显微手术切除颅咽管瘤

目的：探讨切除颅咽管瘤的手术入路和显微手术技巧。方法：本组颅咽管瘤5例。其中2例为实质性视交叉后肿瘤、1例为实质性鞍内鞍上型肿瘤、2例为囊性肿瘤。采用不同的手术入路(双侧额、翼点和经蝶窦手术入路)进行肿瘤切除。结果：4例经颅手术的病例皆达全切除，1例鞍上鞍内型肿瘤采用经蝶窦手术次全切除。所有病例恢复良好。结论：根据肿瘤不同质地、部位和范围，采用恰当的手术入路，结合应用熟练的显微技巧，可以取得良好的临床疗效。     

显微手术切除脊髓内肿瘤

目的：研究脊髓髓内肿瘤的显微手术技术。方法：采用显微手术技术切除5例脊髓内肿瘤(星形细胞瘤2例，鳞癌，血管母细胞瘤和室管膜瘤各1例)。结果：全切除2例，次全切除2例，部分切除1例。除1例外，其余患者症状都较术前改善。结论：运用熟练的显微技术分离肿瘤界面可以取得良好的效果。     

脊髓肿瘤的显微手术治疗

目的：研究脊髓肿瘤的显微手术技术。方法。回顾分析了63例采用显微手术切除的脊髓肿瘤病例（髓外硬膜下39例，髓内24例）的临床资料。结果：全切除55例，次全切除4例，部分切除4例。术后随访57例、随访期1～78个月，51例结果良好，6例结果差（3例死亡）。结论：显微手术治疗脊髓肿瘤结果较好。不同类型的肿瘤应采用不同的手术方法，熟练的显微技术和对脊髓保护意识是手术成功的关键。     

侧脑室肿瘤显微手术切除30例临床分析

目的 探讨侧脑室肿瘤患者临床特点及手术治疗方法。方法回顾性分析30例侧脑室肿瘤患者的临床诊治资料。结果显微手术30例侧脑室肿瘤中18例行全切除，无死亡病例；随访半年，术后恢复良好。结论对侧脑室肿瘤患者行显微手术配合放疗可取得良好疗效。     

颅内软骨肉瘤8例治疗分析

目的：探讨颅内软骨肉瘤显微手术＋放射治疗的治疗效果。方法：对8例颅内软骨肉瘤患者的临床资料，显微手术＋放射治疗的结果进行分析总结。结果：手术全切除5例，次全切除2例，大部分切除1例。随访6个月～5a，肿瘤全切除的5例患者中有2例分别于术后9个月和12个月时复发，行放射治疗，生存良好。结论：积极的显微外科手术切除＋放射治疗对颅内软骨肉瘤的治疗效果良好。     

高位颈段脊髓肿瘤显微手术切除体会

目的：探讨高位颈段肿瘤的特点及显微手术切除方法。方法：对经显微镜下手术及病理证实的15例高位颈段肿瘤进行回顾性分析。结果：15例高位颈段肿瘤全切13例，部分切除2例，无一例死亡。结论：高位颈段肿瘤手术危险性大，显微镜下分块切除对周围脊髓组织影响小，术中生命体征平稳，术后恢复较快。术中寻找肿瘤应仔细，硬膜夹层中亦能隐藏肿瘤。     

经额底入路显微手术切除鞍区肿瘤13例

目的：介绍我院1998－2000年内经额底入路显微手术切除鞍区肿瘤13例的操作技术和体会，方法：所有病例采用经额底入路，先囊内切除部分鞍内及鞍上肿瘤，使肿瘤减压，保护视神经及鞍区动脉，再分离，分块切除瘤壁或囊壁，电灼或刮除肿瘤基底，生发部位硬脑膜，结果：肿瘤全切7例，次全切4例，大部切除2例，全部病例痊愈出院，结论：经额底入路，显微手术切除鞍区肿瘤，明显提高了手术的精细程度，减少了术中对鞍区重要结构的损伤，肿瘤能够达到全除或次全切除，保证了鞍区手术的安全。     

显微手术治疗胼胝体动静脉畸形8例分析

目的：总结胼胝体动静脉畸形(AVM)的显微手术治疗经验。方法：回顾分析1992年1月至2002年12月治疗8例胼胝体AVM的结果。结果：7例行显徽手术切除．术中1例行术中AVM栓塞加手术切除。全切5例，次全切除2次，无手术死亡。1例拒绝手术，半年后死于再出血。随访5例。平均随访26月，均恢复良好。结论：胼胝体AVM一经诊断明确．应积极行显微手术切除。对难以全切者可行栓塞治疗或栓塞后切除。对深部术后部分残留者，再辅以γ刀治疗，可取得良好的效果。     

松果体区肿瘤的显微手术治疗

目的：探讨显微手术治疗松果体区肿瘤的手术入路和技术。方法：采用显微手术技术和幕下小脑上入路切除9例松果体区肿瘤;其中生殖细胞瘤5例、混合性生殖细胞肿瘤2例（分别为生殖细胞瘤合并恶性畸胎瘤和胚胎癌）、脑膜瘤和良性畸胎瘤各1例;1例术后脑积水行三脑室底造瘘术。结果：所有病例全切除肿瘤。术后早期结果全部良好,随访1～7年：良好7例,死亡2例。结论：松果体区肿瘤手术难度较大,但选择适合的手术入路和熟练的显微手术技术可以取得满意的疗效。     

鞍旁脑膜瘤的显微外科治疗

目的：探讨鞍旁脑膜瘤的显微手术技巧及手术疗效。方法：采用翼点和扩大翼点入路行显微手术治疗29例鞍旁脑膜瘤患者。结果：29例患者均顺利完成手术,其中肿瘤全切21例、次全切5例、部分切除3例,平均手术时间4．5h。术后发生动眼神经麻痹5例,1例仍有癫痫发作,对症处理及抗癫痫治疗后好转。该组无手术死亡。5例次全切者术后行放射治疗,随访2年未见肿瘤复发。术后随访3～60个月（平均35个月）,5例患者的视力明显好转,3例患者癫痫发作消失,2例肢体活动改善,其余患者均恢复良好,未见明显并发症。结论：采用翼点和扩大翼点入路,利用显微技术可以明显提高肿瘤全切率。对于无法全切的肿瘤,可考虑姑息手术后行放射治疗。     

外科干预改善马尾神经综合征患者下肢功能和缓解腰腿痛

目的根据马尾神经综合征发病机制的临床研究和临床治疗现状,观察外科干预术式改善马尾神经综合征患者的下肢功能,缓解腰腿痛的效果。方法对长征医院31例(男22例,女9例)马尾神经综合征患者的临床资料进行分析。结果常规术式效果:优(A)7例,良(B)4例,好转(C)3例,差(D)6例;改良术式效果:优(A)3例,良(B)2例,好转(C)4例,差(D)5例。结论马尾神经综合征的改良术式能有效地改善患者下肢功能,缓解腰腿痛。     

脊髓背根入髓区切开术治疗脊髓和马尾神经损伤后慢性疼痛

目的:探讨脊髓背根入髓区(Dorsal root entry zone,DREZ)切开术在脊髓和马尾神经损伤后慢性疼痛中的临床应用。方法:脊髓和马尾神经损伤后慢性神经源性疼痛10例,年龄28~72岁,病程8月~28年。患者均有不同程度的双下肢截瘫,疼痛位于下肢感觉减退和缺失区,为烧灼样、压榨样、痉挛性疼痛,视觉模拟疼痛评分(VAS)8~10分。10例均行脊髓背根入髓区显微外科切开术,切开范围由患者疼痛范围决定。结果:随访4月~2年,4例疼痛消失,停用镇痛剂,生活质量改善;5例疼痛明显减轻,VAS 2~4分,其中,3例停用镇痛剂,2例镇痛剂使用量明显下降,生活质量改善;1例疼痛无明显改善。结论:脊髓背根入髓区切开术对脊髓和马尾神经损伤后慢性疼痛疗效满意,可明显提高患者的生活质量。     

Clinical features of cauda equina tumors requiring surgical treatment

In this study, we evaluated the clinical features of cauda equina tumors requiring surgical treatment. Medical records of 28 patients with cauda equina tumors (13 men and 15 women) undergoing surgical treatment were retrospectively reviewed. The majority of histological diagnoses indicated schwannoma (23 cases, 82%), and the remaining 5 indicated ependymoma, neurofibroma, meningioma, and ganglioneuroblastoma. In 86% of the cases, the initial symptom was pain in the lower back and/or lower extremities. Preoperatively, half of the patients had symmetrical pain in the lower back or lower extremities, severe pain in the supine position, or pain that was increased by coughing. One third of the patients needed morphine to control nocturnal pain. Tumor size, as determined by magnetic resonance imaging (MRI), correlated with preoperative symptom duration (r = 0.66, p < 0.001). These findings indicate that symmetrical lower back pain and/or pain that radiates to both lower extremities and increases in the supine position are characteristic of cauda equina tumors. The correlation between symptom duration and tumor size indicates that earlier diagnosis of this tumor is necessary. Earlier diagnosis based on these characteristic symptoms should make use of further examinations such as MRI.     

An atypical ballistic traumatic cauda equina syndrome with a positive evolution. Focus on prognostic factors

IntroductionTraumatic cauda equina syndromes due to projectile wounds often have a poor prognosis. We report on an unusual ballistic cauda equina traumatism with a good functional outcome.Clinical caseA 44-year-old man was admitted to emergency room for an incomplete cauda equina syndrome after trying to kill himself by means of a pneumatic nail gun. The nail had gone right through the third lumbar vertebra. Because of the stability of the fracture, orthopaedic surgery was not indicated. Neurological recovery was progressive. At 6 months, there was still a partial L5–S1 motor deficit on the left side but the patient could walk without crutches, and within an unlimited walking distance.DiscussionInitial imaging displayed a projectile trajectory focused on the spinal canal on level L3, which could have been considered as bad prognosis. The positive analytic and functional outcome correlates with the limited neurological tissue damage, probably explained by the ballistic properties of the projectile.ConclusionApart from the influence of a possible surgical act, the neurological and functional prognosis of a traumatic cauda equina syndrome caused by a projectile also depends on its physical characteristics.     

Schistosomiasis (Bilharzia) of the spinal cord: case reports and clinical profile

Eight cases of schistosomiasis of the spinal cord are described. These fall into two groups. Four patients had clinical and myelographic evidence of lesions in the conus medullaris and were found to have bilharzial granulomas at operation. Four patients had normal or equivocal myelographic appearances, but the coincidence of unexplained lower cord or cauda equina lesions with evidence of bilharzia led to the presumed diagnosis of spinal cord bilharzia. These patients, together with data from 39 cases reported in the world literature since 1969, have been used to compile a clinical profile of this condition. The clinical picture is the product of two types of reaction to bilharzial infestation, granuloma and necrotic myelitis, affecting the lower cord and cauda equina in varying proportions. Granuloma is the better defined entity because it is diagnosed following operation and biopsy. Myelitis is seldom proved and its diagnosis depends on circumstantial evidence. Both S. mansoni and S. haematobium may be responsible for either type.     

Rapid progression of acute sciatica to cauda equina syndrome.

OBJECTIVE: To demonstrate the importance of clinical examination and continued vigilance for neurologic deterioration in patients with sciatica. Cauda equina syndrome, a rare sequela of sciatica, is considered a medical emergency requiring surgical decompression. Clinical Features: A 32-year-old woman had sciatica that rapidly progressed to cauda equina syndrome. Magnetic resonance imaging revealed the presence of a large nonsequestered disk fragment in the lower lumbar spine. Intervention and Outcome: The disk fragment was surgically excised. The patient experienced immediate pain relief after surgery but retained neurologic deficits. After 6 months of rehabilitation, neurologic integrity was restored, aside from patchy sensory loss of the left foot and buttocks. At the 6-month follow-up, the patient's sciatica had not returned. CONCLUSIONS: Most cases of sciatica, regardless of cause, will self-resolve; as a result, there might be a tendency to maintain a low index of suspicion for serious, progressive disorders such as cauda equina syndrome. Patients need to be educated as to signs of this emergency condition and informed as to the possible consequences of delaying treatment. By maintaining a high index of suspicion for any case that fails to respond as expected to a course of conservative therapy or that demonstrates signs of cauda equina syndrome, chiropractors can assume a pivotal role by investigating and referring appropriately and by aiding in active rehabilitation postoperatively.     

Orbital metastasis from cutaneous melanoma

Although orbital extension from ocular melanoma occurs frequently in advanced cases, orbital metastasis from cutaneous melanoma has been reported but eight times previously. We have reported two such cases. One of the patients had three previous primary melanomas; the other had metastasis to the cauda equina. Both patients died when orbital involvement developed years after the initial lesions. Ours are the first cases to include CT and MRI findings in metastatic orbital melanoma.     

Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients

According to the literature estimations, 10-25% of patients with spinal cord and cauda equina injuries eventually develop refractory pain. Due to the fact that most classical neurosurgical methods are considered of little or no efficacy in controlling this type of pain, the authors had recourse to microsurgery in the dorsal root entry zone (DREZ). This article reports on the long-term results of the microsurgical approach to the dorsal root entry zone (DREZotomy) in a series of 44 patients suffering from unbearable neuropathic pain secondary to spine injury. The follow-up ranged from 1 to 20 years (6 years on average). The series includes 25 cases with conus medullaris, 12 with thoracic cord, four with cauda equina and three with cervical cord injuries. Surgery was performed in 37 cases at the pathological spinal cord levels that corresponded to the territory of the so-called 'segmental pain', and in seven cases, on the spinal cord levels below the lesion for 'infralesional pain' syndromes. The post-operative analgesic effect was considered to be 'good' when a patient's estimation of pain relief exceeded 75%, 'fair' if pain was reduced by 25-75%, and 'poor' when the residual pain was more than 75% of preoperative estimations. Immediate pain relief was obtained in 70% of patients and was long-lasting in 60% of the total series. The results varied essentially according to the distribution of pain. Good long-term results were obtained in 68% of the patients who had a segmental pain distribution, compared with 0% in patients with predominant infralesional pain. Regarding pain characteristics, a good result was obtained in 88% of the cases with predominantly paroxysmal pain, compared with 26% with continuous pain. There were no perioperative mortalities. Morbidity included cerebrospinal fluid leak (three patients), wound infection (two patients), subcutaneous hematoma (one patient) and bacteremia (in one patient). The above data justify the inclusion of DREZ-lesioning surgery in the neurosurgical armamentarium for treating 'segmental' pain due to spinal cord injuries.