颅内动脉瘤的诊断、治疗时机及方法

分析颅内动脉瘤各种常用诊断方法的价值以及治疗时机和方法,认为对颅内动脉瘤应该在准确、快速诊断的基础上,按照安全、有效、经济的原则进行治疗.     

颅内动脉瘤治疗方案的比较

手术和血管内介入是目前临床上治疗颅内动脉瘤的有效方法,针对两者的优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴。     

颅内动脉瘤治疗方案的比较

手术和血管内介入是目前临床上治疗颅内动脉瘤的有效方法,针对两者的优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴.     

48例颅内动脉瘤破裂出血急性期治疗效果分析

总结我科收治的48例颅内动脉瘤破裂出血急性期患者治疗体会。回顾性分析2011年8月～2013年10月我科收治的48例56个颅内动脉瘤破裂出血急性期临床资料,介入栓塞30例（36个动脉瘤）,手术夹闭18例（20个动脉瘤）。结果介入栓塞组恢复良好14例、轻度残疾6例、重度残疾8例,死亡2例,手术夹闭组恢复良好10例、轻度残疾6例、重度残疾2例。两组 Hunt-Hess 分级3级以下患者预后无显著性差异。血管内栓塞和手术夹闭均为颅内动脉瘤破裂出血急性期的有效治疗手段,Hunt-Hess 分级3级以下者两种治疗方式均可得到满意疗效,4级以上者血管内栓塞是挽救患者生命的重要措施,但预后较差。     

颅内动脉瘤治疗方案选择的多维思考

针对颅内动脉瘤手术治疗和血管内治疗的优缺点,分析不同治疗方式的疗效与经济费用比较,就如何选择治疗方法提出医疗原则,并对医疗原则进行伦理学思考,认为治疗应该体现安全、有效、经济的原则.     

从颅内动脉瘤的诊断认识影像技术发展

医学影像技术在其应用与发展中有其自身的内在矛盾 ,包括技术目的与技术手段的矛盾 ,技术结构与技术功能的矛盾。在基本矛盾的作用下 ,医学影像技术的发展遵循量变质变 ,渐进飞跃的规律 ,在这一过程中 ,社会的需要是技术发展的动力源泉。1　从颅内动脉瘤的超声诊断看技术目的———手段的矛盾脑动脉瘤是一种易引起颅内出血的严重疾患 ,常致病人残疾、死亡 ,发病率较高 ,在脑血管意外病人中居第 3位。动脉瘤的严重性和高发病要求人们对动脉瘤的病因、诊断、治疗等各方面作出大量细致的研究。1 1　探测血流动力学———经颅多普勒 (ＴＣＤ)的…     

动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策.运用循证医学时动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率.     

动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策。运用循证医学对动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率。     

出血性脑血管病介入治疗进展

出血性脑血管病的介入栓塞治疗由于血管内辅助技术与各种栓塞材料的综合应用取得快速发展,主要有以下三个方面：（1）生物修饰弹簧圈、封堵球囊和支架技术的应用使复杂颅内动脉瘤的介入治疗成为可能;（2）非粘附性液体栓塞剂的应用提高了脑动静脉畸形和硬脑膜动静脉瘘的单纯栓塞治愈率;（3）带膜支架在颅底部巨大动脉瘤和创伤性动静脉瘘取得开创性应用。     

对颅内宽颈动脉瘤血管内治疗的哲学思考

1　血管内技术治疗宽颈动脉瘤的发展过程1.1　宽颈动脉瘤的治疗效果回顾宽颈动脉瘤如果采用常规的开颅神经外科手术(动脉瘤颈夹闭术 )手术成功率较低 ,主要是因为瘤颈宽大 ,不容易充分地暴露 ,而且开颅手术的创伤较大 ,故目前逐渐采用血管内介入技术来治疗宽颈动脉瘤。初期人们用电解可控铂金弹簧圈技术(Guglielmidetachablecoil,GDC )来治疗宽颈动脉瘤。但逐渐认识到该技术的复发率较高。对于宽颈动脉瘤 (颈宽 >4mm、直径 >10mm ) ,初次治疗的完全栓塞率只有 31.2 %～ 5 0 .0 % [1] 。对于不完全栓塞的动脉瘤的长期随访发现 :小而宽颈的…     

预防患者术中知哓的早期心理干预——颅内动脉瘤介入栓塞术患者中的研究

探讨早期心理干预在预防颅内动脉瘤栓塞术患者术中知晓的效果。将100例患者按入院先后顺序随机分为观察组和对照组,各50例,均实行整体护理,对照组给予常规的术前、术后护理,观察组在常规护理的基础上给予一系列针对术中知晓的心理护理干预措施。观察组干预前后焦虑程度明显减轻（P〈0．01）,对护理质量满意度均优于对照组（P〈0．05）,差异有统计学意义。针对不同患者心理状态进行系统的早期心理干预可减轻脑血管介入患者术前焦虑情绪,从而积极有效地预防颅内动脉瘤栓塞术患者术中知晓的发生,提高护理质量满意度。     

Neuropsychological course after surgery for intracranial aneurysms. A prospective study and a critical review

Previously, only three studies with representative samples of patients with ruptured intracranial aneurysms have provided detailed results of prospective, repeated, neuropsychological assessments after surgery. These studies apparently disagree with regard to occurrence of cognitive deficits and to degree of improvement between early and delayed follow-ups. The present paper attempts to analyze the conditions underlying these differences in results. As a first step in this analysis we present a comprehensive, prospective, neuropsychological investigation of a consecutive sample of 41 patients with rupture of a supratentorial aneurysm, assessed 4 and 12 months after surgery. It is concluded that a prorated course of improvement of a wide specter of psychological functions may be revealed, but that sensitive tests and large samples are needed to establish the range of deficits and improvements with time. Differences in patient selection with respect to severity of the acute clinical state and delayed deterioration apparently contribute importantly to the discrepance in previously reported outcome.     

Skull size and intelligence, and King Robert Bruce's IQ

An estimate of someone's IQ is a potentially informative personal datum. This study examines the association between external skull measurements and IQ scores, and uses the resulting regression equation to provide an estimate of the IQ of King Robert I of Scotland (Robert Bruce, 1274–1329). Participants were 48 relatively healthy Caucasian men (age 71–76 years) resident in Scotland. Using magnetic resonance imaging data, intracranial volume estimated from external skull length and width correlated greater than .5 (p < .001) with measured intracranial area, which correlates very highly with brain volume. IQ scores estimated from the National Adult Reading Test (NART) correlated .56 (p < .001) with measured intracranial area, and .49 (p < .01) with estimated intracranial volume based on external skull width and length. The partial correlation coefficient of this latter association was .25 (p = .09) after adjustment for measured intracranial area. Thus, actual intracranial area accounts for about 74% of the variance shared by NART and estimated intracranial volume. A cast of the skull of Robert Bruce was measured and its intracranial volume estimated. A regression equation between IQ and estimated intracranial volume, based on data from the 48 subjects, estimated the IQ of Robert Bruce at about 128 (95% confidence interval 106 to  130), i.e. almost two standard deviations above the mean. NART scores show a ceiling effect, so this estimated IQ might be an underestimate. Robert Bruce's estimated high IQ is congruent with his military, political and other intellectual achievements.     

颅内脂肪瘤的诊断与治疗

为了分析和讨论颅内脂肪瘤的诊断和治疗,我们回顾性分析23例颅内脂肪瘤患者的临床特点、影像学资料,对17例有症状的患者行手术治疗,6例无相关症状患者行CT或MRI随访。结果显示,17例手术患者中,除1例较术前症状加重外,余16例症状缓解或明显改善。6例无症状患者随访1年～6年,CT或MRI显示脂肪瘤无明显增大。因此,无相关症状患者可行CT或MRI随访;有明显的神经表现者可行手术治疗,手术目的是充分的神经结构减压,部分切除及减压术可实现长期的症状缓解。     

Rehabilitation of executive deficits in closed head injury and anterior communicating artery aneurysm patients

This paper reports a study that was aimed to rehabilitate executive functions in closed head injury (CHI) and anterior communicating artery (ACoA) aneurysm patients. The groups tested comprised 10 CHI patients, 9 ACoA aneurysm patients and 19 controls. We employed a dual-task paradigm that is known to tap the ability to co-ordinate two actions. The treatment consisted of five experimental sessions, in which the dual-task paradigm was used. In the CHI study, the dual-task cost was measured before the treatment (assessment), immediately after the treatment (retest), and 3 months after the treatment (follow-up). In the ACoA aneurysm study, the dual-task cost was also assessed 12 months after the treatment. A significant reduction of the dual-task cost from assessment to retest was found. This reduction remained stable in the follow-up sessions. The results are discussed with reference to the absence of spontaneous recovery of this specific executive function and to the possibility that the beneficial effect of the treatment generalises to other executive functions and/or daily living activities. Received: 31 March 1999 / Accepted: 23 July 1999     

Incidental Finding of Tumor While Investigating Subarachnoid Hemorrhage: Ethical Considerations and Practical Strategies

High-resolution neuroimaging modalities are used often in studies involving healthy volunteers. Subsequently, a significant increase in the incidental discovery of asymptomatic intracranial abnormalities raised the important ethical issues of when follow-up and treatment may be necessary. We examined the literature to establish a practical set of criteria for approaching incidental findings. Our objective is to develop an algorithm for when follow-up may be important and to provide recommendations that would increase the likelihood of follow-up. A systematic literature search was performed using the PubMed and MEDLINE databases to identify articles describing brain tumors and intracranial aneurysms. The treatment algorithm we present suggests that incidental intracranial masses suspicious for glioma should be biopsied or resected, while other masses are to be followed with serial imaging based on the expected growth pattern. Lack of follow-up can result in adverse outcomes that can be mitigated by using technology to facilitate communication and improve follow-up care. The importance of training physicians to be good communicators is also stressed. New technology including automated telephone systems, texting and email will improve access to patients and hopefully encourage compliance and follow-up.     

Comparison of behaviors elicited by electrical brain stimulation in dorsal brain stem and hypothalamus of rats.

Four brain-stimulation phenomena elicited from both dorsal brain stem and hypothalamic sites were investigated with the following results: (a) intracranial self-stimulation rate-intensity functions for dorsal brain stem and hypothalamic sites yielded very high (over 1,000 responses/15 min.) to moderate (201-500 responses/15 min.) response rates; (b) d-amphetamine produced higher response rates than either l-amphetamine or saline at both dorsal brain stem and hypothalamic sites, indicating that noradrenergic dorsal brain stem fibers (or cell bodies) support intracranial self-stimulation; (c) dorsal brain stem and hypothalamic self-stimulation sites reliably produced escape behavior; (d) simultaneous stimulation of dorsal brain stem and hypothalamic sites at subthreshold intensities interacted to produce suprathreshold response rates.     

动态颅内压监测技术的进展

动态颅内压（ICP）监测是重危颅脑疾病病人脑功能的监测技术之一,对颅高压病人的临床诊断、指导治疗和判断预后都有着重要的意义。多种颅内压监测方法被使用于临床。本文综述近年来颅内压监测方法的进展,着重介绍创伤性和非创伤性颅内压监测法,比较其优缺点,评价其临床价值及发展方向。