立体定向脑干病变活检68例临床分析

目的探讨脑干病变立体定向活检的价值和安全性。方法回顾性总结68例脑干病变立体定向活检手术的诊断阳性率及并发症。结果其中64例经立体定向活检手术明确病理诊断,诊断阳性率为94.12%。无死亡病例,并发症发生率为2.94%。结论立体定向活检有助于脑干病变的确诊,从而选择个体化治疗方案、改善预后。     

无框架立体定向下抽吸清除重度原发性脑干出血疗效初步分析

目的 探讨神经外科手术机器人立体定向治疗重度原发性性脑干出血(PBH)的临床效果。方法 回顾性分析2020年11月—2021年4月湖州市南太湖医院经神经外科机器人立体定向下抽吸清除血肿的10例重度原发性脑干出血患者,分析脑干血肿分型与愈后的相关性。结果 术中无死亡病例,为期3个月的随访,存活6例,术后并发症死亡1例,放弃治疗死亡3例;根据改良Rankin评分,术后90 d内3分1例,4分3例,5分2例,死亡4例。结论 手术机器人无框架立体定向穿刺清除引流重度脑干出血是有效的,明显降低死亡率,0型及1型血肿清除术后患者90 d内死亡率及改良Rankin评分均优于2型及3型血肿,基于立体定向为基础的脑干血肿分型,有利于术前评估治疗效果。     

脑脓肿立体定向外科治疗

目的进一步评价立体定向外科手术在脑脓肿治疗中的作用并探讨脑脓肿的最有效治疗方法。方法自1999年1月至2005年3月共外科手术治疗脑脓肿患者24例，其中男19，女5例，年龄7～76岁（平均44．5岁）。单发脓肿21例；多发脓肿3例。共行立体定向引导脓肿穿刺及引流手术20例：脓肿穿刺14例，穿刺置管引流6例；开颅手术切除脓肿4例。结果全部手术均获得成功，一例患者2W后复发施行了第二次定向手术，另一例于立体定向手术结束时出现癫痫大发作。出院时所有患者临床症状全部消失或明显改善，头颅CT或MRI复查显示脓肿腔消失。22例患者接受了4个月至3年的随访（平均14个月），均未见脓肿复发。结论立体定向脑脓肿穿刺抽吸和引流手术应为脑脓肿的首选治疗。     

64排CT导引经颞下入路立体定向治疗重症脑干出血(8例临床分析)

目的探讨64排CT导引经颞下入路立体定向手术治疗重症脑干出血的可行性。方法回顾性分析在64排CT导引下采取经颞下入路立体定向手术治疗的8例重症脑干出血病人的临床资料。结果本组病例均首次采取经颞下入路方法治疗,8例患者手术均取得成功,术中无死亡病例,术后无再次出血病例,术后血肿清除率85%～95%,8例患者中恢复良好2例,轻度残疾2例,重度残疾2例,植物生存1例,死亡1例。结论经64排CT导引颞下入路立体定向治疗重症脑干出血方法可行。     

立体定向手术与常规保守治疗重型脑干出血的疗效对比

目的探讨立体定向手术和常规保守治疗重型脑干出血的临床疗效。方法回顾性分析三门峡市中心医院2015-07—2018-06收治的55例重型脑干出血患者的临床资料,随机分为立体定向组(n=19)和常规保守组(n=36),评估发病后1周GCS评分、3个月后改良Rankin评分,对比2组疗效。结果立体定向引流手术治疗重型脑干出血的疗效好于常规保守治疗(P0.05)。结论立体定向穿刺引流术治疗脑干出血的效果较好。     

立体定向下神经内镜治疗多房性脑脓肿(附14例临床分析)

目的探讨立体定向辅助下神经内镜手术治疗多房性脑脓肿临床可行性。方法对我科2006年11月至2010年10月多房性脑脓肿14例,采用立体定向辅助下神经内镜手术治疗回顾分析。结果均一次穿刺成功,手术后脓腔消失,经随访8个月至3年,13例脓肿壁完全消失,术后1例复发。结论认为立体定向辅助下神经内镜手术治疗多房性脑脓肿具有定位准确、安全、创伤小等优点,此方法操作可行,疗效理想。     

高血压脑干出血的立体定向手术治疗

目的 探讨立体定向手术对高血压重型脑干出血的治疗效果.方法 采用立体定向穿刺置管引流术治疗高血压重型脑干出血20例,其中中脑血肿6例,桥脑血肿9例,中脑、桥脑联合出血5例,血肿量8～15ml.并行侧脑室穿刺,持续监测颅内压,给予亚低温治疗.所有治疗均在神经科重症监护病房进行.结果 全部病例立体定向手术均获成功,无术中死亡及手术并发症,术后存活18例,死亡2例.结论 立体定向手术治疗高血压重型脑干出血是行之有效的治疗方法,术后实施亚低温疗法加以有效的颅内压监测可提高脑干出血治疗的成功率.     

立体定向脓肿抽吸及Ommaya管置入术治疗脑脓肿42例

目的探讨立体定向脓肿抽吸结合Om-maya管置入术,治疗脑脓肿的临床体会及预后.方法对42例颅内脑脓肿病人的病例资料、病情演化、CT影像及手术治疗效果及其术后并发症进行回顾性分析.结果立体定向脓肿抽吸及Ommaya管置入术,治疗脑脓肿具有定位准确,创伤小,并发症少,复发率低,疗效优良的优点.结论立体定向脓肿抽吸及Ommaya管置入术治疗脑脓肿,是一种微创而安全有效的治疗方法.     

多发性脑脓肿的综合性治疗（附5例分析）

目的 探讨立体定向穿刺引流术联合抗生素综合性治疗多发脑脓肿的效果。方法 回顾性分析2018年4月至2020年10月收治的5例多发性脑脓肿的临床资料。急性脑炎期应给予广谱、足量抗感染治疗；脓肿包膜形成时，采取立体定向穿刺引流术，术后采用高通量测序技术检测病原菌，并根据结果调整抗生素。结果 5例中，3例进行两次引流术，2例进行单次引流术。术后高通量测序技术明确致病菌，经充足疗程的抗感染治疗，脓肿灶逐步消失，未发生脑疝，全部治愈出院。术后6个月随访，除1例遗留肢体轻瘫外，其余4例无肢体活动障碍。结论 对于多发性脑脓肿，尽早明确诊断、选择合理的治疗方式是提高脑脓肿治疗效果的关键；高通量测序技术为抗生素调整提供依据，并对感染源治疗有指导作用；立体定向穿刺引流术可以缩短疗程，减少抗生素应用时间，提高治疗效果。     

立体定向术治疗多发性脑脓肿(附11例临床分析)

目的通过对立体定向术治疗多发性脑脓肿的回顾性分析,总结手术经验。方法应用Leksell-G型定向仪,行MRI引导下立体定向穿刺 术中抗生素冲洗术,设计最佳手术入路,行多发脓肿穿刺,术后常规应用抗生素治疗2周。结果11例多发脑脓肿患者,共30个脓肿,均一次穿刺成功,经抽吸冲洗后复查脓腔消失。抗生素治疗2周后,经随访全部病例治愈。结论立体定向术具有定位准确、安全、创伤小等优点,适用于多发性脑脓肿及脓肿部位较深或位于语言、运动中枢等主要功能部位,或由于年老体弱或其他严重疾病不能耐受开颅手术者。     

Bacterial abscess of the medulla oblongata

Isolated brainstem abscess, specifically, medullary abscess, is rare and often fatal. Diagnosis requires appropriate imaging and a high degree of clinical suspicion. Good outcomes are possible. A 69-year-old woman presented with an isolated medulla oblongata abscess that manifested as a syndrome of rapidly progressive multiple cranial nerve palsies and decreased level of consciousness. Microneurosurgical incision and drainage of the medullary abscess were performed. Maximal therapy of antibiotics, intensive care management, and extended rehabilitation was delivered. A prompt diagnosis of medullary abscess, with immediate microneurosurgical intervention and maximal medical therapy, may result in a good outcome.     

MRI appearance of lumbar epidural abscesses: report of three cases

The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.     

Widespread brainstem abscess resolved with medical therapy

The brainstem is an uncommon site of a brain abscess. Such lesions, which were invariably fatal, changed with the arrival of computed tomography and magnetic resonance imaging (MRI). These not only helped in the diagnosis but also in treatment management. A 51-year old patient was diagnosed of widespread pontomesencephalic abscess. He was admitted with a clinical picture of dizziness, headache and involvement of multiple cranial nerves with near complete ophthalmoplegia and cerebellar syndrome in the side of the lesion and contralateral hemiplegia. Microbiologic investigations were negative and the medical management decided was broad spectrum antibiotic and periodic MRI controls. The length of the lesion decreased (from 4 cm in diameter to 0.5 cm) with progressive improvement of the neurological deficits. Treatment of large brainstem abscesses includes primary antibiotic therapy combined with stereotaxic drainage, but in individual cases empirical medical therapy can be effective. Sequential MRI examinations are very important for monitoring treatment efficacy.     

Brainstem abscess caused by Haemophilus influenza and Peptostreptococcus species

We present a patient with a solitary brainstem abscess caused by Haemophilus influenza type b (Hib) and Peptostreptococcus species. This is the first report of a Hib brainstem abscess in the English literature. Hib has been mainly associated with respiratory or nasal infections, and a few cases of intracerebral abscesses, but no brainstem abscesses have been described. The literature on solitary brainstem abscesses was reviewed and an overview of the literature between January 1984 and May 2009 is presented.     

Medical Cure of a Brainstem Abscess and Serial Brainstem Auditory Evoked Potentials

The brainstem abscess of a nine-year-old girl with tetralogy of Fallot was cured after six weeks of parenteral antibiotic therapy, without surgical intervention. Serial studies of brainstem auditory evoked potentials were undertaken until the patient was clinically normal. To the authors' knowledge, this is only the second medically cured case reported in the literature, and it is the first case studied with serial brainstem auditory evoked potentials. If the clinical status allows, medical treatment of a brainstem abscess with appropriate antibiotics could be tried before surgical intervention such as stereotactic aspiration for reducing the mass.     

立体定向手术治疗颅内囊性病变

目的 探讨立体定向手术治疗颅内囊性病变的手术方法 、有效性及优点. 方法 回顾性分析北京军区总医院神经外科自2002年12月至2009年11月采用立体定向手术治疗的29例颅内囊性病变患者(病灶37个)的临床资料,其中颅咽管瘤11例,胶质瘤5例,转移瘤3例,脑脓肿10例.18例肿瘤患者行Ommaya囊置入及32P内放疗[32内放疗剂量根据囊性病变体积,平均为800 μCi(500～1500 μCi)],1例单纯抽液后外放疗;10例脑脓肿患者置管引流8例,穿刺冲洗2例.结果 本组无手术出血及死亡患者.患者随访1～60月,平均10.6月,4例因无法联系而失访.11例颅咽管瘤患者(病灶11个)经32P内放疗症状稳定无复发.8例其他肿瘤患者(病灶12个)中有5例控制症状5～48月,3例无效(转移瘤2例,胶质母细胞瘤1例).10例脑脓肿患者(病灶14个)经穿刺引流症状消失治愈.2例颅咽管瘤患者32P内放疗后出现一过性尿崩、低热及呕吐. 结论 立体定向手术对于脑脓肿、囊性颅咽管瘤、体积不大的深部胶质瘤及转移瘤而言,较传统开颅手术具有明显的优势,但对体积较大、难于短期控制瘤液分泌的囊性转移瘤效果不佳.     

脑干血管畸形的显微手术治疗(附19例报告)

目的 探讨脑干血管畸形的显微外科手术治疗方法和预后.方法 显微手术切除脑干血管畸形19例.6例经枕下正中第四脑室底入路切除;9例经枕下乙状窦后入路切除;3例经小脑延髓裂入路切除;1例经枕下正中入路上抬蚓垂后切除.结果 19例病灶均镜下全切,其中海绵状血管瘤15例,动静脉畸形4例.13例症状改善,5例出现并发症,1例因下呼吸道感染死亡.随访中GOS 5分15例,GOS 4分2例,GOS 3分1例.MRI复查无病灶残留.结论 在恰当选择手术适应证、手术时机和手术入路的基础上,运用娴熟的显微外科技术,脑干血管畸形的手术治疗结果是令人满意的.

Abstract：

Objective To investigate the microsurgical treatment of brainstem vascular malformation and evaluate the surgical outcome. Method Brain stem vascular malformations in 19 cases were resected by microsurgical techniques. Six cases of cavernous malformations ( CM ) in the dorsal of pons and medulla underwent operations via through the base of the forth ventrical approach. Another nine cases of CM in lateral and ventral lateral pons were treated via suboccipito - retrosigmoid approach. Three cases of arteriovenous malformation(AVM) in cerebellomedullary fissure were treated via telovelar approach. One case of AVM in the dosal medulla were resected via transvermian approach. Results All the lesions were totally resected. Pathologic diagnosis were CM( 15 cases) and AVM(4 cases). The diameter of all the CM were less than 1 centimeter. One AVM was 1.5 centimeter in diameter, the other two lesions was 2. 0 centimeter, the last one was 2. 5 centimeter. The functional disorders were improved after operation in 13 cases. Complications appeared in five patients, which improved between one week and three months. One patient died of sever pneumonia. During two months to six years after operation, the brainstem vascular malformation didn't recrudesce and re - bleed. No one patient appeared new syndromes. Conclusions The microsurgical management of brainstem vascular malformation can effectively prevent re - bleeding. Selecting different surgical approach basing on the locations can reduce the neurofunction damage. In order to accelerate the recovery of damaged brainstem, early surgery should be choosen for the patients with surgical indications. Basing on the correct choice of surgical indications, using the extensive knowledge of microanatomy,new concept of minimal invasive surgery and skillful microsurgical techniques, the surgical results of brainstem vascular malformation are satisfactory.     

Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases

Objective

This study aimed to better determine the salient signs and symptoms for diagnosis of a pituitary abscess as well as the determination of the most appropriate treatment.

Methods

A retrospective analysis was performed using clinical presentations, imaging features, diagnosis and treatment of 29 patients with pituitary abscess in our hospital.

Results

We made the correct diagnosis of pituitary abscess before surgery only in 2 cases (13.3%) out of 15 patients between January 2004 and January 2008. While 12 cases (85.7%) out of 14 patients were correctly diagnosed before surgery between January 2008 and June 2010. All of the patients underwent transnasal–transsphenoidal surgery assisted by the microscope or endoscope. The antibiotic therapy and hormonal replacement were routinely administrated. The postoperative courses were uneventful and all symptoms of the patients were gradually improved one week to six months after surgery. None of the 29 cases were recurrent during the follow-up.

Conclusion

With the increased clinical experience, the correct diagnosis rate of pituitary abscess before surgery has been greatly improved in recent three years. The microsurgical drainage, proper antibiotics and hormonal replacement are the keys to the treatment of pituitary abscess.     

Cyanotic congenital heart disease with suspected stroke. Should all patients receive antibiotics?

Two patients with cyanotic congenital heart disease (CHD) and erythremia were seen for abrupt onset of focal neurologic deficits and/or seizure without signs of infection or increased intracranial pressure. Clinical features and initial computed tomography (CT) in both cases suggested stroke. Subsequent CT scans demonstrated cerebral abscess, proved at operation. Review of records of patients with CHD at the University of Rochester (NY) Medical Center from 1965 to 1981 disclosed 12 cases with brain abscess but only two cases with aseptic cerebral infarction. All but one patient with abscess were cyanotic. One third of patients with abscess had a clinical picture suggesting stroke. Clinical or radiologic features of half the cases indicated that cerebral infarction may have led to abscess formation. Diagnosis of brain abscess and immediate antibiotic therapy should be strongly considered in patients with cyanotic CHD who suffer a suspected cerebral infarction.     

Primacy of medical treatment of cerebral abscesses (19 cases)

Therapy in 19 consecutive cases of cerebral abscess was limited to medical treatment whenever possible, using high doses of a combination of several antibiotics. Long-term follow up by serial computed tomography was performed. Antibiotic treatment alone was effective in 8 patients with multiple hemispheric abscesses of metastatic origin, though one patient seen late with three large abscesses die on the 4th day. In 8 cases with single abscesses, medical treatment alone was effective: 5 had lesions less than 4 cm in diameter; in 2 cases with lesions 4 to 5 cm in diameter, additional abscess puncture was carried out. One patient required early excision of an occipital abscess, and 2 cases of pontocerebellar angle abscesses were also treated surgically. Antibiotic therapy alone was effective in 1 patient with a large brain stem abscess. Treatment of cerebral abscess has largely changed since the availability of computed tomography, with a progressively more important place being accorded to antibiotic therapy alone. The stage of the abscess does not appear to be a decisive factor in the choice of treatment, medical therapy appearing to provide a definitive cure with a minimum of sequelae in the majority of cases. Abscess puncture may be an adjunct to antibiotic therapy in large abscesses with clinical signs.