Objective To investigate the peroperative treatment of cranio-orbital tumors and the method of the reconstruction of the skull base. Methods Between April 2008 and April 2011, 35 patients with cranio-orbital tumor were treated. There were 21 males and 14 females, aged 17-73 years (mean, 46.3 years). The first symptoms were orbital pain in 13 cases, hypopsia in 12 cases, exophthalmos or abnormal eye position in 5 cases, headache and dizziness in 2 cases, di plopia in 2cases, and pulsating eyeball in 1 case. Some of the patients needed resecting the zygomatic arch, supercil iary arch, and orbit roof. The autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges were used to reconstruct the skull base. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Postoperative MRI indicated that total removal of tumors was achieved in 30 cases, subtotal in 3 cases, and partial in 2 cases at 3 days. There was no operative death. Cerebrospinal rhinorrhea and infection occurred at 1 week in 1 and 2 cases respectively, and were cured after lumbar drainage and antibiotics. The patients were followed up 6 to 36 months (mean, 18 months). In patients having hypopsia, the visual function was improved in 9 cases at 1 month; in patients having orbital pain, pain rel ief was achieved at 2 weeks after operation; in patients having exophthalmos or abnormal eye position and pulsating eyeball, sympotoms disappeared after operation. In 27 patients with benign tumor, 24 were cured, without recurrence during follow-up; in 8 patients with mal ignant tumor, 6 had recurrence within 18 months and underwent second operation or radiotherapy, 2 relapsed cases died of cerebral hernia and respiratory circulating failure at 24 months after operation. No complication of enophthalmos, pulsating exophthalmos, or collapse of zygomatic region occurred. Conclusion Using the autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges to reconstruct the skull base has rel iable foundation, simple operation, and easy anatomical reconstruction, so it is an effective method after the removal of cranio-orbital tumors; better effectiveness would beobtained when combining with the peroperative nursing.
ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.
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。