英语神经外科病例及英汉神经外科词汇
Case4: Posterior fossa subdural hematoma in neonate
This newborn female was born at a gestational age of 40 weeks, weighing 3780, to a gravida 2 para 1 mother. Forceps were applied to the fetal head for failure to progress. Apgar scores were 6 and 9. within the 1st day of life, the baby was observed to be listless and lethargic and to have a poor suck. The anterior fontanelle was tense. Seizures developed. Endotracheal intubation and ventilation were required for bradycardia and apneic episodes. The hemogram was normal. A lumbar puncture was performed to rule out central nervous system sepsis, and bloody cerebrospinal fluid was obtained. CT was then performed, and a large PFSDH was observed in addition to moderate ventriculomegaly. A neurosurgical consultation was obtained. The neonate was quadriplegic on a ventilator, making only the occasional respiratory effort. The neonate was taken urgently to surgery, and a posterior fossa craniectomy was performed. The clot could be removed from the posterior fossa subdural space. The bleeding sites were identified and successfully coagulated. The infant did not require an external ventricular drain nor did she go on to develop progressive hydrocephalus. She began to breathe readily after the posterior fossa decompression and clot evacuationn. She was weaned from the ventilator within 4 days. Subsequent CT showed minimal left cerebellar parenchyma involvement with calcification and volume loss. The ventriculomegaly had resolved completely. At 4 years of aged, the cild walked and talked normally. A right esotropia remained that had persisted since surgery.
新生儿后颅窝硬膜下血肿
一位妊娠两次生育一胎的母亲，在怀孕四十周后生下了一个重3780克的女婴，在胎头娩出不顺利时应用了产钳，Apgar评分为6和9。在生后的第一天，她吮吸较差并且嗜睡，精神萎靡，前囟门张力较高，抓握反射存在，由于心率过缓窒息，不得不应用气管插管通气，血象正常。为了除外小儿中枢系统脓毒症，进行了腰穿检查，可见血性脑脊液，行头CT检查显示患儿后颅窝硬膜下血肿，并且有轻微的脑室扩大，请神经外科会诊。患儿四肢瘫，并且应用呼吸机辅助呼吸。
患儿被快速送到神经外科，实行后颅窝开颅手术，血块被从后颅窝硬膜下清除，出血点被找出并且确切止血。患儿没有放置外引流，也未检出进展性脑水肿。在后颅窝血肿清除，压迫解除后，她恢复呼吸。四天后她脱离了呼吸机。复查CT可见左侧小脑实质小片钙化，体积缩小。脑室回复正常。小孩四岁时，可以正常走路说话，但在外科手术后就出现的内斜视仍然存在。
Case 5
Astrocytoma of frontal lobe
The patient was a 48-year-old male who presented with complaints of increasingly severe headaches. Workup at another hospital revealed a lucent left frontal lesion. The biopsy diagnosis was gradeⅢ astrocytoma. He was referred to our hopsital after external radiation therapy was delivered. Neurological exam revealed mild bradykinesia, but was otherwise unremarkable. He was admitted and underwent a left frontal lobectomy, with gross total tumor resection. One month later he underwent stereotactic implantation of brachytherapy catheters. He received 6000 rads to the margin of the tumor cavity. Subsequent scans revealed progressively worsening enhancement, edema, and shift around the tumor cavity. Reoperation was undertaken with resection of all grossly abnormal tissue. Pathologic analysis revealed radiation necrosis and tumor. The patient is alive 5 years later, with no evidence of disease progression. 额叶星形细胞瘤
一男性患者，48岁，自诉进行性剧烈头痛数日，在某医院检查示有左额叶高亮度损害，活组织检查诊断为三级星形细胞瘤，在外院应用放疗后，被送入我院。神经系统检查，表明有轻微的运动过缓，但并不明显。入院后行肿瘤全切及左额叶切除术。一个月后，他接受了立体定向导管穿刺移植治疗，在肿瘤腔的边缘吸收6000拉德进行照射，随后CT扫描显示有进行性的瘤腔扩大，周围水肿，并伴有瘤腔移位，再次手术全切了异常组织，病理分析回报，这些异常组织包括放疗后的坏死组织和肿瘤细胞。患者出院后5年，随访无明显的疾病进行性发展的迹象。 Case 6
Glioblastoma multiforme of frontal lobe
A healthy 9-year- old woman presented with a 3-month history of dysphasia. Computed tomography demonstrated a ringenhancing lesion in the right frontal lobe. She was not immunosuppessed or on steroids. The rim was T2 hypointense and T1 hyperintense. There was a small amount of surrounding edema. Brain abscess was considered in the differential diagnosis, but a tumor was believed more likely, because:⑴ there wase an eccentric area of capsular thickening, ⑵ edema was minimal, and ⑶the clinical caurse was long. At operation, glioblastoma multiforme was encountered. Substances with unpaired electrons exhibit an unusual combination of increased T1signal and decreased T2 signal termed paramagnetism. Methemoglobin, melanin, and gadolinium are familiar paramagnetic substances. In an abscess
capsule, paramagnetic changes occur because macrophages release free-radicals that contain unpaired electorns. Although uncommon, clinicians should be aware that paramagnetic rim signal may also be observed in metastasis, primary brain tumors, granulomas like tuberculosis, and in large demyelinating plaques. 额叶多形胶母细胞瘤
一6岁女孩有3个月的言语困难病史，CT检查显示在右侧额叶有一环形增强的损害，她没有免疫抑制也没有应用过类固醇，此损害的边缘在MRI T2像为低信号，T1像为高信号，周围有轻微水肿，此病灶可能为肿瘤，但应除外脑脓肿，考虑肿瘤是因为 （1）有囊性增厚的反常区域 （2）水肿轻微 （3）临床病程长
手术时，看到了多形胶母细胞瘤。带有不成对电子的物质常有T1高信号，T2低信号相结合的特殊表现，这也叫顺磁性。正铁血红蛋白，黑色素，钆是常见的顺磁性的物质。在脓肿囊内，常会有顺磁性的表现，因为巨噬细胞释放放射物质中就包括不成对电子。虽然这不常见，但临床医生们应该意识到，顺磁性的环形信号，可以在转移瘤，脑原发肿瘤，结核性肉芽肿和大的脱髓鞘斑块中出现。
Case 7: glioblastoma multiforme located near motor cortex History
Patient A.L is a 23-year-old right handed man from Hebei who works as a painter and has had nocturnal seizures for approximately two years. In January the seizures increase in frequency and began to occur during the day. They are associated with turning of the head and shoulders to the right prior to generalization. The patient is confused and fatigued afterwards, but does not have a neurologic deficit. A scan was done in February and this demonstrates an area of nonenhancement in the posterior portion of the superior frontal convolution, with a small contrast enhancing area in the center of the lesion. The latter approximately 3 mm, the former measures approximately 3.5 cm. The scan was repeated recently and it appeared that the lesion had grown slightly. Stereotactic biopsy was recommended. The patient in fact was scheduled for a biopsy in Hebei but they decided to seek another opinion. The patient is presently on Dilantin 100 mg three times per day. Past medical history is noncontributory. Family history and social history are not significant. Physical Examination
The patient is a well nourished, well developed, thin, pleasant male who appears intellectually intact. Recent memory is intact, general information is good. Cranial nerve examination dalities. Motor examination reveals no drift to distraction, and good strength in upper and lower extremities. There may be some weakness of the wrist extensors on the right, however. Deep tendon reflexes are symmetrical, the patient walks with a normal gait with a normal arm swing. Radiographic studies
MRI scan shows an approximately 3.5 cm well-demarcated lesion in the posterior aspect of the left superior frontal convolution. Impression
Probable low/intermediate grade glioma, possibly ganglioglioma or ganglio-neurocytoma. If the lesion is anterior to the motor cortex, resection is recommended. If the lesion is within the motor cortex, a biopsy is recommended. Hospital course
The patient underwent magnetoencephalography(MEG) to map his primary motor cortex and define its relationship to the tumor. This confirmed the clinical and radiographic impression that the tumor was anterior to the motor strip.
A stereotactic volumetric resection of the lesion was then performed. The volume of the tumor, based on the contrast-enhancing portions on both CT and MRI, as well as from the area of abnormality on T2-weighted MRI, was digitized for computer targeting. A view of the cortical surface after the trephine craniotomy was performed. A strip electrode placed onto the cortical surface in a direction posterion to the edge of the trephine confirmed the location of sensorimotor cortex by phase reveral.
The tumor volume can be superimposed onto the field of view of the operating microscope, to assist the surgeon in defining the margins of the tumor. The lesion was dissected away from the surrounding brain tissue at its inerface and was removed as a single specimen.
The patient’s neurologic function postoperatively was unchanged from his preoperative status. Pathologic report
The tumor was signed out as glioblastoma multiforme arising as a small focus within a lowgrade astrocytoma. The malignant portion apparently was the contrast-enhancing portion on the preoperative scans. The patient is scheduled to begin external beam radiotherapy followed by chemotherapy.