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find Keyword "立体定向" 31 results
  • Stereotactic Biopsy of Brain Lesions

    目的:探讨立体定向脑病变活检术的手术技巧及影响因素。方法:总结20例立体定向活检病例,其中多发病灶者4例,单发病灶者16例。使用CT、MRI扫描、立体定向仪及手术计划系统精确定位靶点、制定合适的活检轨迹。使用Backlund和Sedan活检针取材,脑浅表病灶使用立体定向环钻开颅全切。术中冰冻活检,术后石蜡包埋病理检查和免疫组化检查。结果:19例获明确的病理诊断,活检阳性率95%。其中,9例脑胶质瘤,3例海绵状血管瘤、2例脑转移瘤,3例非特异性炎性肉芽肿,1例结核性肉芽肿,1例脑弓形虫病。结论:立体定向脑病变活检术是神经外科十分重要的安全的诊治手段。

    Release date:2016-09-08 10:01 Export PDF Favorites Scan
  • Stereotactic Intracystic Irradiation Treatment of Cystic and Cystosolid Craniopharyngioma

    探讨立体定向囊内放射治疗囊性和囊实性颅咽管瘤的方法和疗效。方法:对12例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI 引导立体定向吸除囊液、注入胶体磷酸铬,待瘤囊缩小远离视神经等重要结构后,施行伽玛刀治疗。结果:全部病例经手术排出囊液后临床症状迅速改善。经囊内放疗后2-36个月随访12例患者,CT、MRI扫描显示5例患者瘤囊持续消失,临床症状消失,恢复正常的生活和学习;5例患者肿瘤显著缩小,症状持续改善;2例肿瘤无明显改变;无死亡病例。结论:CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。

    Release date:2016-09-08 10:01 Export PDF Favorites Scan
  • Initial Clinical Experience of Treating Writer’s Cramp with Selective Thalamotomy

    目的:回顾立体定向脑深部微电极记录引导下的术治疗书写痉挛的方法及疗效,探讨治疗的机理。方法:运用脑深部微电极记录引导下立体定向技术,对10例书写痉挛患者实施了丘脑腹中间核(Vim)和丘脑腹嘴核(Vo)的毁损术,进行疗效分析。结果: 10例患者术后书写功能即刻恢复正常,2例出现的感觉异常和构音障碍的可逆性手术并症,无永久性手术并发症,1~2年的随访疗效稳定无复发。结论:选择性丘脑切开是治疗书写痉挛的有效、安全的治疗手段。

    Release date:2016-09-08 10:02 Export PDF Favorites Scan
  • The application of stereoelectroencephalography technique with ROSA on precise epileptogenic zone localization and resection

    ObjectiveTo evaluate the application of stereotactic electrode implantation on precise epileptogenic zone localization. MethodRetrospectively studied 140 patients with drug-resist epilepsy from March 2012 to June 2015, who undergone a procedure of intracranial stereotactic electrode for localized epileptogenic zone. ResultsIn 140 patients who underwent the ROSA navigated implantation of intracranial electrode, 109 are unilateral implantation, 31 are bilateral; 3 patients experienced an intracranial hematoma caused by the implantation. Preserved time of electrodes, on average, 8.4days (range 2~35 days); Obseved clinical seizures, on average, 10.8 times per pt (range 0~98 times); There were no cerebrospinal fluid leak, intracranial hematoma, electrodes fracture or patient death, except 2 pt's scalp infection (1.43%, scalp infection rate); 131 pts' seizure onset area was precisely localized; 71 pts underwent SEEG-guide resections and were followed up for more than 6 months. In the group of 71 resection pts, 56 pts were reached Engel I class, 2 were Engel Ⅱ, 3 was Engel Ⅲ and 10 were Engel IV class. ConclusionTo intractable epilepsy, when non-invasive assessments can't find the epileptogenic foci, intracranial electrode implantation combined with long-term VEEG is an effective method to localize the epileptogenic foci, especially the ROSA navigated stereotactic electrode implantation, which is a micro-invasive, short-time, less-complication, safe-guaranteed, and precise technique.

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  • A clinical study based on SEEG: epileptogenic mapping and surgery in pharmaco-resistant post-encephalitic temporal lobe epilepsy

    ObjectivesPost-encephalitic epilepsy could be of great chance of pharmaco-resistant, even surgery may not achieve seizure free. The aim of this study is to mapping epileptogenic area of pharmaco-resistant post-encephalitic temporal lobe epilepsy, to find whether "temporal plus" epilepsy is the main type and its surgery outcome, based on stereo-EEG(SEEG) study.MethodWe retrospectively studied 15 patients with pharmaco-resistant temporal lobe epilepsy. Scalp EEG, seizure semiology, MRI, FDG-PET, and SEEG were reviewed for all patients. According to epileptogenic area which was analysed by SEEG, 15 patients were divided into 2 groups, temporal lobe epilepsy(TLE) group and temporal plus epilepsy(TPE) group. Clinical characteristics were compared with each group, by t-test or Fisher exact test when data needed.ResultsThere were 8 patients in TLE group, with 6 mesial TLE, 1 lateral TLE, 1 mesial-lateral TLE. And 7 patients in TPE group. Age of seizure onset (P=0.548), duration of epilepsy (P=0.099), age of remote encephalitis (P=0.385), type of semiology (P=0.315) and lateralization of MR lesions (P=1.000), interictal FDG-PET hypometabalism (P=1.000) or intracranial implantation (P=0.619) were of no statistically difference between TLE group and TPE group. Surgery was performed in all patients. Better outcome was obtained in TLE group(5/8 class Ⅰ), and poor was in TPE group(3/7class Ⅰ).ConclusionMesial-TLE and temporal plus epilepsy were common types of pharmaco-resistant post-encephalitic TLE. There was no way to differentiate clinically, except by SEEG. Mesial-TLE had a better outcome after surgery, but temporal plus epilepsy did not.

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  • 立体定向脑电图引导下射频热凝术治疗局灶性癫痫研究进展

    射频热凝术是一种微创局部热疗技术。早在19世纪60年代, 射频热凝就用于行为性疾病的治疗; 后应用于药物难治性颞叶癫痫, 但效果并不如传统的手术治疗。近几年随着立体定向脑电图的应用, 射频热凝得到改进, 可热凝毁损致痫灶以达到治疗目的。现将归纳立体定向脑电图引导的射频热凝的适应证、方法、研究结果及优点等。

    Release date:2016-10-02 06:51 Export PDF Favorites Scan
  • Clinical Application Progress of Stereotactic Radiotherapy for Hepatocellular Carcinoma

    ObjectiveTo summarize clinical application progress of stereotactic radiotherapy for primary hepatocellular carcinoma. MethodsThe literatures about the research progress of the stereotactic radiotherapy for primary hepatocellular carcinoma were reviewed. ResultsRadiotherapy for hepatocellular carcinoma is importantly based on the radiation biology of the liver and the radiophysics of the liver cancer. Stereotactic precision radiotherapy is an effective and low toxic treatment for early hepatocellular carcinoma, moreover, it alone or in combination with microwave ablation, hepatic artery chemoembolization for unresectable hepatocellular carcinoma is safe and effective method for the treatment. ConclusionsThe optimal dose model for hepatocellular carcinoma, hepatocellular carcinoma radical dose level are problems that need further exploration, and radiobiology, radiation physics research must be strengthened to explore it, stereotactic precision radiotherapy treatment modalities in the treatment of hepatocellular carcinoma position will become increasingly people attention.

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  • 局灶性皮质发育不良和神经发育肿瘤的癫痫发作模式与手术预后和神经病理亚型的联系

    颅内脑电图对癫痫发作模式的研究对癫痫灶的精确定位和指导成功切除有重要作用。它也引出了癫痫发生机制相关的重要病理生理问题。目前,植入硬膜下和深部电极等记录方式已经描述了几种癫痫发作模式 (主要是颞叶癫痫和伴有异质新皮层病变的癫痫)。研究分析了53例患者的连续性队列资料,所有患者均行立体定向脑电图 (SEEG) 监测,且病理证实为皮质发育畸形 (Malformation of cortical development, MCD)——局灶性皮质发育不良 (Focal cortical dysplasia, FCD) 和神经发育肿瘤 (Neurodevelopmental tumors, NDTs)。通过对视觉和时间-频率的分析,证实了存在6种癫痫发作模式:低压快波活动 (Low-voltage fast activity, LVFA);发作前棘波继之LVFA;爆发性多棘波继之LVFA;慢波/直流电漂移继之LVFA;θ或α尖波;节律性棘波/棘波。结果表明包含LVFA的模式 (83%) 普遍性较高,但是LVFA并不是癫痫发作的一个固定特征。癫痫发作模式和组织学类型具有相关性 (P=0.01)。更加普遍的模式如下:① FCD Ⅰ型:LVFA占23.1%,慢波/基线漂移继之LVFA占15.4%;② FCD Ⅱ型:爆发性多棘波继之LVFA占31%,LVFA占27.6%;发作前棘波继之LVFA占27.6%;③ NDTs:LVFA占54.5%。发现包含LVFA的癫痫发作模式与较好的手术预后具有相关性,但癫痫灶切除的完整性是一个独立预测因子;FCD和NDTs有6种不同的癫痫发作模式;包含LVFA的癫痫发作模式的患者手术预后更好。

    Release date:2017-04-01 08:51 Export PDF Favorites Scan
  • 立体定向脑电图相关并发症的系统评价

    立体定向脑电图(SEEG)是针对难治性癫痫患者的一项术前评估手段,可定位致痫灶及可能相关的功能皮质区的解剖位置。避免大骨瓣开颅术及其植入精确性,SEEG可能减少相关并发症。然而,由于植入并发症相对较高,颅内电极被认为是具有过度侵入性的操作。此前并无关于SEEG并发症的系统文献综述及Meta分析。该研究的目的是定量回顾文献中SEEG电极植入后各种手术并发症的发生率并进行汇总评估,以便内科医生能够就该术外侵入性监测的相关潜在并发症提供准确建议。此项系统评价是基于PRISMA实现的。通过检索MEDLINE, Scopus, Web of Science数据库,用逆方差加权的固定效应模型对并发症的发生率进行分析。Meta分析与森林图的制作都是通过成熟的制表软件完成的。主要结局指标是总效应量及其95%置信区间(CI)。检索到的1 901篇文献,除重787篇后,通过标题和摘要对1 114篇文章进行了筛选。在这一阶段,排除了没有提及SEEG术后并发症或未达到纳入标准的研究。在排除1 057篇文献后,对剩余的57篇文献进行全文阅读以确定合格标准。最常见的并发症是出血[合并患病率1.0%,95%CI (0.6, 1.4)]或感染[合并患病率0.8%,95%CI(0.3, 1.2)]。确定了5例死亡[合并患病率0.3%,95%CI(0.1, 0.6)]。文章分析确定了与SEEG植入和监测相关的121例手术并发症[合并患病率1.3%,95%CI(0.9, 1.7)]。对SEEG相关并发症的实际发生率的综合评估。相比其他术外侵入性监测方法,SEEG并发症的发生率实际上更低。这些数据可能减轻一些关于“立体定位”方法的安全性的担忧,在选择不同的侵入性监测方法时做出更好的决策,并减轻深度电极植入相关的恐惧。

    Release date:2017-07-26 04:06 Export PDF Favorites Scan
  • Progress of stereotactic radiotherapy in the treatment of brain metastatic tumor

    Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.

    Release date:2018-04-23 05:00 Export PDF Favorites Scan
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