ObjectiveTo analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.MethodsRetrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018, which confirmed by pathology and unrelieved thoroughly after operation performed, the pathological types and MRI signs were analyzed, as well as the frequency of different MRI signs in FCD of each pathological type. Analyzed the possible factors of surgical failure.ResultsAmong the 21 cases, there were 15 males and 6 females, with an average age of (5.7±0.3) years and an average course of disease of (3.4±0.5) years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries, abnormal cortical structure changes (thickening and/or thinning), transmantle signs (abnormal cone signals extending from subcortical white matter to the ventricle) and abnormal gray matter signals, which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control. 17 cases (80.9%) appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months, FCD type I and type Ⅱ accounted for 35.3%, 64.7% respectively. During intraoperative EEG monitoring, no epileptiform discharge was observed in the transmantle sign region in 6 cases, and the region was retained, and only the surrounding abnormal discharge cortex was removed, complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases, and different degrees of epileptic epilepsy were observed in both methods.ConclusionMRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific, there were still epilepsy of varying degrees after all epileptogenic lesions have been removed, the cause may be related to potential epileptic factors.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
ObjectiveTo explore the effect of the cluster intervention in new nurses in the Department of Neurosurgery in occupation training, so as to provide reference for the clinical training of new nurses. MethodsEight nurses who entered the Department of Neurosurgery in January 2013 were set as control group and the 8 new nurses entering in January 2014 as the observation group. The control group was adopted the traditional training methods, while the observation group underwent used extra cluster intervention. The differences in the results of theory, technology, operation and the 360-degree evaluation between the two groups were analyzed at the end of year. ResultsIn the observation group, the median theory examination score was 91.50, median operation assessment grades was 95.00, which were higher than those in the control group (82.00 and 83.00). The average scores of 360-degree evaluation in the observation group were higher than those in the control group with a significant difference (P < 0.01). ConclusionsIntensive intervention should be used for new nurses' training. It helps to improve the training effect and new nurses' ability.
To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.
In recent years, the system of standardized resident training has been set up and improved gradually in our country.However, the medical specialist training system for neurosurgeons is still at the stage of exploration.It is important to cultivate and select the best neurologic surgery specialists in China.Mayo Clinic is one of the best teaching hospitals in the United States, which has been ranking the second in the United States for the recent 20 years.Analyzing the neurologic surgery specialist training program of the world's top hospital and learning from its advanced experiences are beneficial for the establishment of medical specialist training system and the production of the highest caliber neurosurgeons in the Department of Neurosurgery in West China Hospital of Sichuan University.The Department of Neurosurgery in West China Hospital of Sichuan University is advantageous in its advanced technology and equipment, sufficient operations, rich teaching resources and independent laboratories.Our goal is to establish strict accessing, management and assessment system, perfecting security and feedback system, focusing on the cultivation of humanistic spirit, building neurosurgery specialist personnel, and establishing a unique brand of West China in the field of teaching.
目的 探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法 纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果 本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论 规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。
【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
Objective To systematically review the efficacy, safety, cost-effectiveness, indications, contraindications, and ethical issues for surgical treatment of Alzheimer's disease (AD). Methods The CNKI, WanFang Data, VIP, PubMed, Web of Science, Embase and Cochrane Library databases were electronically searched to collect for relevant studies on surgical treatment of AD from inception to November 26, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by using Stata 17 software. Results A total of 59 studies were included. The results revealed that surgical treatment for AD had higher safety (OR=0.44, 95%CI 0.17 to 0.72, P<0.05), and patients had better ADAS-cog scores (SMD=0.54, 95%CI 0.18 to 0.90, P<0.05), with statistically significant differences. The economic burden of surgical treatment for AD increased with the severity of the disease. Deep brain stimulation may offer high economic benefits in the treatment of mild AD. The surgical indications can be summarized as: short disease duration, mild to moderate severity, and insufficient response to pharmacological interventions. Regarding contraindications, analysis of the included literature identified four core aspects: physiological and pathological contraindications, medical comorbidities and surgical risk contraindications, cognitive and psychological factor contraindications, and other contraindications. Ethical issues can be categorized into: informed consent and autonomy, ethical review and approval of research, and assessment of risks and benefits. Conclusion Current evidence suggests that surgical treatment for AD has certain benefits, but the surgical approaches for treating AD are still in the exploratory stage. Limited by the number and quality of the included studies, the above conclusion still requires more high-quality research to be verified.
目的 总结神经外科复杂脑脊髓血管病杂交手术的护理配合经验。 方法 回顾分析2011 年4 月－2012 年5月华西医院手术室完成的 56例神经外科杂交手术的临床资料，总结神经外科杂交手术的护理配合经验。 结果 所有手术均顺利进行，未出现明显危及患者安全的情况。 结论 神经外科Hybrid手术治疗复杂脑脊髓血管病较普通手术更为安全有效。但手术护理准备及配合更为复杂，在手术室布局、手术流程方面需要医护协调专门进行优化。有神经外科专业经验的护士经过一段时间专门培训后担任手术巡回及器械护士更有利于手术的顺利、安全进行。