Perioperative Nursing of a Case of Right Temporal Lobe Brain Abscess Ruptured into the Ventricle

Objective: To explore the perioperative nursing method of brain abscess breaking into the ventricle. Methods: By reviewing the clinical data of 1 case of right temporal lobe brain abscess into the ventricle, the effective nursing methods were summarized. Results: The patient’s condition was advanced quickly, and the diagnosis was treated in time to avoid brain hernia, but the treatment was difficult because of the critical condition. Conclusion: Brain abscess is a very serious intracranial infectious disease. It is of great significance to observe the changes in patients’ condition and take effective nursing measures.

Effects of lateral ventricular transplantation of bone marrow-derived mesenchymal stem cells modified with brain-derived neurotrophic factor gene on cognition in a rat model of Alzheimer's disease

In the present study, transplantation of bone marrow-derived mesenchymal stem cells modified with brain-derived neurotrophic factor gene into the lateral ventricle of a rat model of Alzheimer＇s disease, resulted in significant attenuation of nerve cell damage in the hippocampal CA1 region. Furthermore, brain-derived neurotrophic factor and tyrosine kinase B mRNA and protein levels were significantly increased, and learning and memory were significantly improved. Results indicate that transplantation of bone marrow-derived mesenchymal stem cells modified with brain-derived neurotrophic factor gene can significantly improve cognitive function in a rat model of Alzheimer＇s disease, possibly by increasing the levels of brain-derived neurotrophic factor and tyrosine kinase B in the hippocampus.

The Relation of Ventricle Remodeling and Brain Natriuretic Peptide in Patients After Acute Myocardial Infarction

Objectives To study the relationship between plasma BNP and cardiac structural, functional changes after AMI, and to evaluate the application of plasma BNP determination in predicting the early phase of ventricle remodeling after AMI. Methods AMI group included 37 patients, all patient underwent strict medical treatment; 32 healthy individuals were enrolled as controls. Plasma BNP was determinated by immunofluorescence. Echocardiograrn examination was used to determinate LVEF, VE , VA , VE/ VA , LVEDd, LVEDV ; All patients underwent the examinations at 72 h, 30 days and 90 days after AMI occurred, respectively, and were compared with healthy controls. Results In comparing to controls, Plasma BNP in AMI 72 h, 30 days and 90 days elevated significantly. LVEDd and LVEDV were increased significantly in all 3 phases of AMI, and EF, VE/ Va were significantly lower than in controls. Correlation analysis revealed that plasma BNP level in 72 h after AMI was positively correlated to LVEDd, LVEDV, and was positively correlated to EF, VE/ VA in 30 days and 90 days after AMI. Conclusions Plasma BNP level in 72 h after AMI is a powerful index to predict left ventricle remodeling and ventricle function as plasm BNP level is positively correlated to ventricle remodeling; lowering the plasm BNP level might be used as an end point for treatment of heart failure. （ S Chin J Cardiol 2009 ; 10（4） ： 208 -211）

Cerebral corridor creator for resection of trigone ventricular tumors:Two case reports

BACKGROUND Resection of deep intracranial tumors requires significant brain retraction,which frequently causes brain damage.In particular,tumor in the trigone of the lateral ventricular presents a surgical challenge due to its inaccessible location and intricate adjacent relationships with essential structures such as the optic radiation(OR)fibers.New brain retraction systems have been developed to minimize retraction-associated injury.To date,there is little evidence supporting the superiority of any retraction system in preserving the white matter tract integrity.This report illustrates the initial surgical excision in two patients using a new retraction system termed the cerebral corridor creator(CCC)and demonstrates its advantage in protecting OR fibers.CASE SUMMARY We report two patients with nonspecific symptoms,who had trigone ventricular lesions that involved the neighboring OR identified on preoperative diffusion tensor imaging(DTI).Both patients underwent successful surgical excision using the CCC.Total tumor removal was achieved without additional neurological deficit.DTI showed that the OR fibers were preserved along the surgical field.Preoperative symptoms were alleviated immediately after surgery.Clinical outcomes were improved according to the Glasgow-Outcome-Scale and Activity-of-Daily-Living Scale assessments.CONCLUSION In the two cases,the CCC was a safe and useful tool for creating access to the deep trigonal area while preserving the white matter tract integrity.The CCC is thus a promising alternative brain retractor.

Unique Occurrence of a Subependymoma Presenting Bilaterally with Hemorrhage:A Case Report

Subependymomas are rare brain tumors derived from the ventricular system and are usually asymptomatic. The interest of this report is to demonstrate that subependymomas can very exceptionally present bilaterally and with hemorrhage. A 69-year-old woman presented with headache, ataxia, and focal neurologic deficits. Magnetic resonance imaging revealed a bilateral intra-axial lesion with unilateral hemorrhage. Patient underwent surgical resection of the tumor and the pathology was consistent with subependymoma. Postoperatively, patient recovered progressively with improvement of symptoms. This is the first case of a subependymoma that is both bilateral and hemorrhagic, two rare occurrences previously mutually exclusive in literature for this type of tumor. In the present case report we perform a review of the literature to analyze and compare retrospectively all other cases of hemorrhagic subependymomas.

侧脑室穿刺辅助颅骨修补手术1例

去骨瓣减压术是治疗重型颅脑损伤、大量脑出血、大面积脑梗死等疾病的有效手段,能减少患者的致死率和致残率,但术后遗留的较大范围的颅骨缺损可导致头痛、癫痫、神经功能减退等一系列临床表现,降低患者的生存质量。颅骨缺损患者常因脑软化灶形成、脑室穿通畸形形成、硬脑膜下积液、脑积水出现脑膨隆情况,导致颅骨修补手术时修补材料置入困难,本例患者通过术中侧脑室穿刺释放脑脊液、缓解脑膨隆后顺利完成颅骨修补手术,为部分脑膨隆的颅骨缺损患者提供新的治疗思路。

中线部位和脑室节细胞胶质瘤临床病理分析及文献复习

目的探讨中线部位和脑室节细胞胶质瘤的临床病理及分子遗传学特点。方法收集11例中线部位和脑室节细胞胶质瘤患者的临床特征、免疫表型及分子检测结果,并复习总结相关文献。结果镜下观察节细胞胶质瘤由异常神经元和肿瘤性增生的胶质细胞构成,免疫表型NeuN、MAP2可标记肿瘤中的神经元成分,GFAP和Olig-2标记出了肿瘤性神经胶质细胞成分;分子遗传学常存在BRAFV600E点突变,但也可发现存在其他形式BRAF基因以及MAPK信号通路基因的改变。随访病例多数预后良好。结论发生在中线部位及脑室的节细胞胶质瘤较为罕见,对于发生于不典型部位的这种低级别神经上皮肿瘤,要将其纳入鉴别诊断中,可在形态学基础上,结合免疫组织化学以及分子检测结果进行综合分析。

基于体表标志定位急诊单引流管双靶点治疗丘脑出血破入脑室伴脑积水

目的 探讨颞部体表定位急诊单引流管双靶点丘脑血肿脑室引流术在丘脑出血破入脑室伴脑积水治疗中的应用价值。方法 回顾性选择丘脑出血破入脑室伴脑积水患者223例,其中包括采取颞部体表定位急诊单引流管双靶点丘脑血肿脑室引流术的研究组115例,以及先行急诊脑室外引流,病情稳定后再行立体定向丘脑血肿引流术的对照组108例。对比2组患者术后并发症及治疗效果的差异,评价颞部体表定位单引流管双靶点丘脑血肿脑室引流术在丘脑出血破入脑室伴脑积水治疗中的应用价值。结果研究组与对照组丘脑术后再出血率(5.2%vs.4.7%)、血肿清除率(87.5%±7.3%vs.90.2%±8.5%)、死亡率(13.9%vs.15.7%)比较差异无统计学意义(P>0.05)。研究组与对照组带管时间、术后颅内感染、分流依赖型脑积水、治疗有效、预后良好分别为(75.5±18.4)h、3.5%、19.1%、53.9%、51.3%与(130.8±22.9)h、13.9%、35.1%、38.7%、38.0%,2组比较差异有统计学意义(P<0.05)。结论 急诊颞部体表定位单引流管双靶点丘脑血肿脑室引流术治疗丘脑出血破入脑室伴脑积水,手术安全可靠,可改善患者预后。

Pleomorphic xanthoastrocytoma in the lateral ventricle with extensive subarachnoid dissemination： report of a case and review of the literature

Pleomorphic xanthoastrocytoma （PXA） is a rare benign tumor that is usually located in the superficial cerebral hemisphere.Most reports of PXAs have included only a single case or small series.Therefore,the data with respect to the natural history of this tumor are fragmentary.We report a case of a PXA in the unusual location of the right lateral ventricle with extensive subarachnoid dissemination.To our knowledge,this is a rare case of PXA in the lateral ventricle.In addition,extensive subarachnoid space dissemination of this distinctly benign type of glioma is exceedingly rare.In our case,there was meningeal dissemination and metastases to the bilateral trigeminal nerves and oculomotor nerves.The neuroradiographic features,tumor location,and dissemination were reviewed.

大鼠侧脑室置管方法的改良

国际上公认的实验动物脑室内给药方法是先在侧脑室内埋置固定于颅顶的套管,5～10 d后待动物从埋管过程造成的应激反应恢复后再经内管给药,这可以去除插管过程造成的应激对实验结果的干扰.但目前此种方法所用的管道系统多依赖进口,价格昂贵,且为一次性使用,其代价是很多国内实验室难以承受的.故国内神经生物学实验中动物脑室内给药的方法多为在颅骨钻孔后以微量注射器或玻璃微电极直接插入脑室内即刻给药,这种方法显然是有缺陷的.为克服这一问题,我们研究出了重复使用进口管道系统的方法,自行设计了置管时将管道固定在立体定向仪上的装置以取代国外公司昂贵的相关产品并可适用于国产定向仪.实验结果证实了这种方法是可行的.本文对这一实验方法的改造进行了详细的描述.

成人第四脑室肿瘤的显微手术治疗和术后并发症的防治

目的:探讨第四脑室肿瘤显微外科技巧及并发症的防治经验,提高手术的效果。方法:回顾性分析2005年8月至2007年8月68例在湘雅医院经手术治疗的第四脑室肿瘤患者的临床资料。选择小脑蚓部或小脑延髓裂入路切除肿瘤,手术过程中对侵袭延髓呼吸中枢的部分肿瘤不必勉强切除,但均打通导水管下口,关颅时采用颈肌-硬膜悬吊法。结果:肿瘤全切除58例,近全切除10例,本组无死亡病例。术后出现症状性脑积水10例,行脑室-腹腔分流术;原瘤腔出血4例,行二次手术;颅内积气8例,颅内感染10例,上消化道出血18例,均经保守治疗后痊愈。气管切开16例,其中5例呼吸机辅助呼吸,均经治疗后痊愈。本组无枕后皮下积液病例。结论:术中生命中枢的保护及完全打通导水管下口是手术成败的关键,熟练的显微外科技术有助于提高手术疗效,术后积极防治并发症,辅以综合治疗,可改善预后。

第三脑室脊索样胶质瘤3例报道及文献复习

目的探讨第三脑室脊索样胶质瘤临床病理学特征及其鉴别诊断,提高对脊索样胶质瘤的认识。方法对3例脊索样胶质瘤进行光镜、免疫组化标记及电镜观察,并复习3例患者的临床资料及相关文献。结果3例患者中2例为女性,1例男性,发病年龄32-46岁,主要症状为记忆力下降、头痛、呕吐、昏睡、短期失去知觉等,女性常有月经不调。肿瘤均位于第三脑室附近,直径3-4cm。光镜下瘤细胞呈团簇状或条索状分布于空泡状黏液样基质中。瘤细胞圆形到多边形,胞质红染,未见核分裂,无坏死及血管内皮增殖。肿瘤周边间质内散在淋巴细胞、浆细胞浸润。免疫表型示所有瘤细胞表达GFAP和vimen-tin,少数瘤细胞表达S-100及EMA,2例中有灶性瘤细胞表达CKpan及CD34。结论第三脑室脊索样胶质瘤是一种独特的、罕见的中枢神经系统肿瘤,诊断主要依靠临床特点、组织病理特征、免疫表型及电镜检查。

高血压病患者血浆中脑利钠肽水平与不同左室构型的相关性

目的 :分析心脏功能代偿期的高血压患者不同心脏构型之间的血浆中脑利钠肽 (BNP)水平差异 ,探讨左室重构可能的机制 .方法 :心脏收缩功能正常的高血压患者 16 6例 ,血压正常对照组 87例 ,应用彩色多普勒超声诊断仪 ,按Ganau分类法 ,将高血压组患者的左心室重构分为正常型、向心性重构型、向心性肥厚型、离心性肥厚型 4种构型 .对比血浆BNP水平 .结果 :总体上高血压组BNP水平高于对照组 ,按心脏重构分组后 ,以向心性肥厚组BNP水平升高最显著 (P <0 .0 1) ,向心性构型组和离心性肥厚组次之 (P <0 .0 1,P <0 .0 5 ) ,而正常构型组虽高于对照组 ,但差别不具有显著差异 .结论 :尽管高血压患者尚未出现心功能失代偿 ,但BNP水平有升高 ;在不同左心室构型之间 ,BNP水平不同 ,提示BNP可能参与了高血压左心室的重构 .

术中超声在脑外伤后脑室穿刺中的应用

目的探讨术中超声在脑外伤后脑室穿刺中的应用价值。方法选取脑外伤后需接受侧脑室穿刺术的患者68例,随机均分为2组,对研究组实施超声引导下侧脑室穿刺术,对照组实施传统盲穿术,分别记录每例穿刺成功所需时间、单次穿刺成功情况及每组的术后并发症情况,并对两组结果进行比较。结果研究组一次穿刺成功率为100%(34/34);手术时间5～12min,平均(6.35±1.51)min;术后无并发症发生。对照组24例一次穿刺成功,成功率70.59%(24/34);手术时间5～17min,平均(11.21±3.10)min;术后8例(8/34,23.53%)出现并发症,分别为穿刺道出血4例、误穿入对侧脑室2例、反复穿刺致使窦道形成1例及脉络丛损伤1例。研究组与对照组间的一次穿刺成功率、穿刺手术时间及术后并发症发生率差异均有统计学意义(P均<0.05)。结论在脑外伤患者的脑室穿刺术中,超声引导法穿刺成功率明显优于传统盲穿法,手术时间明显短于传统盲穿法,并可减少并发症的发生,可在临床推广应用。

人参皂甙Rg1对大鼠局灶性脑缺血后侧脑室下区神经干细胞增殖分化的影响

目的观察人参皂甙Rg1对大鼠局灶性脑缺血后侧脑室下区神经干细胞增殖分化的影响,探讨其促进神经发生的作用。方法将60只Wistar大鼠随机分为假手术组、单纯缺血组及人参皂甙Rg1治疗组。用Longa线栓法制作成年大鼠大脑中动脉闭塞模型。腹腔注射5-溴脱氧尿苷(BrdU)标记处于增殖状态的神经干细胞,用免疫单标及双标免疫荧光技术观察人参皂甙Rg1对局灶性脑缺血后侧脑室下区BrdU免疫活性及BrdU/神经元特异性烯醇化酶和BrdU/胶质纤维酸性蛋白双标免疫活性的影响,并计数作定量分析。结果脑缺血后侧脑室下区存在BrdU阳性细胞分布;应用人参皂甙Rg1后,上述部位及周边脑区BrdU阳性细胞数及双标阳性细胞明显增多(P<0.01)。结论人参皂甙Rg1能诱导侧脑室下区神经干细胞增殖、分化,提示其具有促进神经发生的能力。

经额中回-侧脑室-脉络裂入路显微手术切除第三脑室前部肿瘤

目的介绍并探讨一种切除第三脑室前部病变的显微手术入路。方法经额中回-侧脑室-脉络裂入路手术切除第三脑室前部肿瘤10例。结果显微镜下全切除8例,近全切除2例;死亡1例。结论该入路利用脑室的自然裂隙到达第三脑室,几乎不损伤正常脑组织和血管结构,具有手术损伤小,术野暴露清楚等优点,是切除第三脑室前部肿瘤的优选入路之一。

脑室内脑膜瘤的MRI诊断

目的分析脑室内脑膜瘤的MRI特点,提高诊断准确性。资料与方法经手术病理证实的脑室内脑膜瘤10例,其中9例位于侧脑室,1例位于四脑室。10例均行MR平扫及增强扫描。结果脑室内脑膜瘤具有典型的MRI表现:(1)病灶大多为类圆形(8/10),边界规则、清晰。T1WI呈等信号(8/10)、稍低信号(2/10),T2WI呈略高信号(5/10)、等信号(2/10)、低信号(3/10),增强扫描大部分呈中到重度均匀强化(8/10),少数不均匀强化(1/10)和轻度强化(1/10)。部分瘤内可见粗大血管影(2/10),可有小囊变、坏死(4/10)及瘤周脑实质水肿(2/10)。(2)脑室内脑膜瘤以成年女性多见(8/10)。好发于侧脑室(9/10)及四脑室(1/10)。所有病例的病理类型均为纤维型。结论脑室内脑膜瘤有较典型的MRI特点,结合其发病部位和患者性别,可以提高诊断准确性。

脑室内胶质瘤的MRI诊断

目的分析脑室内胶质瘤的MRI特点,提高诊断准确性。资料与方法经手术病理证实的脑室内胶质瘤29例,其中20例位于侧脑室,2例位于三脑室,7例位于四脑室。29例均行MR平扫及增强扫描。结果(1)大多数脑室内胶质瘤如室管膜瘤、星形细胞瘤、脉络丛乳头状瘤等具有特征性的MRI表现;(2)部分肿瘤具有其好发部位,如脉络丛乳头状瘤好发于侧脑室三角区,室管膜瘤好发于侧脑室体部,髓母细胞瘤好发于四脑室区;(3)某些肿瘤具有年龄和性别特征,如星形细胞瘤患者年龄均<30岁,脉络丛乳头状瘤患者年龄均>50岁,室管膜瘤女性占66.67%。结论脑室内胶质瘤有比较特征性的MRI表现,结合患者临床和发病年龄、性别、部位等特点,可进一步提高其术前诊断准确性。

血清脑钠素对高血压伴左心室肥厚的影响

目的探讨血清脑钠素(BNP)与原发性高血压伴左心室肥厚(LVH)相关性,并观察氨氯地平治疗对血清BNP的影响。方法选择轻、中度高血压患者120例和健康对照组40例,高血压患者给予氨氯地平(络活喜)治疗6个月后观察血清BNP、收缩压(SBP)、舒张压(DBP)、左心室质量指数(LVMI)的变化。结果治疗前LVH组与高血压无左心室肥厚(NLVH)组的血清BNP水平、SBP、DBP和LVMI均较健康对照组高(P<0.01),且LVH组比NLVH组血清BNP高(P<0.01)。氨氯地平治疗后LVH组BNP、SBP、DBP与LVMI均降低(P<0.01);NLVH组血清BNP、LVMI治疗后亦降低,但差异无统计学意义(P>0.05)。血清BNP与LVMI呈显著正相关(r=0.43,P<0.01)。结论LVH组应用氨氯地平后血清BNP、LVMI均较治疗前降低,血清BNP与LVMI呈显著正相关。氨氯地平不仅可以使血压平稳下降,还可逆转高血压伴LVH。

重型颅脑损伤后并发脑积水的多因素分析

目的探讨重型颅脑创伤后并发脑积水的危险因素。方法回顾性分析2009年1月～2014年5月收治的248例重型颅脑损伤患者的临床资料,其中男性180例,女性68例;年龄18～74岁,平均51.2岁。致伤原因：道路交通伤200例,高处坠落伤23例,殴打伤8例,硬物砸伤10例,其他伤7例。根据伤后是否并发脑积水分为脑积水组（50例）和无脑积水组（198例）。对颅脑损伤后并发脑积水的相关因素,如患者的年龄、入院时格拉斯哥昏迷评分（GCS）、去骨瓣、硬脑膜有无缝合、蛛网膜下腔出血（SAH）情况、血肿位置及腰椎穿刺有无引流脑脊液等,进行Logistic回归分析。结果 248例颅脑损伤患者中,50例（20.2%）发生脑积水;通过Logistic回归分析发现重型颅脑损伤患者发生脑积水主要危险因素为年龄（OR=1.823,P=0.031）、去骨瓣（OR=1.136,P=0.000）、弥散性SAH（OR=2.288,P=0.018）、硬脑膜缝合（OR=1.711,P=0.037）、腰椎穿刺放血性脑脊液（OR=0.449,P=0.002）。结论高龄患者、去骨瓣减压、硬脑膜开放以及弥散性SAH是重型颅脑损伤后并发脑积水的危险因素,采取硬脑膜缝合、腰椎穿刺引流血性脑脊液可降低脑积水的发生率。