目的应用磁共振相位对比电影成像(Cine PC MRI)对第三脑室底造瘘术(ETV)后瘘口区脑脊液流动情况进行定性及定量分析。方法对15例因中脑导水管狭窄或闭塞行ETV的病人,行Cine PC MRI检查(研究组),并选择15名正常志愿者作为对照组。观察瘘...目的应用磁共振相位对比电影成像(Cine PC MRI)对第三脑室底造瘘术(ETV)后瘘口区脑脊液流动情况进行定性及定量分析。方法对15例因中脑导水管狭窄或闭塞行ETV的病人,行Cine PC MRI检查(研究组),并选择15名正常志愿者作为对照组。观察瘘口区脑脊液流动情况,测量并计算瘘口区的收缩期最大流速(MSV)、舒张期最大流速(MDV)、平均流率(AFR)及1个心动周期脑脊液搏动量(SV)、净流量(NV);并对两组参数进行比较。结果研究组瘘口区脑脊液流动表现为与对照组导水管区相似的双向搏动。研究组脑脊液进入收缩期时间点为(35.52±10.26)%,对照组为(24.47±7.64)%;研究组脑脊液达到MSV时间点为(54.89±12.8)%,对照组为(42.95±10.88)%;研究组SV为(121.27±75.97)μl,对照组为(41.77±20.05)μl;研究组AFR为(20.79±10.16)ml/min,对照组为(7.28±2.42)ml/min;以上参数两组差异均具有统计学意义(P<0.05)。而两组脑脊液收缩期占心动周期的百分比、MSV及MDV差异均无统计学意义(P>0.05)。结论 Cine PC MRI可对ETV后瘘口区脑脊液流动行定性、定量分析。瘘口区收缩期较正常导水管区滞后,但SV和AFR明显大于正常导水管区。展开更多
Background: Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractor...Background: Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI. It is our hypothesis that DC can enhance survival and minimize secondary brain injury in this patient subset. Methods: Patients younger than 20 years treated at a level I regional trauma center between November 2001 and November 2004, who met inclusion criteria for the Brain Trauma Foundation TBI-trac clinical database were included. All patients with a mechanism of injury consistent with TBI and Glasgow Coma Scale score of less than 9 for at least 6 hours after resuscitation and who did not die in the emergency department are entered into a clinical database. Patients who arrived at the study hospital more than 24 hours after injury are excluded. Results: There were 30 patients with TBI identified. The mean Glasgow Coma Scale score at presentation was 8 with a range of 3 to 13. Six patients underwent DC for intractable elevated ICP. Of 6 patient’s postoperative ICP, 5 were less than 20 mm Hg. One patie nt required a return to the operating room where further debridement of brain was performed. All patients who received a DC survived and were discharged to a TBI rehabilitation facility. Conclusion: Although this is a small sample, DC should be considered in patients with TBI with refractory elevated ICP. Long-term follow-up of this patient population should consist of neuropsychiatric evaluation in conjunction with measurement of social function.展开更多
文摘目的应用磁共振相位对比电影成像(Cine PC MRI)对第三脑室底造瘘术(ETV)后瘘口区脑脊液流动情况进行定性及定量分析。方法对15例因中脑导水管狭窄或闭塞行ETV的病人,行Cine PC MRI检查(研究组),并选择15名正常志愿者作为对照组。观察瘘口区脑脊液流动情况,测量并计算瘘口区的收缩期最大流速(MSV)、舒张期最大流速(MDV)、平均流率(AFR)及1个心动周期脑脊液搏动量(SV)、净流量(NV);并对两组参数进行比较。结果研究组瘘口区脑脊液流动表现为与对照组导水管区相似的双向搏动。研究组脑脊液进入收缩期时间点为(35.52±10.26)%,对照组为(24.47±7.64)%;研究组脑脊液达到MSV时间点为(54.89±12.8)%,对照组为(42.95±10.88)%;研究组SV为(121.27±75.97)μl,对照组为(41.77±20.05)μl;研究组AFR为(20.79±10.16)ml/min,对照组为(7.28±2.42)ml/min;以上参数两组差异均具有统计学意义(P<0.05)。而两组脑脊液收缩期占心动周期的百分比、MSV及MDV差异均无统计学意义(P>0.05)。结论 Cine PC MRI可对ETV后瘘口区脑脊液流动行定性、定量分析。瘘口区收缩期较正常导水管区滞后,但SV和AFR明显大于正常导水管区。
文摘Background: Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI. It is our hypothesis that DC can enhance survival and minimize secondary brain injury in this patient subset. Methods: Patients younger than 20 years treated at a level I regional trauma center between November 2001 and November 2004, who met inclusion criteria for the Brain Trauma Foundation TBI-trac clinical database were included. All patients with a mechanism of injury consistent with TBI and Glasgow Coma Scale score of less than 9 for at least 6 hours after resuscitation and who did not die in the emergency department are entered into a clinical database. Patients who arrived at the study hospital more than 24 hours after injury are excluded. Results: There were 30 patients with TBI identified. The mean Glasgow Coma Scale score at presentation was 8 with a range of 3 to 13. Six patients underwent DC for intractable elevated ICP. Of 6 patient’s postoperative ICP, 5 were less than 20 mm Hg. One patie nt required a return to the operating room where further debridement of brain was performed. All patients who received a DC survived and were discharged to a TBI rehabilitation facility. Conclusion: Although this is a small sample, DC should be considered in patients with TBI with refractory elevated ICP. Long-term follow-up of this patient population should consist of neuropsychiatric evaluation in conjunction with measurement of social function.
