Surgical Neurology最新文献

英文中文

Predominance of neurologic diseases in international aeromedical transportation 国际航空医疗运输中神经系统疾病的优势

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.04.021

Wan-Lin Chen MD , Yu-Ming Lin MD , Hong-Ping Ma MD , Wen-Ta Chiu MD, PhD , Shin-Han Tsai MD, PhD

Background

International travel industry in Taiwan is expanding. The number of people traveling abroad was approximately 480 000 people in 1980; 2 940 000 in 1990; 7 320 000 in 2000, and in 2007, it has reached 8 960 000, which was more than one third of total population. Air medical transportation will be necessary when local medical facilities do not approximate the international standards. No previous study on epidemiology in Taiwan on patients received international medical repatriation. This is the first report to discuss the epidemiology of Taiwan's international aeromedical transportation and its focus on neurologic diseases.

Method

Retrospective analysis of all international aeromedical transports on Taiwanese patients from October 2005 to September 2007 was performed. All materials were collected from the databank of International SOS, Taipei. The data were analyzed with Microsoft Excel and SPSS v. 11.0 software (SPSS, Chicago, Ill).

Results

A total of 416 patients were transported. Excluding expatriates transported outbound and 2-stage inbound transports, the Taiwanese patient number with international aeromedical transport was 379; 51 by air ambulance and 328 commercially. There were 271 male (72%) and 108 female patients (18%). Of the 379 patients, 178 (47%) were neurologic diseases. Two hundred ninety-five (78%) patients were transported from China. Patient transports peaked in autumn by 105 (28%). Of all 33 ventilated patients, 12 (36%) were neurologic diseases. In-flight complications occurred in 10% of neurologic and 2% of nonneurologic cases. No in-flight mortality occurred in both groups.

Conclusion

Neurologic diseases comprise most of the Taiwanese patients that requires medical transportation. With relatively suboptimal medical standard and high medical expenses in China, patients with neurologic conditions need timely and safe aeromedical transport than those with other diseases. Transport of patients with neurologic diseases, either by air ambulance or commercial flights, can only be safely performed by well-trained medical escorts and comprehensive logistic arrangements.

背景台湾的国际旅游业正在发展。1980年出国旅游的人数约为48万人;1990年2940 000;2000年为732万人，2007年达到896万人，占总人口的三分之一以上。当当地医疗设施不符合国际标准时，就有必要进行空中医疗运输。台湾对国际医疗遣返患者的流行病学研究尚无前例。本文首次探讨台湾国际航空医疗运输的流行病学及其对神经系统疾病的关注。方法回顾性分析2005年10月至2007年9月台湾所有国际航空医疗运输病例。所有资料均来自国际SOS台北市数据库。采用Microsoft Excel和SPSS v. 11.0软件(SPSS, Chicago, illinois)对数据进行分析。结果共运送患者416例。不包括出境和两段入境的外籍人员，台湾国际航空医疗运输患者人数为379人;51架是空中救护车，328架是商业飞机。其中男性271例(72%)，女性108例(18%)。在379例患者中，178例(47%)为神经系统疾病。295例(78%)患者来自中国。患者转运在秋季达到高峰，为105例(28%)。33例通气患者中，12例(36%)为神经系统疾病。飞行中出现并发症的神经系统病例占10%，非神经系统病例占2%。两组均未发生飞行中死亡。结论台湾地区需要医疗转运的患者以神经系统疾病为主。中国的医疗水平相对较低，医疗费用较高，神经系统疾病患者比其他疾病患者更需要及时、安全的航空医疗运输。通过空中救护或商业航班运送神经系统疾病患者，只有在训练有素的医疗护送和全面的后勤安排下才能安全进行。

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引用次数: 3

Surgical treatment of brainstem cavernous malformations 脑干海绵状畸形的外科治疗

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.05.031

Mark Garrett MD, Robert F. Spetzler MD

Background

The contemporary neurosurgeon is often confronted by cavernous malformations. Those located in the brainstem are particularly challenging

Methods

This article reviews published series on the natural history and surgical outcomes of these lesions and discusses the surgical approaches used at our institution for their resection.

Results

Despite their challenging location in the brainstem, appropriately selected lesions can be resected surgically with acceptable rates of morbidity and mortality.

Conclusions

Our institutional philosophy on the surgical treatment of brainstem cavernous malformations reflects the substantial surgical experience of the senior author.

当代神经外科医生经常遇到海绵状血管瘤。这些位于脑干的病变尤其具有挑战性。本文回顾了已发表的关于这些病变的自然历史和手术结果的系列文章，并讨论了我们机构用于切除这些病变的手术入路。结果尽管其在脑干的位置具有挑战性，但适当选择的病变可以手术切除，发病率和死亡率可接受。结论我院脑干海绵状血管瘤手术治疗的制度理念反映了资深作者丰富的手术经验。

引用次数: 79

Attempting homicide by inserting sewing needle into the brain 用缝衣针插入大脑企图杀人

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.02.029

Abbas Amirjamshidi MD, MPH , Arman Rakan Ghasvini MD , Maysam Alimohammadi MD , Kazem Abbassioun MD

Background and objectives

Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.

Material and methods

The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed.

Results

Among the 4 patients who underwent surgery, 1 died after a short period of ‘akinetic mutism.’ Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr.

Conclusion

In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life.

背景与目的用缝纫针虐待儿童是一种罕见但众所周知的威胁受害者生命的谋杀企图。关于诊断和治疗这类病例的信息，无论是在急性或慢性阶段是缺乏和模糊的文献。本研究拟报告6名未遂杀人案受害者的经历，这些人在不同的年龄阶段被提交给作者，并被以不同的方式处理。这可能为神经外科医生遇到的进一步病例的处理提供一些文献证据。材料和方法作者有机会处理6例转到创伤中心的患者，他们的头盖骨内藏有一根或多根缝纫针。有3名男性和3名女性患者，其中2名患者在生命的前10年，其他的，每个人都在生命的前10年。最小的6岁，最大的51岁。老年患者有模糊头痛，颅脑x线平片或CT诊断为持续存在的颅内异物。慢性头痛是患者的主要主诉。4名患者接受了手术切除缝衣针，2名患者正在接受随访。结果4例手术患者中，1例因短时间的“动性缄默症”死亡。术后6个月头痛和肢体感觉异常2例改善，1例无明显变化。目前正在观察的病例情况良好。对生锈针的生化分析显示，针中的一些元素如铁、锰和铬的氧化形式是复合的。结论尽管对穿透性头部伤口的治疗提出了标准的算法，但对于脑内有缝纫针的受害者，选择最佳治疗方案需要神经外科医生、儿科医生、精神科医生和社会工作者的密切合作。此外，在以后的几十年里，没有绝对的迹象表明需要切除颅内缝合针。

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引用次数: 30

Commentary 评论

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.07.013

Phillip Dickey MD

引用次数: 0

Commentary 评论

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.03.019

Jorge Lazareff MD

引用次数: 0

Commentary 评论

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.06.020

Y. Pierre Gobin MD

引用次数: 0

Distal intracranial catheterization of patients with tortuous vascular anatomy using a new hybrid guide catheter 一种新型混合式导尿管在血管解剖扭曲患者远端颅内置管中的应用

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.03.016

Scott D. Simon MD , Arthur J. Ulm MD , Antonio Russo MD , Erminia Albanese MD , Robert A. Mericle MD

Background

A hybrid guide catheter mates the traditional strong guide catheter with a thin, soft distal tip, allowing placement further into the distal cervical or proximal cranial circulation.

Case Description

We present 5 cases in which traditional guide catheters were unable to successfully navigate tortuous anatomy or provide stable support for intervention.

Conclusion

Hybrid guide catheters provided safe, stable support for successful treatment. Hybrid guide catheters allow for treatment for patients who previously were not candidates for neuroendovascular surgery.

混合导尿管将传统的强导尿管与薄而软的远端尖端相结合，允许进一步放置到颈远端或颅近端循环中。病例描述:我们报告了5例传统导尿管无法成功导航复杂解剖结构或为介入提供稳定支持的病例。结论混合式导尿管为成功治疗提供了安全、稳定的支撑。混合导尿管允许治疗以前不适合神经血管内手术的患者。

引用次数: 16

Preparing the ethical future of deep brain stimulation 为深部脑刺激的伦理未来做准备

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.03.029

Emily Bell PhD , Ghislaine Mathieu MA , Eric Racine PhD

Background

Deep brain stimulation is an approved and effective neurosurgical intervention for motor disorders such as PD and ET. Deep brain stimulation may also be effective in treating a number of psychiatric disorders, including treatment refractory depression and OCD. Although DBS is a widely accepted therapy in motor disorders, it remains an invasive and expensive procedure. The ethical and social challenges of DBS need further examination, and discussion and emerging applications of DBS in psychiatry may also complicate the ethical landscape of DBS.

Methods

To identify and characterize current and emerging issues in the use of DBS, we reviewed the neurosurgical literature on DBS as well as the interdisciplinary medical ethics and relevant psychological and sociological literatures. We also consulted the USPTO database, FDA regulations and report decisions, and the business reports of key DBS manufacturers.

Results

Important ethical and social challenges exist in the current and extending practice of DBS, notably in patient selection, informed consent, resource allocation, and in public understanding. These challenges are likely to be amplified if emerging uses of DBS in psychiatry are approved.

Conclusions

Our review of ethical and social issues related to DBS highlights that several significant challenges, although not insurmountable, need much closer attention. A combination of approaches previously used in neuroethics, such as expert consensus workshops to establish ethical guidelines and public engagement to improve public understanding, may be fruitful to explore.

脑深部刺激是一种被批准的有效的神经外科干预措施，用于治疗运动障碍，如PD和ET。脑深部刺激也可能有效治疗许多精神疾病，包括治疗难治性抑郁症和强迫症。尽管DBS是一种被广泛接受的运动障碍治疗方法，但它仍然是一种侵入性和昂贵的手术。DBS的伦理和社会挑战需要进一步研究，DBS在精神病学中的讨论和新兴应用也可能使DBS的伦理前景复杂化。方法为了识别和描述DBS应用中当前和新出现的问题，我们回顾了关于DBS的神经外科文献、跨学科医学伦理学以及相关的心理学和社会学文献。我们还查阅了USPTO数据库、FDA法规和报告决策以及主要DBS制造商的业务报告。结果DBS在当前和未来的实践中存在着重大的伦理和社会挑战，特别是在患者选择、知情同意、资源分配和公众理解方面。如果DBS在精神病学中的新应用获得批准，这些挑战可能会被放大。结论我们对星展银行相关伦理和社会问题的回顾强调了一些重大挑战，尽管并非不可克服，但需要更加密切地关注。将神经伦理学中以前使用的方法结合起来，例如建立伦理准则的专家共识研讨会和提高公众理解的公众参与，可能会有丰硕的探索成果。

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引用次数: 147

Dermoid tumor with diastematobulbia 皮样瘤伴胫外凸

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.03.036

Krishna Prabhu MCh , Roy Thomas Daniel MCh , Sunithi Mani MD , Ari G. Chacko MCh

Background

Dermoid tumors are rare congenital lesions and account for 0.2% to 1.8% of all intracranial tumors. Dermoid tumor with diastematobulbia is very rare.

Case description

We report a dermoid tumor in an adult female with an unusual location and morphology. The lesion had 2 major components with different material within the cysts. The posterior part of the dermoid had presented on the floor of the fourth ventricle and had split the pons into 2 distinct halves. The anterior part of the lesion was situated in the prepontine cistern and encircling the anterior half of the brainstem. The lesion was radically excised, and the postoperative images showed return of the 2 halves of the pons to appose each other in the midline.

Conclusion

This case report demonstrates the anatomical peculiarities of this extremely unusual presentation of a dermoid cyst with diastematobulbia. Total excision of the lesion through a dorsal approach resulted in a good outcome.

皮样瘤是一种罕见的先天性病变，约占颅内肿瘤的0.2% ~ 1.8%。皮样瘤合并胫外凸是非常罕见的。病例描述:我们报告一位成年女性的皮样瘤，其位置和形态都不寻常。病变有2个主要组成部分，在囊肿内有不同的物质。皮样的后部出现在第四脑室的底部，将脑桥分成两半。病变前部位于脑干前池，环绕脑干前半部分。病变被彻底切除，术后图像显示桥的两半在中线重合。结论:本病例报告显示了这一极其不寻常的皮样囊肿伴髋外侧畸形的解剖特点。通过背侧入路完全切除病变获得了良好的结果。

引用次数: 7

Surgical technique for a cystic-type metastatic brain tumor: transformation to a solid-type tumor using hydrofiber dressing 囊型转移性脑瘤的手术技术:使用纤维敷料转化为实体型肿瘤

Surgical Neurology

Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.07.045

Takeshi Okuda MD , Yoshifumi Teramoto MD , Haruki Yugami MD , Kazuo Kataoka MD , Amami Kato MD

Background

Many metastatic brain tumors have a distinct border with normal brain tissue, which facilitates tumor removal. However, residual tumor tissue may be present after surgery when metastatic brain tumors are of cystic type. We have developed a method using hydrofiber dressing to transform cystic-type into solid-type tumors.

Methods

Hydrofiber dressing is a sodium carboxymethylcellulose hydrocolloid polymer with high fluid-absorptive capacity. This material was originally used as a dressing for exudative wounds. Hydrofiber dressing was used for 8 patients with cystic-type metastatic brain tumor. Tumor removal was performed after hydrofiber dressing was inserted into the cyst cavity to transform the tumor into a solid-type tumor.

Results

Transformation of cystic-type metastatic brain tumors into smaller solid-type tumors using hydrofiber dressing facilitated en bloc resection of tumor. The dressing also absorbed residual cyst fluid and was thus also effective in preventing intraoperative dissemination of tumor cells. This approach enabled ideal en bloc resection in all patients. There were no adverse events.

Conclusions

These findings suggest hydrofiber dressing may be useful in surgery for cystic-type metastatic brain tumors.

背景:许多转移性脑肿瘤与正常脑组织有明显的边界，这有利于肿瘤的切除。然而，当转移性脑瘤为囊性型时，术后可能存在残留的肿瘤组织。我们开发了一种利用纤维敷料将囊型肿瘤转化为实体型肿瘤的方法。方法水纤维敷料是一种具有高吸水性的羧甲基纤维素钠水胶体聚合物。这种材料最初是用作渗出性伤口的敷料。应用纤维敷料治疗8例囊型转移性脑瘤。在囊肿腔内插入纤维敷料使肿瘤转化为实体型肿瘤后，行肿瘤切除术。结果应用纤维敷料将脑囊型转移瘤转化为较小的实体型肿瘤，有利于肿瘤的整体切除。该敷料还能吸收残留的囊肿液，因此也能有效地防止术中肿瘤细胞的播散。该方法在所有患者中实现了理想的整体切除。没有不良事件发生。结论纤维敷料可用于囊型转移性脑肿瘤的手术治疗。

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