目的：研究比较松果体区肿瘤的显微外科手术切除不同手术入路及其优缺点。方法：回顾分析收治的48例松果体区肿瘤患者的手术情况及术后表现，并进行分析。结果：48例患者中，经枕小脑幕切开（Poppen）入路31例，幕下小脑上（Krause）入路8例，经胼胝体-穹窿间入路6例，经胼胝体后部（Dandy）入路2例，颞部侧脑室三角部入路1例。肿瘤全切除40例，次全切除5例，大部分切除3例。8例未全切者及病理证实为恶性的病变术后行放疗和（或）化疗，5例术后并发脑积水行分流术，偏盲1例，死亡2例,随访6个月～6年，KPS大于80分者约43例。结论：松果体区肿瘤的手术治疗效果较好，全切率高、死亡率低，合理的入路及体位，娴熟的显微外科手术技巧是手术成功的关键，Poppen入路和Krause入路是符合微创理念的理想入路。
OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.
目的：总结54例Chiari畸形合并脊髓空洞症的显微外科手术治疗经验。方法：本组对1998年9月至2005年9月共收治的54例Chiari畸形合并脊髓空洞症患者采用后路手术入路，对颅底凹陷症采用后路减压，显微镜下行小脑扁桃体软膜下部分切除，正中孔开放手术治疗。结果：54例患者术中观察发现延髓和上颈髓明显受压和不同程度同小脑扁桃体粘连，正中孔引流不畅；随访1月～7年，术后42例症状显著改善，12例明显改善；影像学复查提示脊髓空洞明显缩小。结论：显微外科手术治疗Chiari畸形合并脊髓空洞症疗效确切可靠。
ObjectiveTo study the anatomicopathological relation between facial nerve (FN) and acoustic neuronoma (AN) and summarize the techniques of how to protect facial nerves in microsurgery. MethodsA retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and March 2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. ResultsThe tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. After one-year follow-up, 549 patients had House-Brackmann Ⅰ-Ⅳ function. The location and shape of the FN along the tumor was identified as the follows: FN displaced along the ventral and superior surface of the tumor in 279 patients (47.7%), the ventral and central in 243 (41.5%), the ventral and inferior in 33 (5.6%), the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. ConclusionGood understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.
PURPOSE:To investigate the cause and treatment of iatrogenic retinal breaks(lRB)in microvitreoretinal surgery. METHODS:The causes and treatments of 40 iatrogenie retinal breaks of 24 cases in micro-vitreoretinal surgery from July1994 to March 1996 in our department were analyzed retrospectively. RESULTS:40 IRB were found in 24 eyes,among them there were 16 eyes of proliferative vitreoretinopathy(PVR),5 eyes of taumatic PVR and 3 eyes of tractional retinal detachment, The treatments of IRB included scleral cryotherapy ,silicone band buckling,endodiathermy,intraocular tamponade and postoperative argon laser. The IRB of inferior retina and posterior Io scleral buckling acounded for 70% and 92% respectively. The total retinal and macular attachment were 17 eyes and the visual acuity of 19 eyes improved to 0.02 or better during the mean follow up periods of 5 months. CONCLUSION:The IRB is a severe complication in micro-vitrecretinal surgery and has to be obliterated either intraoperatively or postoperatively. （Chin J Ocul Fundus Dis,1997,13: 19-21 ）