010)、使用脱水药(OR值1.874,95%CI 1.209~6.572,P=0.041)为颅脑创伤并发硬脑膜下积液的危险因素.结论颅脑创伤并发硬脑膜下积液(TSE)可能与年龄、去骨瓣减压及使用脱水药相关.
  • 摘要：面神经是以运动神经为主的混合神经,由运动、感觉、副交感神经纤维共同组成,靠近中耳和内耳结构,与前庭神经伴行,与椎动脉或小脑上动脉、小脑下后动脉临近,并穿过腮腺。面神经容易被周围组织病变累及和发生炎症,成为发病最多的颅神经。面神经疾病中包括炎性疾病、损伤、压迫性疾病、周围肿瘤累及等。其病理生理改变主要是神经核兴奋性增高、神经水肿、脱髓鞘改变和神经变性,进而影响神经纤维的生物电传导。
  • 摘要：Objective To explore the related factors of the effect of post-operative arterial aneurysm(PCoA)and to improve the prognosis of patients.Methods The clinical data of 204 patients who underwent aneurysm clipping were performed by Glasgow outcome scale(GOS)were analyzed retrospectively.Results The patients'gender,age,and the size of the aneurysm, postoperative complications,oculomotor nerve paralysis,intraoperative blood flow blocking time was not the significant factors influencing the prognosis of surgery,and Fisher grading,intraoperative rupture,preoperative Hunt-Hess grading,times of preoperative SAH,cerebral vasospasm(CVS), aneurysm neck width was the independent risk factors affecting prognosis,among them,the preoperative Hunt-Hess classification(P =0.000),number of preoperative SAH(P =0.001), cerebral vasospasm(CVS)(P=0.000)was a strong correlation factors influencing surgical curative effect.Conclusion The preoperative Fisher grading,intraoperative rupture,preoperative Hunt-Hess classification,times of preoperative SAH,cerebral vasospasm(CVS),aneurysm neck width analysis can assess the patient's prognosis.%目的 探讨影响后交通动脉瘤(PCoA)夹闭术疗效的相关因素,为提高手术效果改善患者预后提供借鉴.方法 回顾性分析2012年1月至2017年6月204例行开颅夹闭术且符合纳入标准的后交通动脉瘤患者的临床资料,以格拉斯哥预后量表(GOS)评分作为预后标准,选取可能影响预后的12项因素先进行单因素分析,选取其中有统计学意义因素进行多分类有序Logistic回归分析并选择出对预后有意义的因素.结果 患者的性别、年龄、动脉瘤大小、术后并发症、术中血流阻断时间、动眼神经麻痹不是影响手术预后的因素,而Fisher分级、术中有无破裂、术前Hunt-Hess分级、术前SAH次数、脑血管痉挛(CVS)、动脉瘤颈宽是影响预后的因素.其中,术前Hunt-Hess分级(P=0.000)、术前SAH 次数(P=0.001)、脑血管痉挛(P=0.000)是影响手术疗效的独立危险因素.结论 通过对术前Fisher分级、术中有无破裂、术前Hunt-Hess分级、术前SAH次数、脑血管痉挛、动脉瘤颈宽的分析,可对患者的预后情况进行评估.
  • 摘要：Objective To study the experience of emergent surgery dealing with anterior circulation intracranial aneurysm at primary level hospital.Methods The clinical data of 38 patients with anterior circulation aneurysm underwent emergent operation were analyzed retrospectively.Results Among 38 cases,included 38 ruptured and 3 unruptured aneurysm,27 were anterior cerebral communicating aneurysm(Acom An),8 middle cerebral aneurysm(MCA An),6 internal carotid artery-posterior communicating artery aneurysm(Pcom An),1 anterior choroidal artery aneurysm(AChoA). There were 10 cases of mature rupture and 1 case of immature rupture during the process of exposing the aneurysm.Bone flap were removed in 13 cases and put back in 25.28 patients recovered to normal life with no obvious disability,4 cases with contralateral paralysis and/or other deficit,4 remained in vegetative state and 2 died after operation.Conclusion Having intimate knowledge of the microanatomy about intracranial artery,skillful dissecting technique,selecting appropriate cases are crucial to carry out emergent ruptured anterior circulation intracranial aneurysm surgery in primary level hospital.%目的 研究基层医院开展急诊手术治疗前循环颅内动脉瘤的效果及临床经验.方法 回顾性分析38例前循环动脉瘤急诊手术患者的临床资料.结果 38例患者共有41个动脉瘤,其中前交通动脉瘤27个、大脑中动脉瘤8个、颈内后交通动脉瘤5个、脉络膜前动脉瘤1个;38个动脉瘤为破裂动脉瘤,3个为对侧未破裂的动脉瘤.38个破裂动脉瘤均行急诊动脉瘤夹闭术,3个对侧未破裂动脉瘤行择期手术.手术中瘤颈完全显露时破裂者10例,瘤颈未完全显露时破裂者1例;13例患者去骨瓣,25例患者骨瓣复位.28例患者术后恢复正常,无明显后遗症,4例患者有对侧肢体不全瘫痪,4例患者植物生存,2例患者术后死亡.结论只要具备丰富的颅内动脉显微解剖知识,掌握一定的显微手术操作技巧,严格选择合适的病例;基层医院神经外科可以谨慎地开展前循环颅内动脉瘤急诊手术,并取得较好的疗效.
  • 摘要：Objective To compare the effect of microvascular decompression(MVD)versus percutaneous balloon compression(PBC)for recurrent trigeminal neuralgia after MVD.Methods The clinical data of 92 patients o with recurrent trigeminal neuralgia after MVD,in whom 25 were treated by MVD(MVD group),and 67 by PBC(PBC group)from January 2009 to January 2016, were analyzed retrospectively.The therapeutic efficacy, operation time, inpatient time and complications were compared between two groups.Results There were no significant differences in overall effective rate between two groups(96.0%vs.94.0%,P>0.05).However,the curative rate in MVD group was higher than that in PBC group(88.0% vs.64.2%,P<0.05).The recurrence rate was higher in PBC group than in MVD group(27.0%vs.4.2%,P<0.05).The operation time and hospital stay in MVD group was longer than that in PBC group[(102.0 ±28.2)min vs.(20.9 ±10.6)min,(11.7 ±3.5)d vs.(4.3 ±1.8)d,all P <0.05).The incidence of trigeminal depressor response and facial numbness was significantly greater in PBC group than MVD group (26.9%vs.4.0%,92.5% vs.16.0%,all P <0.05).There was no significant differences of herpetic stomatitis in both groups(32.0 % vs.40.3%,P >0.05).37 patients had masseter weakness in PBC group.One patient had surgical incision infection and one patient had tinnitus in MVD group.Conclusions MVD and PBC both are effective in treatment of recurrent trigeminal neuralgia after MVD.The MVD is higher cure rate,lower pain recurrence rate and lower incidence of trigeminal depressor response,facial numbness and masseter weakness.The PBC has the higher security,minimal injury,shorter operation time and inpatient time.%目的 探讨微血管减压术(MVD)与经皮穿刺球囊压迫(PBC)治疗MVD术后复发三叉神经痛的临床疗效.方法 回顾性分析2009年1月至2016年1月分别采用MVD(25例,MVD组)与PBC(67例, PBC组)治疗的MVD术后复发三叉神经痛患者的临床资料,比较两组患者的手术疗效、手术时间、住院时间及并发症.结果 MVD组和PBC组的有效率分别为96.0%和94.0%,两组比较差异无统计学意义(P>0.05);MVD组治愈率高于PBC 组(88.0% vs 64.2%,P<0.05);PBC 组复发率高于MVD组(27.0% vs 4.2%,P<0.05);MVD组手术时间及住院时间长于PBC组[(102.0 ±28.2)min vs(20.9 ±10.6)min,(11.7 ±3.5)d vs(4.3 ±1.8)d,均P<0.05);PBC组三叉神经抑制反应、面部麻木发生率高于MVD组(26.9% vs 4.0%,92.5%vs 16.0%,均P<0.05);MVD组与PBC组口角疱疹发生率比较差异无统计学意义(32.0 % vs 40.3%,P>0.05).PBC组出现咀嚼肌乏力37例;MVD组发生切口感染1例,术侧耳鸣1例.结论 MVD和PBC均能有效治疗MVD术后复发三叉神经痛.MVD的治愈率高,复发率低,三叉神经抑制反应、面部麻木、咀嚼肌乏力等并发症少;而PBC具有安全性高、创伤小、手术时间及住院时间短的优点.
  • 摘要：目的 探讨有创颅内压监测在颅脑外伤术后的临床应用价值.方法 对61例颅脑外伤行开颅手术患者,术中放置颅内压探头于硬膜下或脑室中;术后用颅内压监护仪连续观察颅内压数值,同时观察患者意识、瞳孔及生命体征变化.根据颅内压的变化及时指导、调整治疗方案.结果 本组患者中,颅内压正常者25例,未使用脱水剂;其余患者均使用不同剂量的甘露醇、速尿、白蛋白、甘油果糖等降颅内压药物,应用时间为2~11 d.1例患者术后当天死亡,死亡原因为脑干功能急性衰竭.3例患者在监测过程中发现颅内压骤然升高,考虑颅内迟发性血肿或脑挫伤血肿增大,及时复查头颅CT证实诊断而行二次手术治疗.相关性分析结果显示,患者术后第1 d脱水前颅内压越高,其术后6个月时的预后越差(χ2=9.55,P<0.05).患者术后颅内压与格拉斯哥昏迷量表(GCS)评分呈负相关(r=-0.643,P<0.05).结论 有创颅内压监测是诊断颅脑外伤术后颅高压最迅速、客观和准确的方法,也是观察患者病情变化、早期诊断、判断手术时机、指导临床药物治疗,判断和改善预后的重要方法,值得临床重视与推广.%Objective To investigate the clinical application of invasive intracranial pressure monitoring after craniocerebral trauma operation.Methods 61 cases of craniocerebral trauma underwent operation were selected from Jan.2015 to Jun.2016 in our hospital.Codman intracranial pressure monitor was used intraoperatively.Intracranial pressure data were continuously observed and recorded postoperatively.Meanwhile,patients'awareness,pupil and vital signs were observed closely. The therapy plan could be decided or adjusted in time according to the monitoring results. Results 25 cases of normal ICP in this group,without the use of dehydrating agents,the rest of the patients were using different doses of intracranial pressure lowering drugs such as mannitol, furosemide,albumin and glycerol fructose.The application of time for 2 to 11 days.One of the cases died on the day of the operation,the cause of death was the acute brain stem function failure.3 cases in the monitoring process found a sudden increase in intracranial pressure were considered delayed intracranial hematoma or brain contusion hematoma increased.Timely CT review confirmed diagnosis and conducted secondary surgery.The relationship between the ICP before dehydration at the first day after surgery in patients and the prognosis 6 months later were observed and it was found that the higher the intracranial pressure,the worse the prognosis(χ2=9.55,P<0.05).Correlation analysis results showed that there was a negative correlation between ICP and GCS(r=-0.643,P<0.05). Conclusions The invasive intracranial pressure monitoring is the most rapid, objective and accurate method.It is also an important method such as to observe the change of patients'condition, early diagnosis,determine the timing of the operation,guiding drug prescription,to judge and improve prognosis.In summary,it is worth attention and promotion.
  • 摘要：Objective To evaluate the curative effects of the surgical treatment for hypertensive cerebellar hemorrhage.Methods The clinical data of 35 patients with hypertensive cerebellar hemorrhage underwent operation from January 2007 to June 2013 were analyzed retrospectively.Results All patients were followed up for six months after operations.GOS score showed that there were 19 patents in grade Ⅴ,6 in gradeⅣ,3 in gradeⅢand 7 in gradeⅠ.The majority symptoms of patients were dizziness, nausea, ataxia.Conclusions Hypertensive cerebellar hemorrhage has the rapid progression of disease,with high morbidity and mortality.Early diagnosis and early operation are the keypoints to improve the prognosis.%目的 探讨外科手术治疗高血压性小脑出血的疗效.方法 回顾性分析2007年1月至2013年6月手术治疗的35例高血压性小脑出血患者的临床资料;观察疗效并进行随访.结果 术后随访6个月,格拉斯哥预后量表(GOS)评分为良好者19例,中残6例,重残3例,死亡7例.25例良好和中残患者术后均有不同程度的头晕、恶心、共济失调等症状.结论 高血压性小脑出血病情重,进展迅速,具有很高的致残率和死亡率;及早诊断和手术,是提高治疗效果的关键.
  • 摘要：Objective To investigate the clinical characteristics,the diagnosis and treatment of diabetes insipidus subsequent to thalamic hemorrhage.Methods The clinical data of 1 patient with secondary diabetes insipidus of right thalamic hemorrhage was analyzed retrospectively and the relevant literature were reviewed.Results The patient was diagnosed right thalamic hemorrhage,volume of 10 mL with obvious edema.Due to closely monitoring the amount of urine,the urine volume 5 100/24 h,diabetes insipidus was detected at the fourth day of the occurrence timely.The urine volume returned to normal level after the prompt treatment with desmopressin acetate.According to the literature reports,the mechanism of diabetes insipidus associated with thalamic hemorrhage may be related to the volume of hematoma and the degree of brain edema.Conclusion Large volume of hematoma and obvious edema of thalamic hemorrhage patients are prone to diabetes insipidus,early detection and early treatment are mostly good prognosis.%目的 探讨丘脑出血并发尿崩症的临床特点及诊疗经验.方法 回顾性分析1例丘脑出血并发尿崩症患者的临床资料,并对相关文献进行复习.结果 本例患者为右侧丘脑出血,出血量10 mL,血肿周围水肿明显.因密切监测尿量发现患者发病第4 d出现尿崩,24 h尿量达5100 mL;及时采用醋酸去氨加压素等治疗后尿量恢复至正常水平.结合文献报道,考虑丘脑出血并发尿崩的机制可能与丘脑出血量及脑水肿程度等相关.结论 丘脑出血量大、水肿重的患者容易出现尿崩症,早期发现、早期治疗,大多预后良好.
  • 摘要：癫痫是一种慢性反复发作性短暂脑功能失调综合征,以脑神经元异常放电引起反复痫性发作为特征,这一病症严重影响患者的日常生活。其中颅脑外伤后产生的癫痫（posttraumatic epilepsy,PTE）是脑外伤后最严重的并发症之一。有报道称57%癫痫患者的病因与脑外伤相关^（[2]）。在颅脑损伤后,会导致相关区域的脑组织产生电生理的异常。
  • 摘要：吞咽障碍是脑卒中的常见并发症之一,其发生率高达37%~78%。脑卒中后吞咽障碍患者常并发吸入性肺炎、营养不良和脱水等,导致患者的病死率显著增高^（[1-2]）。有研究表明,吞咽障碍是脑卒中患者死亡的独立危险因素之一^（[3]）。越来越多的研究报道,药物在促进受损的吞咽皮质功能恢复方面的作用甚小^（[4-5]）。因此,探索对脑卒中后吞咽障碍患者的非药物治疗尤为重要。
  • 摘要：目的 探讨神经内镜下手术治疗脑室内胆脂瘤的手术技巧和疗效.方法 回顾性分析7例神经内镜下手术治疗的脑室内胆脂瘤患者的临床资料.肿瘤主体分别位于侧脑室5例、三脑室2例,合并脑积水5例.结果 7例患者的脑室内胆脂瘤均得到瘤体全切.其中包膜全切2例,包膜部分切除5例;4例患者行三脑室底造瘘术,2例患者行透明隔造瘘术.合并脑积水患者术后脑积水明显改善,无明显手术并发症.平均随访23.4个月,无复发及脑积水加重病例.结论 神经内镜下手术治疗脑室内胆脂瘤是一种创伤小、全切率高、安全性高的有效方法,尤其适合合并脑积水的患者;术中同时行三脑室底造瘘或透明隔造瘘可有效缓解脑积水.%Objective To explore the surgical techniques and effects of intraventricular epidermoid cyst treated by operation with neuroendoscope.Methods The clinical data of 7 patients with intraventricular epidermoid cyst treated by operation with neuroendoscope were analyzed retrospectively,which located in 5 of lateral ventricles,third ventricles in 2 and 5 of them with hydrocephalus.Results Total removal was achieved in all cases,condition with hydrocephalus was improvement after the surgery.There was no complication relate to surgery,and no condition get worse and cyst relapse by the follow up.Conclusions Neuroendoscopic procedure is an effective method for intraventricular epidermoid cyst,which is minimally invasive,high total removal rate and high sfaty.Especially suitable for the cases with hydrocephalus,third ventriculostomy and pellucid septostomy during the surgery can effectively relieve the hydrocephalus.
  • 摘要：Objective To explore the protection of sesamin in brain damage after experimental intracerebral hemorrhage.Methods Manufacture of autologous blood cerebral hemorrhage model in mice.Rats were randomly divided into sham operation group,cerebral hemorrhage group and the injection of sesamin in cerebral hemorrhage group.The changes of brain edema by weighing tissue dry wet weight were observed.Blood-brain barrier damage by the evans blue effusion quantity were evaluated.The expression of tight junction protein in the blood brain barrier by double-labelling immunofluorescence and western blot were detected.The expression of inflammation factor IL-1β,IL-6,and TNF-α in cerebral hemorrhage by Real-time fluorescent quantitative PCR were detected. Results Sesamin significantly reduced the severity of brain edema of cerebral hemorrhage(P <0.05).The effusion quantity of evans blue(P<0.001)and the degradation of tight junction protein after cerebral hemorrhage were reduced.The structural integrity of the blood-brain barrier were improved.The inflammatory response after cerebral hemorrhage were suppressed.Conclusion Sesamin probably protect the brain injury after intracerebral hemorrhage by inhibiting the inflammatory reaction,improve the blood brain barrier damage and reduce brain edema.%目的 探讨芝麻素对实验性脑出血后继发脑损伤的保护作用.方法 采用自体血脑出血模型,随机将小鼠分为假手术组、脑出血组、脑出血后注射芝麻素组.称量脑组织干湿重来观察脑水肿的变化;通过伊文思蓝渗出量评估血-脑屏障的破坏;同时用免疫荧光双标和Western blot方法检测血-脑屏障结构中紧密连接蛋白的表达改变;采用实时荧光定量PCR检测脑出血周围组织中炎症因子IL-1、IL-6和TNF-α的表达水平.结果 芝麻素显著减轻了脑出血后脑组织的水含量(P<0.05);减少了伊文思蓝的渗出量(P<0.001)和紧密连接蛋白的降解;并降低了炎症因子IL-1β、IL-6和TNF-α的表达水平(均P<0.001).结论 芝麻素可能是通过抑制炎症反应,改善血-脑屏障的破坏,减轻脑水肿,从而保护脑出血后继发脑损伤.
  • 摘要：目的 探讨持续颅内压(ICP)监测在自发性脑出血破入脑室治疗中的意义.方法 100例自发性脑出血破入脑室患者,其中50例患者行侧脑室穿刺引流加持续性ICP监测(ICP监测组),另50例患者单纯行侧脑室穿刺引流(对照组).比较两组患者的预后、并发症的发生率、脱水剂用量及再出血发生率.结果 ICP监测组与对照组患者的预后比较,差异无统计学意义(P>0.05).ICP监测组患者血电解质紊乱、肾功能损害的发生率及甘露醇使用量均明显少于对照组(P<0.05~0.01).两组其他并发症及再出血的发生率之间比较,差异均无统计学意义(均P>0.05).结论 持续ICP监测并不能改善自发性脑出血破入脑室患者的预后,但可以减少甘露醇的使用量及部分并发症的发生率;并能及时预警患者病情的变化.%Objective To investigate the significance of continuous intracranial pressure(ICP) monitoring in the treatment of spontaneous intracerebral hemorrhage(SICH)for patients. Methods Of 100 patients with SICH,50 underwent lateral ventricle puncture drainage combined with continuous ICP monitoring in ICP monitoring group(n=50),other 50 were treated with lateral ventricle puncture drainage as control group(n =50).The overall prognosis,the incidence of complications,dehydration agent usage and rebleeding were compared.Results Compared to the ICP monitoring group and control group,there was no significant difference in overall survival(P>0.05).The electrolyte disorders,renal dysfunction and the per capita amount of mannitol in the ICP monitoring group were less than in the control group(P<0.05-0.01).There was no significant difference between the two groups in the other complications and rebleeding(all P >0.05). Rebleeding could be found timely through continuous ICP monitoring.Conclusion Continuous ICP monitoring could not improve the prognosis of patients with SICH into the ventricles of the brain,but could reduce the use of mannitol and the incidence of some complications,and timely warning of changes in the disease.
  • 摘要：Object To study the therapeutic effects of stereotactic microimpact burr-hole drainage and conservative treatment for conscious patients of hypertensive cerebral hemorrhage in basal ganglia area.Methods The clinical data of 116 conscious patients with hypertensive cerebral hemorrhage in basal ganglia area from October 2013 to October 2016 were analyed retrospectively.Of 116 patients,74 were treated with stereotactic microimpact burr-hole drainage with instillation of urokinase,and 42 received conservation treatment.compared between the two groups of the prognosis effect and 6 months follow-up recovery.Results In stereotactic group,the dissipation time of hematoma was significantly shorter(P <0.05).14 days of limb muscle recovery and 90 days Glasgow outcome scale score were significantly better than that of the conservative treatment group (all P<0.05).Conclusion The therapeultic effect of stereotactic microimpact burr-hole drainage was significantly superior to the conservative treatment in conscious patients of hypertensive cerebral hemorrhage in basal ganglia area.It improves limb muscle recovery and worthy of clinical use.%目的 研究未昏迷基底节区高血压脑出血患者立体定向微创钻孔引流手术治疗与内科保守治疗的疗效.方法 分析116例未昏迷的基底节区高血压脑出血患者的临床资料;其中74例患者采用立体定向钻孔引流手术治疗(微创手术组),42例患者采用内科保守治疗(保守治疗组).对比两组患者的治疗效果和预后.结果 微创手术组患者基底节区血肿的消除时间明显短于保守治疗组.治疗2周后,微创手术组血肿清除≥95%的患者的比率(97.3%)显著高于保守治疗组(47.6%),患侧肢体肌力改善亦显著优于保守治疗组,差异均有统计学意义(χ2=40.297,Z=5.617,均P<0.001).结论 对有手术指征的未昏迷基底节区脑出血患者,立体定向钻孔引流手术的治疗效果显著优于内科保守治疗;能明显改善患者的神经功能及预后.
  • 摘要：Objective To investigate the effects of hyperbaric oxygen treatment(HBOT)in rats with traumatic brain injury(TBI)associated to the neurological function improvement and the expression of CyclinD1.Methods According to the random number table,24 adult Sprague Dawley rats were randomly divided into three groups(8 rats each group):sham-operated group,TBI group and HBOT group.The TBI group was subjected to TBI procedure according to the method,the 50 g weight-drop device employed and fallen from 40 cm height to define the severity of the injury;the sham-operated group was subjected to skull open only but not brain injury.The HBOT group was performed for HBO treatment for 10 days(one time every day)after TBI.The neurological severity scores(NSS)records were evaluated after 1,5,10 days post injury.Then all rats were sacrificed and the injury cortex was obtained for the following immunohisto-chemical staining and reverse transcription-polymerase chain reaction(rt-PCR)of CyclinD1.Results Comparing to the shame group,the NSS score records in the TBI group were significantly increased,while HBOT group showed a significant decrease comparing to the TBI rats.Meanwhile,the expressions of protein and mRNA for CyclinD1 in the TBI group were significantly up-regulated compared with the shamed one, while HBOT group was significantly down-regulated compared with TBI rats.Conclusion The HBO treatment ameliorates the neurological function of the rats and inhibits the expression of CyclinD 1 after experimental traumatic brain injury.%目的 研究高压氧治疗对创伤性脑损伤大鼠的神经功能及细胞周期蛋白D1(CyclinD1)表达的影响.方法 用随机数字表法将24只成年Sprague Dawley 大鼠随机分为假手术组、脑创伤组及高压氧治疗组,每组8只.采用自由落体打击法制作中度脑创伤大鼠模型,高压氧治疗组大鼠在脑创伤后给予高压氧治疗,每天1次,连续10d;假手术组大鼠仅行开颅而不致脑损伤.在伤后第1d、5d、10d对各组大鼠进行神经功能缺损(NSS)评分.在伤后第10 d将大鼠处死,取右侧大脑损伤皮质区组织;采用免疫组织化学法检测CyclinD1蛋白的表达水平,逆转录聚合酶链式反应(rt-PCR)检测CyclinD1 mRNA的表达水平.结果 脑创伤组大鼠伤后各时间点的NSS评分均明显高于假手术组(均P<0.01),而高压氧治疗组大鼠伤后第5 d、10 d的NSS评分明显低于脑创伤组(均P<0.05).免疫组化染色检测显示,CyclinD1阳性染色产物主要分布于胶质细胞和神经元的胞核.与假手术组比较,脑创伤组的CyclinD1阳性细胞数明显增多(P<0.01);而高压氧治疗组的阳性细胞数比脑创伤组明显减少(P<0.01),但仍高于假手术组.脑创伤组的CyclinD1阳性染色相对光密度值与假手术组比较明显升高,而高压氧治疗组的相对光密度值与脑创伤组比较则明显降低,差异均有统计学意义(均P<0.01).脑创伤组的CyclinD1 mRNA表达水平与假手术组比较明显升高,而高压氧治疗组的CyclinD1 mRNA表达水平则明显低于脑创伤组,差异均有统计学意义(均P<0.01).结论 高压氧治疗能显著促进创伤性脑损伤大鼠的神经功能恢复,并抑制了CyclinD1的表达.
  • 摘要：Objective At present,the Neuromate,Rosa and other stereotactic surgical robots were approved by the FDA and the European CE standard certification,so robot assisted stereotactic electrode implantation is gradually used in neurosurgery.Cooperating with Beijing Tinavi Medical Technology Co Ltd,Beijing Tiantan Hospital made full use of the advantages of stereotactic surgical technology,in developing intracranial electrode implantation experiments assisted by Tirobot Cranial robot to verify the accuracy of electrode position and analyze the relevant factors.Methods Deep brain electrode were implanted assisted by stereotactic neurosurgerical robot Tirobot Cranial in Swines'head.The maximum and minimum distance of electrode deviation according to postoperative CBCT were recorded and the average distance and standard deviation were calculated,so as to evaluate the accuracy of implantation and analyze the relevant factors.Results A total of 35 electrodes were successfully implanted in all 7 experiments with a success rate of 100%.The average implant length of the electrode was 43.17 mm ±6.64 mm,the average entry deviation of the electrode was 0.63 mm ±0.23 mm,and the average target deviation was 0.96 mm ±0.41 mm.The error factor analysis showed that there was a positive correlation between the deviation of the entry and the deviation of the target(r =0.399,P<0.05).Conclusions The overall positioning accuracy of Tirobot Cranial system is up to 0.5mm by correcting the deviation of implant tool's parameters and using the threaded needle in advance to prevent slipping and other measures,which means brain electrode implantation assisted by Tirobot Cranial system is accurate and stabilized and meets the clinical needs.%目的 目前,国外研发的Neuromate、Rosa等立体定向手术机器人已通过美国FDA、欧洲CE标准认证,从而使得立体定向电极植入术逐渐在神经外科展开使用.北京天坛医院充分利用立体定向手术技术的优势,与北京天智航公司合作开展应用,研究Tirobot Cranial 机器人辅助颅内电极植入定位的精准性,并分析影响电极植入定位精确度的相关因素.方法 北京天坛医院神经外科与北京天智航公司合作,以家猪头颅为实验对象,进行Tirobot Cranial机器人辅助脑深部电极植入实验.术后复查CBCT验证入颅点及靶点的偏差,计算平均值及标准差,以评价机器人定位精准性;并进行误差影响因素分析.结果 共进行7次实验,计划植入电极35根,术中实际植入电极35根,成功率达100%.电极平均植入长度(43.17 ±6.64)mm,植入电极平均入颅点误差为(0.63 ±0.23)mm,平均靶点定位误差为(0.96 ±0.41)mm.误差影响因素分析显示,入颅点偏离与靶点偏离的误差呈正相关(r=0.399,P<0.05).结论 通过修正电极植入工具参数的偏差,以及预先使用螺纹针钻孔,防止打滑等措施;Tirobot Cranial 系统辅助颅内电极植入整体最佳的定位精度达到0.5 mm,具有良好的精准性及稳定性;电极植入的准确性可基本满足临床定位的需求.
  • 摘要：Objective To explore the levels of p21Waf1/cip1and p27Kip1in functional pituitary adenomas,and analyse the relationship between the levels of p 21Waf1/cip1and p27Kip1and clinical features.Method Tissue microarray technology was performed among 6 cases with normal pituitaries, 36 invasive pituitary adenomas and 58 non-invasive pituitary adenomas. Immunohistochemistry experiment was used to detect the protein levels of p 21Waf1/cip1and p27Kip1.The clinicopathologic data of 94 patients was collected and followed up.Methylation-specific polymerase chain reaction and sequencing were detected among 3 normal pituitaries and 24 adenomas cases. Results High-p21Waf1/cip1level cases were featured by 8/36 and H-Score 148 ±28.4 in invasive functional adenomas,and 39/58 and 217.2 ±43.2 in non-invasive adenomas(χ2=18.017,P=0.000).High-p27Kip1level cases were featured by 10/36 and H-Score 122.1 ±31.1 in invasive functional adenomas, and 37/58 and 187.2 ±36.6 in non-invasive adenomas(χ2=9.446,P =0.002).The p27Kip1level was negative with serum prolactin levels in prolactinoma patients(r =-0.237,P<0.01).Average 33 CpG sites per sample were analyzed by using MALDI-TOF Mass array,and 7/33 CpG sites methylation levels of p27Kip1were higher than 50%.There were significant differences in 4 CpG sites between invasive specimens and non-invasive cases(P <0.01).Conclusion In functional pituitary adenomas,the levels of p21Waf1/cip1and p27Kip1are negatively correlated with the invasion,and promoter methylation influences the level of p 27Kip1.%目的 探讨细胞周期蛋白p21Waf1/cip1和p27Kip1在功能性垂体腺瘤中的表达,及其与患者临床特征、预后的关系.方法 构建包含6例正常垂体、36例侵袭性腺瘤(侵袭组)和58例非侵袭性腺瘤(非侵袭组)石蜡标本的组织芯片;免疫组化染色检测 p21Waf1/cip1和 p27Kip1蛋白的表达水平;MALDI-TOF 法分析p21Waf1/cip1和p27Kip1启动子甲基化水平.分析垂体腺瘤患者p21Waf1/cip1和p27Kip1蛋白表达水平与其临床特征的关系.结果 侵袭组高表达 p21Waf1/cip1者为8例(22.2%),H-Score 值为148 ±28.4;非侵袭组高表达p21Waf1/cip1者为39例(67.2%),H-Score值为217.2 ±43.2;侵袭组高表达p27Kip1者为10例(27.8%),H-Score值为122.1 ±31.1;非侵袭组高表达p27Kip1者为37例(63.8%),H-Score值为187.2 ±36.6.两组的p21Waf1/cip1和p27Kip1表达水平的差异均有统计学意义(χ2=18.01,P=0.000;χ2=11.52,P=0.001).p27Kip1表达水平与血清促乳素水平呈负相关(r=-0.237,P<0.01).CpG 位点甲基化检测显示,p27Kip1启动子甲基化水平>50%的为7/33,其中4个位点的差异有统计学意义(P<0.01).结论 功能性垂体腺瘤的p21Waf1/cip1和p27Kip1表达水平降低与肿瘤的侵袭行为有明显关系;启动子甲基化程度影响p27Kip1的表达水平.
  • 摘要：目的 探讨miR-137对胶质瘤细胞株LN229细胞增殖和侵袭能力的影响及相关作用机制.方法 采用miR-137寡聚核甘酸(miR-137 mimics)转染LN229细胞;用实时定量PCR(qRT-PCR)检测转染后细胞中的miR-137表达水平;应用噻唑蓝细胞增殖试验(MTT)、Transwell实验评价过表达miR-137对LN229细胞增殖和侵袭能力的影响;Western blotting 法检测miR-137对侵袭相关蛋白T细胞因子-4(TCF-4)蛋白表达水平的影响.结果 MTT法检测显示,miR-137 mimics组细胞相对存活率明显低于空白组和阴性对照组;Transwell实验显示,miR-137组细胞穿过人工基底膜数为(16.9 ±2.1)个,而空白组、阴性对照组分别为(44.4 ±6.8)个和(42.2 ±6.1)个.miR-137 mimics显著抑制TCF-4蛋白的表达水平.结论 miR-137抑制人脑胶质瘤细胞的增殖和侵袭能力,可成为胶质瘤基因治疗的潜在靶点.%Objective To explore the effect and mechanism of miR-137 on invasive ability of LN229 glioma cells.Methods The miR-137 mimics were transfected to human glioma cell line LN229.The expression of miR-137 was identified by Quantitative real-time PCR(qRT-PCR)after transfection.Methylthiazol tetrazoliu(MTT),transwell assay was employed to detect the cell invasive ability.Relative targeting protein expression was assayed by Western blotting.Results After transfection of miR-137 mimics,the miR-137 mimics treated cells survival rate was decreased obviously in comparison with blank group cells by the MTT assay.miR-137 mimics had greatly suppressed ability to invade matrigel in LN 229 cell,exhibiting about 44.4 ±6.8,42.2 ±6.1,16.9 ±2.1 respectively in blank group,negative control group and mimics treated group cells.Moreover, Tcf-4 protein expression level were inhibited after transfected by miR-137 mimics.Conclusion miR-137 inhibits proliferation and invasive ability of glioma cells,suggesting that miR-137 could be tumor suppressor gene in glioma.
  • 摘要：Objective To investigate the protective mechanism of erythropoietin(EPO)on neurological deficits caused by ruptured aneurysms.Methods A total of 180 patients with ruptured intracranial aneurysms were selected,meanwhile the control group and the treatment group were randomly divided with 90 cases in each group.The treatment group was given a hypodermic injection of EPO from the first day after the operation for three days,while the control group was replaced by normal saline,and the remaining treatment was the same.The NIHSS scores of the two groups were compared on admission,7 d,14 d,21 d,28 d and 35 d after the admission.And the changes of specific enolase(NSE)and interleukin 6(IL-6)in cerebrospinal fluid(CSF)of the two groups of patients after 1 d,4 d,7 d,10 d,and 14 d were analyzed.Results The NIHSS scores of 21 d,28 d and 35 d after operation in the treatment group were 8.8 +1.6,8.2 +1.5 and 7.2 +1.3, respectively,while the scores of control group were 11.4 +2.1,10.5 +2 and 10.3 +2 respectively.The two groups were compared(P <0.05),and the difference was statistically significant.Through the comparison of the percentage reduction of cerebral ischemia volume between the two groups,the reduction rates of 21 d,28 d and 35 d cerebral ischemia volume in the treatment group were(20.6 ±3.7)%,(29.1 ±6)%,(31.7 ±5.2)%,which were significantly higher than that in the control group(15.7 ±3)%,(19 ±3.4)%,(19.1 ±3.0)%.The difference between the two groups was statistically significant(P<0.05).The content of NSE and IL-6 in cerebrospinal fluid (CSF)in the treatment group was lower than that of the control group on 7 d,10 d and 14 d after operation,and the difference between the two groups was statistically significant(P <0.05). Conclusion EPO can promote the recovery of the progressive function of ruptured aneurysm,and it is worthy of clinical application.%目的 探讨促红细胞生成素(erythropoietin,EPO)对破裂动脉瘤引起的神经功能缺失的保护机制.方法 颅内动脉瘤破裂出血患者180例,随机分为对照组及治疗组,每组90例.治疗组患者从术后第1 d 开始给予EPO皮下注射,连用3 d;对照组患者应用生理盐水代替,其余治疗相同.对比两组患者在入院后当天和术后7 d、14 d、21 d、28 d、35 d的美国国立卫生研究院卒中量表(NIHSS)评分,以及术后7 d、14 d、21d、28d、35d的脑缺血体积缩小的比率.检测分析两组患者术后1d、4d、7d、10d、14d的脑脊液特异性烯醇化酶(NSE)和白介素6(IL-6)的水平.结果 治疗组术后第21 d、28 d、35 d的NIHSS评分分别为8.8 ± 1.6、8.2 ±1.5、7.2 ±1.3,对照组分别为11.4 ±2.1、10.5 ±2.0、10.3 ±2.0;两组相比差异均有统计学意义(均P<0.05).两组脑缺血体积缩小比率比较,治疗组术后第21 d、28 d、35 d的脑缺血体积缩小(20.6 ±3.7)%、(29.1 ±6.0)%和(31.7 ±5.2)%,明显高于对照组的(15.7 ±3.0)%、(19.0 ±3.4)%、(19.1 ±3.0)%,差异均有统计学意义(均P<0.05).治疗组术后第7 d、10 d、14 d的脑脊液NSE和IL-6含量明显低于对照组,差异有统计学意义(均P<0.05).结论 EPO能促进破裂动脉瘤患者的神经功能恢复,缩小脑缺血体积,降低脑脊液炎性因子水平;值得临床推广应用.
  • 摘要：目的 探讨血管母细胞瘤(HB)的临床特点、诊断及治疗方法.方法 回顾分析1例岩骨-斜坡区血管母细胞瘤患者的临床资料;并结合相关文献对其临床特点、诊疗方法进行分析.结果 本例患者的血管母细胞瘤位于颅底的岩骨-斜坡区,取耳前颞下入路实行全切,解除占位,达到预期效果.术后病理学检查证实为血管母细胞瘤.此部位的血管母细胞瘤尚未见文献报道.结论 岩骨-斜坡区解剖结构复杂,供血动脉较多,术中较难辨认,可在术前行脑血管栓塞辅助治疗.%Objective To investigate the clinical features,diagnosis and treatment of hemangioblastoma(HB). Methods The clinical data of one patient with HB located in petroclival region was analyzed retrospectively.The clinical characteristics,diagnosis and treatment of this disease were discussed according to the relevant literature. Results In this case,HB was located in petroclival region of the skull base,this kind of case has not been reported yet.The tumor was totally resected by anterolateral and inferior approach and the desired results were achieved. Postoperative pathology was also suggested for HB.Conclusions The anatomical structure of petroclival region is complicated.It is difficult to identify the feeding vessels of HB in this position,and it can be assisted by cerebral vascular embolization before operation.
  • 摘要：Objective Study on the method of measuring Parkinson's disease(PD)freezing of gait(FOG)using inertial sensor.Methods In this work,a frequency domain analysis method combined with the gait cycle from time domain analysis was employed to identify the FOG signal among the signal of 10-meter-round trip and the double task round trip.Results The databases of control group,PD patients and PD with FOG patients were employed in this work to verify the method.The experiment results show that this FOG labeling method can effectively and correctly identify FOG patients with a sensitivity of 100% and a specificity of 88.9% and identify FOG segments with a sensitivity of 84.7%.Conclusion The inertial sensor can detect the PD motor function accurately, and the improved time-frequency domain labeling method can acquire more accurate FOG recognition results than the existing method(P <0.05).The FOG accurate early recognition is of great significance for follow-up treatment.%目的 研究以惯性传感器测量数据识别帕金森病(PD)冻结步态(FOG)的方法及其准确性.方法 用惯性传感器对正常对照者、PD患者及PD合并冻结步态患者,进行10 m往返和双重任务往返行走的运动功能检测;采用改进的结合时域步态参数的频域分析方法进行测试数据分析.结果 惯性传感器测试数据经改进的方法分析,显著提升了识别的敏感性(P<0.05);针对实验的敏感性为100%,特异性88. 9%;针对冻结步态片段的敏感性为84.7%.结论 惯性传感器能对PD冻结步态精准检测,改良分析方法对其的识别更加有效.PD冻结步态的早期、精准识别,对临床治疗有重要指导意义.
  • 摘要：目的 研究Smad 6对人脑胶质瘤细胞增殖能力的影响及其机制.方法 采用Western blot 检测原代胶质瘤细胞核中Smad 6的表达水平.构建慢病毒介导的细胞核稳定过表达和敲减Smad 6的胶质瘤细胞株;CCK8细胞增殖和EdU掺入增殖实验检测Smad 6对胶质瘤细胞增殖能力的影响;干细胞成球实验检测Smad 6对胶质瘤干细胞样细胞自我更新能力的影响.裸鼠皮下荷瘤模型检测Smad 6对胶质瘤细胞体内成瘤能力的影响;荧光素酶报告基因和Western blot检测Smad6对STAT3靶基因的调控,分析Smad 6对信号转导和转录激活因子3(STAT3)活性的调节作用.结果 Western blot和细胞增殖实验显示,原代胶质瘤细胞核中Smad 6表达水平与细胞增殖能力相关.成功构建Smad 6细胞核稳定过表达和敲减胶质瘤细胞株;核Smad 6过表达显著促进胶质瘤细胞的增殖和干细胞样细胞的自我更新能力,而Smad 6敲减则显著抑制胶质瘤细胞的增殖和干细胞样细胞的自我更新能力.细胞核Smad 6促进胶质瘤细胞中STAT3的转录调控活性及其靶基因的表达.结论 胶质瘤细胞核中Smad 6通过调控STAT3的转录调控活性,促进胶质瘤细胞的增殖和干细胞样细胞的自我更新能力.%Objective To investigate the effects of Smad 6 on gliomagenesis and its mechanism.Methods The expression of Smad 6 in primary glioma cells was detected by Western blot.Stable glioma cell lines with nuclear-Smad 6 overexpression or knockdown mediated by lentivirus were established.Cell proliferation was examined by CCK8 and EdU experiments.The effect of Smad 6 on the self-renew of glioma stem-like cells was tested by tumor-sphere formation assay.Effect of Smad 6 on tumorgenesis in vivo was tested in nude mice.Luciferase reporter assay and Western blot analysis were used to examine STAT 3 transcriptional activity and its targeting proteins expression.Results Western blot and cell growth assay confirmed that Smad 6 expression was associated with cell growth of patient-derived glioma cells.Smad 6 overexpression significantly promoted cell proliferation and tumor-sphere formation.Reporter assay and Western blot assay revealed that Smad 6 enhanced the activity of STAT3.Conclusion Smad 6 that expressed in nuclei of glioma cells promotes cell proliferation and self-renew of tumor stem-like cells via enhancing the transcriptional activity of STAT3.
  • 摘要：目的 探讨锥颅穿刺治疗稳定型硬膜外血肿的疗效及适应证.方法 48例患者动态复查头颅CT示硬膜外血肿出血稳定后,局麻下行硬膜外血肿锥颅穿刺置管引流术,术后予以尿激酶5万U+0.9%氯化钠注射液3 mL注入,并夹闭2 h后放开引流,每天2次.结果 术后48例患者的症状均明显缓解.复查头颅CT示,血肿完全消失42例,少量残留6例,无发生再出血;手术效果良好.结论 锥颅穿刺置管引流治疗稳定型硬膜外血肿的疗效确切,损伤小,安全可靠.%Objective To explore the clinical efficacy and applicability of skull puncture treatment on the stable epidural hematoma.Method 48 patients with epidural hematoma accepted repeated head CT scan till the epidural hematoma turned stable,and perform skull puncture catheterzation under local anesthesia for subsequent drainage. When the operations were completed,patients were all given injection with fifty thousand U of urokinase with 3 mL of 0.9%sodium chloride and two hours'clipping,after which drainage was taken twice a day.Results 48 patients got significantly eased,of whom 42 got dramatical cure according to the Head CT reexamination.6 patients,despite minimal residue,also got excellent efficacy of no hemorrhage.Conclusion The skull puncture treatment with postoperative drainage has an exact advantage of less damage and safe efficacy on treating the stable epidural hematoma.
  • 摘要：Objective To evaluate the effect of deep brain stimulation(DBS)on the short-term static posture balance in Parkinson's disease(PD)patients with wearable device.Method 16 PD patients at Hoehn-Yahr grade 3 were recruited in this study,and 12 age-matched healthy subjects served as the control group.Data of three-dimensional body posture joint angle were collected in PD patients at OFF/ON stimulation and in control group.The sway distance of center of gravity and sway velocity were calculated.Results Compared with the control group,the sway distance and sway velocity of the PD patients increased significantly.Compared with the PD patients at OFF stimulate, the sway distance and sway velocity of the PD patients at ON stimulate increased significantly. Conclusion The experiment showed that DBS improved the static balance of Parkinson patients, and improved the proprioceptive ability and balance adjustment ability of PD patients.%目的 通过使用可穿戴设备对帕金森病(PD)患者的静态姿态平衡稳定性进行评估,以确定脑深部电刺激术(DBS)对患者术后短期的静态姿势平衡能力的影响.方法 选取H-Y分期为3期的16例原发性帕金森病患者,以及12名年龄相仿的健康受试者.通过可穿戴式传感器采集PD患者DBS开关机前后及对照者在静态姿势平衡实验中的三维人体关节姿态角,并计算重心摇晃距离和摇晃速度.结果 与正常对照者相比,帕金森病患者的重心摇晃距离和摇晃速度明显增大,差异均有统计学意义(均P<0.05).DBS开机帕金森患者相比于 DBS关机帕金森患者,重心摇晃距离和摇晃速度明显降低,有统计学差异(均 P<0.05).结论 使用可穿戴设备评估DBS对帕金森病患者术后短期静态姿势平衡稳定性的影响实验显示, DBS开机的帕金森病患者姿势平衡稳定性增强,DBS对帕金森病患者的静态姿势平衡稳定性有改善作用.

    临床神经外科杂志的期刊信息

    • 曾用名：临床神经外科医学
    • 创刊时间：2004
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