目的 探讨中脑导水管及其周围病变的神经内镜手术疗效.方法 对2010年5月至2013年5月贵州省人民医院收治的14例中脑导水管及其周围病变的患者采取经额-室间孔入路经神经内镜下手术治疗,先行第三脑室底造瘘术,再行病变切除或活检术、中脑导水管成形术.结果 14例中中脑导水管原发性梗阻4例,胶质瘤4例,脑室型脑囊虫病2例,松果体细胞瘤1例,淋巴瘤1例,脑脓肿1例,生殖细胞瘤1例.术后头颅CT和(或)MRI示脑积水好转,经治疗后好转出院5例,无变化5例,加重4例,无死亡患者.结论 在神经内镜下行第三脑室底造瘘术、病变活检术或病变部分切除术、中脑导水管成形术是治疗中脑导水管及其周围病变的较为理想的选择.

Objective To explore the surgical efficacy of lesions in mesencephalic aqueduct and around it with neuroendoscope. Methods A total of 14 cases with lesion underwent neuroendoscope. Endoscopic third ventriculostomy (ETV), excision or biopsy and mesencephalic aqueduct plasty were performed. Results There were primary obstruction (n=4), glioma (n=4), intraventricular cysticercosis (n=2), pineal cell tumor (n=1), lymphoma (n=1), brain abscess (n=1) and genminoma (n=1). Postoperative cranial computed tomography (CT) and/or magnetic resonance imaging (MRI) showed narrowed ventricle. The outcomes were symptomatic improvement (n=5), no change (n=5), worsening (n=4) and mortality (n=0). Conclusion ETV, lesion biopsy or partial lesion resection and aqueductal plasty are efficacious for the patients with lesions in mesencephalic aqueduct and around it.

目的探讨脑干磁共振(MRI)病灶特征对脑干临床孤立综合征转归的预测价值。方法随访脑干临床孤立综合征患者,回顾性分析患者的转归与脑MRI特点。结果纳入25例脑干临床孤立综合征患者,随访中位时间为65个月。25例患者中,13例(52%)出现复发,其中5例(20%)诊断为视神经脊髓炎(NMO),4例(16%)诊断为视神经脊髓炎系谱疾病(NMOSD),4例(16%)诊断为多发性硬化(MS)。MRI显示:(1)NMO+NMOSD患者的T2加权的"雾状"病灶发生率高于MS患者(P=0.001)和无复发患者(P0.0001);(2)5例(55.6%)NMO+NMOSD的患者出现脑干连续病灶;(3)NMO+NMOSD患者中脑导水管病灶发生率高于MS患者(P=0.021)和无复发患者(P=0.002)。T2加权的"雾状"病灶对NMO+NMOSD的诊断有100.00%的灵敏度和93.75%的特异度。脑干连续病灶诊断NMO+NMOSD的灵敏度和特异度分别为55.56%和100.00%,中脑导水管病灶的灵敏度和特异度分别为77.78%和93.75%。结论脑干T2加权的"雾状"病灶、连续性病灶和中脑导水管病灶可能是预测脑干临床孤立综合征发展为NMO和(或)NMOSD的影像学特征。

Objective To explore the MRI features of brainstem lesions in clinically isolated syndromes ( CIS) and evaluated their association with clinical conversion .Methods Patients with brainstem CIS were prospectively fol-lowed-up and brain MRI features were retrospectively analyzed .Results A total of 25 patients were followed -up for a median of 65 months.Neuromyelitis optica ( NMO), NMO spectrum disorder ( NMOSD) and multiple sclerosis ( MS) were observed in 5, 4 and 4 cases, respectively.According to MRI,"Fog-like"lesions were significantly more abundant in NMO+NMOSD patients than in MS patients (P=0.001) or stable patients (P<0.000 1).Extensive lesions were on-ly found in 5 (55.6%) patients with NMO+NMOSD.Aqueduct lesions were also significantly more frequently found in NMO+NMOSD patients than in MS patients (P=0.021) or stable patients (P=0.002).The sensitivity and specificity of"Fog-like"lesions in T2 -weight image for diagnosis of NMO +NMOSD were 100% and 93.75%, respective

目的提高临床医师对percheron动脉梗死的认识及诊治水平。方法总结2例percheron动脉梗死的临床表现、影像学特点、治疗及预后,并复习近5年国内外相关文献,进一步探讨其临床与影像学特点。结果 2例患者均有脑血管病危险因素,急性起病,以突发意识障碍,双瞳孔不等大为主要表现;文献有报道以嗜睡、反应迟钝、精神改变、眼睑下垂、复视、视物模糊等起病的,很少有运动及感觉障碍;其影像学改变有显著特点,按缺血性脑血管病系统治疗,临床症状多数明显好转,以栓塞可能性大。结论临床遇到突发意识障碍、眼球运动障碍、瞳孔不等大、智能障碍等情况,排除其他疾病引起,要考虑percheron动脉梗死,percheron动脉梗死累及双侧丘脑、中脑导水管周围灰质,可有或无中脑病变;颅脑CT示双侧丘脑、中脑低密度改变,脑MRI检查见双侧丘脑、中脑长T1长T2信号,Flair高信号,中脑信号呈"V"字征表现,诊断percheron动脉梗死主要根据典型临床和MRI表现。

Objective To improve the recognition and diagnosis of caused by Percheron artery occlusion. Methods The clinical features, imagines, treatment and prognosis of 2 cases were analyzed, And review the related literature home and abroad in recent 5 years, further to explore the clinical and imaging features. Results Cerebrovascular disease risk factors of 2 cases in all patients, acute onset, with sudden disturbance of consciousness, double pupil range as the main performance;literature reports to sleepiness, unresponsive, mental changes, ptosis, diplopia, blurred vision, onset, there has been little movement and sensory obstacle;the imaging changes significantly according to the system characteristics, ischemic cerebrovascular disease treatment, clinical symptoms improved significantly in most possibility, the possibility to embolism. Conclusion The clinical encounter unexpected disturbance of consciousness, pupil eye movement disorders, ranging from large, intelligent obstacle, the exclu

目的 探讨神经内镜下第三脑室底造瘘术(endoscopic third ventriculostomy,ETV)对迟发特发性中脑导水管狭窄(Late-onset idiopathic aqueduct stenosis,LIAS)脑积水的临床疗效.方法 2009年1月至2012年12月间收治的15例LIAS患者,在神经内镜下行第三脑室底造瘘治疗,并利用MRI、临床症状、蒙特利尔认知评估量表(MoCA)在术前和术后对患者进行评估、比较分析,了解LIAS患者的临床特点和神经内镜治疗效果.结果 15例LIAS患者术前MRI均有可见的中脑导水管狭窄或梗阻,侧脑室和第三脑室扩大,脑组织相对萎缩,无室管膜下渗出；术后3个月MRI显示第三脑室底造瘘口通畅,脑室缩小.MoCA、临床症状评估显示术后3个月较术前有明显改善.所有病人利用Odom评价标准进行调查,显示患者对手术效果满意度高.结论 神经内镜第三脑室底造瘘可明显改善LIAS患者的认知功能和临床症状,注意不应该把此类患者定义为静止性脑积水进行保守治疗.

Objective To analyze the clinical outcomes of Endoscopic Third Ventriculostomy for the treatment of Late-onset idiopathic aqueduct stenosis (LIAS).Methods A total of 15 patients of LIAS were diagnosed during the period time from 2009.01 to 2012.12,and ETV were undergone to all of them.Evaluation were taken before and after operation (3 months) in terms of clinical symptoms,MRI results,MoCA Scale,which were analyzed and compared after operation so as to learn the cognitive characteristics of LIAS and the efficacy of ETV.Results Pre-op MRI scanning showed obvious aqueduct stenosis without any neoplasm,ventriculomegaly of the lateral and third ventricle,relatively encephalatrophy and no signs of subependymal effusion in all these patients.Post-op MRI indicated flow through the stoma at the floor of third ventricle and decreased in the size of ventricle.MoCA evaluation and clinical symptoms showed an obviously improvements after surgery and the rate of satisfaction was high according to th

目的 分析外科手术后营养障碍并发韦尼克脑病(Wernicke''s encephalopathy,WE)的MRI特点及与预后的关系.方法 回顾性分析2012年1月至2013年11月我院诊治的5例外科手术后营养障碍并发Wernicke脑病的临床、MRI影像学表现及治疗转归等资料.结果 外科手术后营养障碍并发WE的临床表现缺乏特异性;病灶主要对称性分布于双侧丘脑内侧、第三脑室周围、中脑导水管周围、穹窿柱及中脑、桥脑背侧;病灶T1 WI呈等或低信号,T2WI呈高或稍高信号,FLAIR呈明显高信号,DWI(b值为1 000 s/mm2)呈高信号,所有病灶治疗前ADC值均下降[(0.46 ～0.59)×10-3mm2/s],治疗后病灶ADC值均升高[(0.81 ～ 1.10)×10-3 mm2/s].结论 Wernicke脑病具有典型的发病部位及MRI影像学特点,早期诊断并补充硫胺素对改善预后尤为重要.

Objective To analyze MRI imaging features of patients with Wernicke encephalopathy after major surgical operation.Methods Clinical data including cranial MRI features were reviewed on five patients of Wernicke encephalopathy after major surgical operation from Jan 2012 to Nov 2013.Results The clinical features of patients with Wernicke encephalopathy after major surgical operation were noncharacterized and most of them had no specific value for diagnosis except for a definite history of vit B1 insufficiency.MRI imaging showed abnormal signal in the medial thalamus,third ventricle,surrounding area of the aqueduct of midbrain,column of fornix and the dorsal midbrain and pons ; Lesions were showed with long T1 and long T2 signal intensity and high signal intensity on fluid-attenuated inversion recovery (FLAIR),and high signal intensity on DWI(b equals 1 000 s/mm2).ADC value in all lesions increased from [(0.46-0.59) ×10-3 mm2/s] before treatment to [(0.81-1.10) ×10-3 mm2/s] af