目的 探讨颅内动脉瘤破裂后，患者血清促肾上腺皮质激素、甲状腺激素水平的变化情况。 方法 监测2010年3月－6月共51例动脉瘤患者术前、术后2～3、4～5 d促肾上腺皮质激素（ACTH）、甲状腺激素水平的变化情况，并对监测结果进行统计学处理。 结果 ACTH、促甲状腺激素、甲状腺素、血清游离甲状腺素在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05），三碘甲状腺原氨酸（T3）、血清游离三碘甲状腺原氨酸（FT3）在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）；不同部位动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05）；Fisher、Hunt分级不同级别的动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）。 结论 动脉瘤破裂患者的血清T3、FT3的变化水平情况，可以作为判断患者病情的轻重与预后的一项重要指标。
Objective To investigate the therapeutic effects of endovascular covered stent on vertebral dissecting aneurysm and carotid-cavernous fistula (CCF). Methods From March 2006 to May 2007, Jostent coronary stent grafts were used to treat 4 patients with vertebral dissecting aneurysm and 3 patients with CCF. The patients of vertebral dissecting aneurysmwere male and 37-57 years old, the lesion was located on the left vertebral artery in 3 patients and on the right vertebral artery in 1 patient, with the primary symptoms of sudden headache and vomiting; CT scan demonstrated subarachnoid hemorrhage; and the medical history varied from 2 days to 10 years. The patients of CCF were male and 35-51 years old, the lesion was located on the left carotid artery in 2 patients and on the right carotid artery in 1 patient, with the primary symptoms of headache, lateral exophthalmos, eyeball distending pain, conjunctive hyperemia and impaired eyesight; all 3 patients got head injury 2 days to 1 month before the appearance of symptoms and 1 of them had a history of severe nosebleed; and the medical history ranged from 1 week to 2 months. Results For the patients with vertebral dissecting aneurysm, complete obl iteration of aneurysms was achieved, the circulations of the vertebral artery, the adjacent posterior inferior cerebellar artery and the adjacent anterior inferior cerebellar artery were smooth, no compl ications relative to operation occurred, and no recurrence of symptoms and intracranial rehaemorrhagia were observed during the follow-up period of 8 months-2 years. For the patients with CCF, the fistula were completely obl iterated, the circulation of carotid artery was smooth, the exophthalmus and conjunctiva hyperemia were improved obviously 3 days after operation, the eyesight of patient was improved at different levels over the follow-up period of 1-3 months. Conclusion Endovascular covered stent is a new and useful tool for the treatment of vertebral dissecting aneurysm and CCF .
目的 探讨显微手术治疗破裂大脑中动脉动脉瘤（MCAA）的适应证、术前评估及手术技巧。 方法 回顾性分析2008年1月－2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例，女25例；年龄22～78岁，平均46.8岁。术前Hunt-Hess分级：Ⅰ级15例，Ⅱ级25例，Ⅲ级13例，Ⅳ级10例，Ⅴ级2例。动脉瘤直径＜5 mm 10个，5～15 mm 36个，15～25 mm 15个，＞25 mm 4个，平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部，5例位于大脑中动脉的M1段，4例位于分叉后M2段。 结果 手术夹闭动脉瘤60例，余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月，平均16个月，均无动脉瘤复发或再出血发生。按格拉斯哥预后评分（GOS）结果评定：恢复良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 结论 充分的术前评估，合适的手术入路选择，以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。
【摘要】 目的 探讨脑干海绵状血管瘤患者临床表现及影响预后的相关因素。 方法 回顾分析2008年9月-2010年9月27例脑干海绵状血管瘤患者临床资料。 结果 20例（74.1%）患者CT显示出血及血肿。急性或突然神经功能废损22例，渐进性功能障碍15例，病情平稳4例。显微手术12例，放射治疗6例，保守观察9例。长期随访25例，2例再次出血，无新发病灶，无患者死亡。手术组患者年龄（Plt;0.05）、术前病情严重程度（Plt;0.05）与术后KPS评分相关。非手术组不良预后评分与患者高龄及再出血有关。 结论 展神经麻痹和面瘫患者功能恢复较差。年龄、术前病情严重程度及手术时机影响患者预后，术中全切病灶对复发和并发症发生起主要作用，如何处理合并发生的静脉畸形有待讨论。立体定向放射治疗明显降低再出血风险，但其适应证尚有争议。【Abstract】 Objective To discuss the clinical manifestations and prognostic factors of brain stem cavernous hemangioma. Methods Based on the literature, the clinical data of 27 patients having brain stem cavernous hemangioma from September 2008 to September 2010 were reviewed and analyzed. Results Twenty patients (74.1%) presented with hemorrhage and hematoma in CT scan. Acute or sudden neurological deterioration occurred to 22 patients, progressive in 15 and stable in 4. Twelve patients underwent surgical removal of the lesion; 6 underwent radiosurgery; and 9 continued with conservative management. Twenty-five patients were followed up. Two patients had rehaemorrhagia. There were no de novo lesions or death. The risk factors indicative of a possible poor postoperative KPS score in the operative group included age (Plt;0.05) and the initial clinical condition (Plt;0.05). In the non-operative group, old age and rehaemorrhagia were obviously related to the poor outcome. Conclusions Patients with abducens and facial palsy have poor functional recovery. Age, the initial clinical condition and timing of operation are the major factors correlated to surgical outcome. The factor that affects recurrence and the occurrence of complications is complete resection during the operation. How to deal with the concomitant venous malformation should be further studied. The indications for stereotactic radiosurgery are still controversial, although it has confered a reduction in the risk of rehaemorrhagia.