The effect of severe carotid occlusive disease and its surgical treatment on cognitive functions of the brain

Surgery of a high-grade carotid stenosis is evidence-based stroke prevention. Also cognitive effects are reported after carotid endarterectomy (CEA): both deterioration and improvement, the former attributed to perioperative complications and the latter often to learning effect. By imaging, brain perfusion and diffusion changes were shown in subjects with a high-grade stenosis undergoing CEA. We wanted to find out if the cognition of patients undergoing CEA display postoperative worsening or true improvement in association with findings in serial MR imaging. The patients had a poorer overall cognition than healthy matched controls. The cerebral hemisphere ipsilateral to the stenosis had higher diffusion and more sluggish perfusion leading to perfusion deficits. These asymmetries were abolished by CEA. Postoperatively, the patients showed a trend for cognitive worsening, most often attentional, but over months, the group performance improved similarly to the controls. Still, lower baseline perfusion was associated with a greater cognitive improvement, most clearly in executive functions. Consequently, despite the risk for transient decline, true cognitive benefit by CEA seems possible.     

胸椎管狭窄症的临床分型与术式选择

为探讨胸椎管狭窄症的临床分型与术式选择,对35例患者行后路椎管减压术,所有患者术后12个月时ASIA分级均有1级或1级以上的恢复;按Epstein标准：优良率：85．7％;影像学检查示脊髓减压充分,植骨患者术后6个月均达骨性融合。据不同的临床类型选择不同的术式,可取得满意的临床疗效。     

一期颈椎后前路手术治疗伴有后凸畸形的多节段颈椎管狭窄的临床研究

为了研究与探讨一期颈椎后前路联合手术治疗伴有后凸畸形的多节段颈椎管狭窄的临床疗效,回顾性研究2011年3月至2013年2月在我院由同一组外科医生治疗且符合标准纳入研究的患者32例,比较术前与术后的 JOA 评分,颈髓功能改善率,Borden 氏测量法的 D 值,Vas 评分,评估一期颈椎后前路联合手术治疗该疾病的临床疗效。患者术后均随访12个月,患者接受一期后前路手术治疗后双臂双手麻木、间歇性跛行、走路有踩棉花感、肢体感觉障碍症状均有明显改善。一期颈椎后前路联合手术治疗伴有后凸畸形的多节段颈椎管狭窄症,可有效地矫正颈椎的后凸畸形,恢复颈椎正常的生理弯曲,解除颈髓压迫,恢复颈椎生理曲度,是安全有效的手术方法。