目的:探讨内镜在梗阻性脑积水治疗中的临床应用价值。方法:将我院80例梗阻性脑积水患者随机分为治疗组及对照组,对照组患者采用分流术,治疗组患者采用神经内镜下三脑室底造瘘术。结果:治疗组均造瘘成功,无中转分流术。手术时间治疗组明显短于对照组,术后并发症例数也明显少于对照组,差异有统计学意义(Plt;0.05),术后症状缓解率差异无统计学意义(Pgt;005)。两组患者均获随访,时间6～12个月,症状均有锁缓解,复查CT或MRI见脑室均有不同程度缩小.结论:ETV治疗梗阻性脑积水符合当今神经外科微创原则,疗效确切,手术时间短、脑暴露少、对组织损伤小,手术费用降低,并发症少,值得推广。
Objective To systematically review the clinical effectiveness and safety of programmable valves (PV) vs. standard valves (SV) for hydrocephalus. Methods Literature search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and WanFang Data to collect both randomized controlled trials (RCTs) and non-randomized concurrent controlled trials on hydrocephalus treated by PV and SV published from January 1992 to January 2012. According to the inclusion criteria, two reviewers independently screened articles, extracted data, and evaluated and cross-checked the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 11 non-randomized concurrent controlled trials involving 1,485 participants were included. The results of meta-analysis showed that, compared with SV, PV was superior in overall effective rate (RR=1.14, 95%CI 1.03 to 1.27, P=0.01), 2-year survival rate (RR=1.25, 95%CI 1.04 to 1.51, P=0.02), secondary surgery rate (RR=0.53, 95%CI 0.39 to 0.73, Plt;0.001), overall complications rate (RR=0.62, 95%CI 0.51 to 0.76, Plt;0.001), and over-drainage/ under-drainage rates (RR=0.42, 95%CI 0.21 to 0.83, P=0.01). But there were no significant differences in 1-year survival rate (RR=1.04, 95%CI 0.91 to 1.19, P=0.55), postoperative infection rate (RR=1.08, 95%CI 0.73 to 1.60, P=0.71) and valve related complication rate (RR=0.80, 95%CI 0.56 to 1.21, P=0.20) between the two groups. Conclusion Current evidence suggests that PV is superior to SV in increasing the effective rate, decreasing complications, and prolonging the long-term survival rate. Because of the limitation of quantity and quality of the included studies, more high quality, multicenter and double-blind RCTs are needed to prove whether PV can be clinically recommended as a preferred drainage surgery or not.
目的 探讨经胼胝体-穹窿间入路切除第三脑室肿瘤术后，近期下丘脑反应的发生情况及相关因素，为防治第三脑室肿瘤术后下丘脑反应提供参考。 方法 回顾分析2003年1月－2008年12月经胼胝体-穹窿间入路切除的78例第三脑室肿瘤患者手术后近期（1个月内）下丘脑反应的发生情况，并将其按照肿瘤部位、病理性质、大小、血供、手术切除程度进行分类统计，用SPSS 13.0软件logistic 回归分析影响这些并发症的因素。 结果 78例术后下丘脑反应37例，发生率47.4%；死亡5例，下丘脑反应病死率为13.5%（5/37）。其中电解质糖代谢紊乱33例（42.3%），尿崩症27例（34.6%），激素水平低下16例（20.5%），高热6例（7.7%）。好转痊愈率：激素水平低下43.7%，其余均＞70%。第三脑室前部颅咽管瘤术后最容易发生下丘脑反应（P＜0.05）。 结论 经胼胝体-穹窿间入路切除第三脑室肿瘤术后近期存在程度不同的下丘脑反应，其发生与肿瘤部位、病理性质有密切关系。经积极治疗，大部分下丘脑反应能在术后1个月内好转甚至痊愈。
ObjectiveTo investigate the application of stereoelectroencephalography (SEEG) in the refractory epilepsy related to periventricular nodular heterotopia (PNH). MethodsTen patients with drug-resistant epilepsy related to PNHs from Guangdong Sanjiu Brain Hospital and the First Affiliated Hospital of Jinan University from April 2017 to February 2021 were studied. Electrodes were implanted based on non-invasive preoperative evaluation. Then long-term monitoring of SEEG was carried out. The patterns of epileptogenic zone (EZ) were divided into four categories based on the ictal SEEG: A. only the nodules started; B. nodules and cortex synchronous initiation; C. the cortex initiation with early spreading to nodules; D. only cortex initiation. All patients underwent SEEG-guided radiofrequency thermocoagulation (RFTC), with a follow-up of at least 12 months. ResultsAll cases were multiple nodules. Four cases were unilateral and six bilateral. Eight cases were distributed in posterior pattern, and one in anterior pattern and one in diffused pattern, respectively. Seven patients had only PNH (pure PNH) and three patients were associated with other overlying cortex malformations (PNH plus). The EZ patterns of all cases were confirmed by the ictal SEEG: six patients were in pure type A, two patients were in pure type B, one patient in type A+B and one in type A+B+C, respectively. In eight patients SEEG-guided RF-TC was targeted only to PNHs; and in two patients RFTC was directed to both heterotopias and related cortical regions. The mean follow up was (33.4±14.0) months (12 ~ 58 months). Eight patients (in pure type A or type A included) were seizure free. Two patients were effective. None of the patients had significant postoperative complications or sequelae. ConclusionThe epileptic network of Epilepsy associated with nodular heterotopia may be individualized. Not all nodules are always epileptogenic, the role of each nodule in the epileptic network may be different. And multiple epileptic patterns may occur simultaneously in the same patient. SEEG can provide individualized diagnosis and treatment, be helpful to prognosis.
ObjectiveTo analyze safety and feasibility of transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting. MethodsThe clinical data of 36 patients who diagnosed as hydrocephalus underwent ventriculoperitoneal shunting from May 2013 to August 2015 in this hospital were collected. Twelve patients were performed transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting (laparoscopy group) and 24 patients were performed laparotomy ventriculoperitoneal shunting (laparotomy group). The abdominal operation time, postoperative exhaust time, postoperative hospital stay, postoperative pain score, and postoperative complications rate were compared between the laparoscopy group and the laparotomy group. ResultsAll the operations were completed successfully. Compared with the laparotomy group, the abdominal operation time (P < 0.05), postoperative exhaust time (P < 0.05), and postoperative hospital stay (P < 0.05) were significantly shorter, the postoperative pain score was significantly less (P < 0.05) in the laparoscopy group. The postoperative complications rate had no significant difference between the laparoscopy group and the laparotomy group (P > 0.05). ConclusionsThe preliminary results of limited cases in this study show that transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting is safe and feasible, with better cosmetic. more comparative studies or randomized controlled trials are required to make a confirmed conclusion.
目的:研究微创侧脑室穿刺联合置管外引流术治疗脑室出血的疗效。方法:将我院48例脑室出血患者随机分为治疗组及对照组,对照组采用常规内科药物治疗,治疗组在对照组基础上采用微创侧脑室穿刺联合置管外引流术。结果:治疗组的总有效率为83.33%,显著高于对照组的50.0%,死亡率显著低于对照组,以上差异有统计学意义(Plt;0.05)。结论:微创侧脑室穿刺联合置管外引流术治疗脑室出血效果好,损伤小、操作简便易行,缩短了病程,显著降低了患者致残率及死亡率,及早手术,可提高治愈率和生存质量,值得推广。