ABSTRACT
Objective:To investigate the diagnosis and treatment of one patient with pneumocephalus caused by congenital mastoid dysplasia,and to clarify the clinical features,diagnostic methods and treatment strategies of intracranial accumulation of pneumocephalus.Methods:The patient with ineffective right upper limb activity accompanied stupid speech for 12 h was admitted to hospital.After admission,the head CT and MRI examination were performed again,and the patient was diagnosed as pneumocephalus.The paitent scheduled for stoma repair,neurotrophic treatment,infection prevention and other symptomatic treatments were performed after operation;the patient was instructed avoid cough forcefully,blowing nose,defecating and sneezing to increase the intracranial pressure.Results:Due to congenital dysplasia of mastoid wall,local thinning bones and intense swimming choking cough of the patient destroyed the intracranial pressure balance to form pneumocephalus,the patient scheduled for stoma and damaged dura repair;when discharged from hospital,the patient's right upper limb muscle strength and language function returned to normal;the head CT results showed that pneumocephalus disappeared completely.Conclusion;Pneumocephalus is common in clinic,and its reason is diversiform;it should be combined with the patient's history and imaging findings to explore the causes,the most reasonable treatment measures should be performed in order to relieve the patient's symptoms of increased intracranial pressure,and promote the recovery of neural function.
ABSTRACT
Objective To expore the application of intraoperative neural electrophysiological monitoring in microvascular decompression (MVD)of idiopathic facial spasm (HFS), and to clarify the effect of MVD in increasing the operative efficacy of MVD and decreasing the postoperative complications.Methods From December 2010 to December 2014,163 patients with HFS received MVD were selected;from December 2010 to December 2010,73 patients with facial spasm without electrophysiological monitoring in the operation were used as control group;from January 2013 to December 2014,90 patients with facial spasm with BAEP/LSR/FN MEP monitoring in the operation were used as monitoring group.The postoperative efficiency of MVD and the occurrence of hearing loss,dizziness, facial paralysis and other complications after operation were compared between two groups. Results The immediate efficiency in monitoring group was 52.55% (47 cases), minor facial paralysis 1.11%(1 case),hearing loss and dizziness 5.56% (5 cases).The postoperative follow-up time was 6 to 12 months,an average of 9.6 months; the facial paralysis, hearing loss, and dizziness were significantly improved and the operation efficiency was 65.56% (59 cases).The Immediate efficiency in control group was 30.14% (22 cases), minor facial paralysis 13.69% (10 cases),hearing loss and dizziness 23.29% (17 cases);the postoperative follow-up time was 6 to 12 months,an average of 9.6 months;the facial paralysis,hearing loss,and dizziness were significantly improved, and the operation efficiency was 64.38% (47 cases ). The immediate surgery had statistically significant difference between two groups (P 0.05).The incidence of facial paralysis, hearing loss and the incidence of complications such as dizziness had statistically significant differences between two groups (P <0.05),and monitoring group was better than control group.Conclusion LSR monitoring can improve the short-term curative efficiency of facial nerve MVD,but the significance for the long-term curative efficiency is not obvious; BAEP, LSR and FN MEP monitoring have great significance in identification of responsibility vessel,judgement of decompression effect and surface and auditory nerves protection.