英語神經(jīng)外科病例及英漢神經(jīng)外科詞匯

1、英語神經(jīng)外科病例及英漢神經(jīng)外科詞匯Case 4 Posterior fossa subdural hematoma in neonateThis 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

2、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 nervo

3、us 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

4、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 dev

5、elop 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 ha

6、d resolved completely. At 4 years of aged, the cild walked and talked normally. A right esotropia remained that had persisted since surgery. 新生兒后顱窩硬膜下血腫 一位妊娠兩次生育一胎的母親， 在懷孕四十周后生下了一個(gè)重3780 克的女嬰， 在胎頭娩出不順利時(shí)應(yīng)用了產(chǎn)鉗， Apgar 評(píng)分為 6 和 9 。在生后的第一天，她吮吸較差并且嗜睡，精神萎靡，前 囟門張力較高，抓握反射存在，由于心率過緩窒息，不得不應(yīng)用氣管插管通氣，血象正常。為 了除外小兒中樞系

7、統(tǒng)膿毒癥，進(jìn)行了腰穿檢查，可見血性腦脊液，行頭CT 檢查顯示患兒后顱窩硬膜下血腫，并且有輕微的腦室擴(kuò)大，請(qǐng)神經(jīng)外科會(huì)診?；純核闹c，并且應(yīng)用呼吸機(jī)輔助呼 吸。 患兒被快速送到神經(jīng)外科，實(shí)行后顱窩開顱手術(shù)，血塊被從后顱窩硬膜下清除，出血點(diǎn)被找出 并且確切止血。患兒沒有放置外引流，也未檢出進(jìn)展性腦水腫。在后顱窩血腫清除，壓迫解除 后，她恢復(fù)呼吸。四天后她脫離了呼吸機(jī)。復(fù)查 CT 可見左側(cè)小腦實(shí)質(zhì)小片鈣化，體積縮小。腦 室回復(fù)正常。小孩四歲時(shí)，可以正常走路說話，但在外科手術(shù)后就出現(xiàn)的內(nèi)斜視仍然存在。Case 5Astrocytoma of frontal lobeThe patient was a

8、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 grade m astrocytoma. He was referred to our hopsital after external radiation therapy was delivered. Neurological exam revealed

9、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 re

10、vealed 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. 額葉星形

11、細(xì)胞瘤 一男性患者， 48 歲，自訴進(jìn)行性劇烈頭痛數(shù)日，在某醫(yī)院檢查示有左額葉高亮度損害，活組織 檢查診斷為三級(jí)星形細(xì)胞瘤，在外院應(yīng)用放療后，被送入我院。神經(jīng)系統(tǒng)檢查，表明有輕微的 運(yùn)動(dòng)過緩，但并不明顯。入院后行腫瘤全切及左額葉切除術(shù)。一個(gè)月后，他接受了立體定向?qū)?管穿刺移植治療，在腫瘤腔的邊緣吸收6000 拉德進(jìn)行照射，隨后CT 掃描顯示有進(jìn)行性的瘤腔擴(kuò)大，周圍水腫，并伴有瘤腔移位，再次手術(shù)全切了異常組織，病理分析回報(bào)，這些異常組織 包括放療后的壞死組織和腫瘤細(xì)胞?；颊叱鲈汉?5 年，隨訪無明顯的疾病進(jìn)行性發(fā)展的跡象。Case 6Glioblastoma multiforme of fron

12、tal lobeA 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 ed

13、ema. Brain abscess was considered in the differential diagnosis, but a tumor was believed more likely, because: there wase an eccentric area of capsular thickening, edema was minimal, and the clinical caurse was long. At operation, glioblastoma multiforme was encountered. Substances with unpaired el

14、ectrons exhibit an unusual combination of increased T1signal and decreased T2 signal termed paramagnetism. Methemoglobin, melanin, and gadolinium are familiar paramagnetic substances. In an abscesscapsule, paramagnetic changes occur because macrophages release free-radicals that contain unpaired ele

15、ctorns. 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.額葉多形膠母細(xì)胞瘤一 6 歲女孩有 3 個(gè)月的言語困難病史， CT 檢查顯示在右側(cè)額葉有一環(huán)形增強(qiáng)的損害，她沒有免疫抑制也沒有應(yīng)用過類固醇，此損害的邊緣在 MRI T2 像為低信號(hào)， T1

16、 像為高信號(hào)，周圍有輕 微水腫，此病灶可能為腫瘤，但應(yīng)除外腦膿腫，考慮腫瘤是因?yàn)椋?1 ）有囊性增厚的反常區(qū)域（ 2 ）水腫輕微（ 3 ）臨床病程長(zhǎng)手術(shù)時(shí)，看到了多形膠母細(xì)胞瘤。帶有不成對(duì)電子的物質(zhì)常有 T1 高信號(hào)， T2 低信號(hào)相結(jié)合的 特殊表現(xiàn)，這也叫順磁性。正鐵血紅蛋白，黑色素，釓是常見的順磁性的物質(zhì)。在膿腫囊內(nèi)，常會(huì)有順磁性的表現(xiàn)，因?yàn)榫奘杉?xì)胞釋放放射物質(zhì)中就包括不成對(duì)電子。雖然這不常見，但臨床醫(yī)生們應(yīng)該意識(shí)到，順磁性的環(huán)形信號(hào)，可以在轉(zhuǎn)移瘤，腦原發(fā)腫瘤，結(jié)核性肉芽腫和大的 脫髓鞘斑塊中出現(xiàn)。Case 7: glioblastoma multiforme located near m

17、otor cortex HistoryPatient 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 t

18、o 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

19、 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 s

20、eek 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 ExaminationThe patient is a well nourished, well developed, thin, pleasant male who appears intellectually inta

21、ct. 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 symmetr

22、ical, the patient walks with a normal gait with a normal arm swing. Radiographic studiesMRI scan shows an approximately 3.5 cm well-demarcated lesion in the posterior aspect of the left superior frontal convolution.ImpressionProbable low/intermediate grade glioma, possibly ganglioglioma or ganglio-n

23、eurocytoma. 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 courseThe patient underwent magnetoencephalography(MEG) to map his primary motor cortex and define its relationship to the tumor. This confi

24、rmed 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-weigh

25、ted 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

26、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 postoperat

27、ively was unchanged from his preoperative status. Pathologic reportThe 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 be

28、gin external beam radiotherapy followed by chemotherapy.Case 7運(yùn)動(dòng)區(qū)附近的多形膠母細(xì)胞瘤一位來自湖北的右利患者，職業(yè)是畫家，自訴近兩年有夜間癲癇癥狀。今年一月，癲癇的發(fā)病次數(shù)增加，并且在白天也時(shí)有發(fā)生，且常隨著轉(zhuǎn)頭轉(zhuǎn)肩而發(fā)生，每次癲癇發(fā)病后，病人意識(shí)模糊，但沒有神經(jīng)系統(tǒng)功能缺陷。二月， CT 掃描顯示額上回后部有一個(gè)未增強(qiáng)區(qū)域，并且在這個(gè)損傷中心有 一個(gè)小的對(duì)比增強(qiáng)的區(qū)域，后者約 3mm,前者約3.5cm,最近復(fù)查CT,顯示病灶 有輕度增大，我們建議病人行立體定向活檢，事實(shí)上在湖北，病人已經(jīng)被安排做活檢，但后來他們決定尋找其他方法，

29、患者現(xiàn)在在應(yīng)用苯妥英那，每日三次，每次100mg 。既往病史，家族史，社交史對(duì)此次診斷無特殊幫助。體格檢查：患者是一個(gè)營(yíng)養(yǎng)狀態(tài)良好，發(fā)育正常，體形偏瘦，并且沒有智力障礙的快樂男性。近期記憶完整，大體信息都很好。顱神經(jīng)檢查未見異常，所有形式的感覺功能測(cè)試都正常，運(yùn)動(dòng)功能檢查沒有異常的傾向，并且上下肢肌力良好，右側(cè)腕部伸肌力量減弱，而深反射對(duì)稱， 病人走路為雙臂擺動(dòng)的正常步態(tài)。放射學(xué)檢查： MRI 顯示左側(cè)額上回后部有一邊界清楚約 3.5cm 的病灶。印象：這可能為低度或中度惡性腫瘤，可能為神經(jīng)膠質(zhì)瘤或神經(jīng)節(jié)細(xì)胞瘤，如果病灶在運(yùn)動(dòng)區(qū)前部，應(yīng)采取切除術(shù)，如果病灶在運(yùn)動(dòng)區(qū)內(nèi)，應(yīng)采取活檢。醫(yī)院治療過程：

30、對(duì)病人應(yīng)用腦磁波描記術(shù)來描繪第一運(yùn)動(dòng)區(qū)，明確它和腫瘤的關(guān)系，這進(jìn)一步確定了臨床和影象學(xué)印象，即腫瘤在運(yùn)動(dòng)區(qū)前面。病灶立體定向測(cè)體積切除術(shù)被應(yīng)用。腫瘤的全部，也就是在CT， MRI 上被對(duì)比增加的部分，同時(shí)也是T2 像上顯示的異常部分，被數(shù)字化顯示在計(jì)算機(jī)上。在用環(huán)鉆進(jìn)行開顱術(shù)后，大腦表面呈現(xiàn)出來，放在大腦表面環(huán)鉆邊緣后方的多層電極，可以通過階段性反轉(zhuǎn)顯影的方法來確定感覺運(yùn)動(dòng)區(qū)的位置。為了能幫助外科醫(yī)生確定腫瘤的邊界，我們把腫瘤的整體呈現(xiàn)在手術(shù)顯微鏡中。我們?cè)谀[瘤周圍組織的內(nèi)表面將腫瘤剝離，并把他做為一個(gè)獨(dú)立的標(biāo)本取出。病人的神經(jīng)系統(tǒng)功能和術(shù)前相比沒有變化。病理報(bào)告：腫瘤被確認(rèn)為多形膠母細(xì)胞瘤為

31、低度惡性的星形細(xì)胞瘤，在術(shù)前掃描對(duì)比增強(qiáng)的部分就是惡性的部分。隨后安排病人開始外部射線放療并輔以化療。Case 12： olfactory groove meningiomaA 59-year-old women presented with a 2-year history of progressive dementia. Clinical examination disclosed bilateral anosmia and a concentric contraction of the left visual field with visual acuity reduced 20%. P

32、lain radiographs showed erosion of the cribriform plate, and CT scans demonstrated a large mass lesion suspicious for meningioma. The angiogram showed elevation of the anterior cerebral arteries and pathological staining of the tumor vessels supplied via the ophthalmic arteries. The tumor was apppro

33、ached through a bifrontal craniotomy and exposed by gentle retraction of the frontal lobes. Piecemeal removal of the highly vascular tumor was accoplished by bipolar coagulation and resection. Both anterior cerebral arteries, the optic nerves, and the optic chiasm were microsurgically freed of tumor

34、. After removal of the dura bordering on the tumor, the thickened crista galli and cribriform plate were removed with the diamond burr. The small skull base defect was closed in two layers with a dural graft and a galeal pericranial flap. The postoperative course was uncomplicated, and Ct scans conf

35、irmed total tumor removal. One year later, the patient was clinically asymptomatic and recurrence-free.Case 12 嗅溝腦膜瘤 一患者 59 歲，有兩年的癡呆病史，體格檢查顯示雙側(cè)嗅覺喪失，左側(cè)視野向心性盲，視力減弱 到正常時(shí)的百分之二十。平片示視神經(jīng)盤侵蝕，并且CT 掃描示有巨大的腦膜瘤侵害，血管造影顯示大腦前動(dòng)脈抬高，又進(jìn)行了病理染色說明有眼動(dòng)脈穿過瘤體。我們應(yīng)用雙額入路顱骨牽開 器小心暴露額葉，后在雙極電凝的輔助下逐漸切除這個(gè)血管豐富的腫瘤，與腫瘤相連的大腦前 動(dòng)脈，視神經(jīng)，視交叉也

36、被剝離出來，去除腫瘤邊界的硬腦膜，增厚的雞冠和視盤也用金剛鉆 處理，小的顱骨缺損被封閉在硬腦膜和顱骨骨膜帽狀腱膜之間。術(shù)后的處理并不復(fù)雜，CT 確定腫瘤已完全切除，一年后，此病人無臨床癥狀，并且也沒有復(fù)發(fā)。Case 42Trigeminal neurinomaThis 48-year-old woman was hospitalized in March, 1985, for assessment of disturbance. Neurological examination revealed decreased corneal sensation on the right ride and

37、 an awkward tandem gait. A CT scan showed an expanding lesion in the right cerebellopontine angle with a slight supratentorial extension. An enlarged Bernasconis artery was visible on the right carotid angiogram. Vertebral angiography showed elevation of the first segment of the posterior cerebral a

38、nd superior cerebellar arteries on the right side. Surgery was performed via a transpetrosal transtentorial approach in April, 1985, and the tumor was totally removed. The tumor originated from the root of the right trigeminal nerve and was well encapsulated. The pathological diagnosis was a schwann

39、oma without any sign of malignancy. Postoperatively, there was anesthesia on the right side of face without any trophic corneal disorder. Slight right abducens nerve palsy was also noted. At the patient 2-year follow-up examination, the onlysequelae still remaining were fifth nerve dificits.三叉神經(jīng)瘤 一患

40、者女， 48 歲， 1985 年 3 月由于視力障礙被送入我院，神經(jīng)系統(tǒng)檢查為右側(cè)角膜感覺減退，并且有動(dòng)作遲緩性交叉步態(tài)，CT示右側(cè)橋小腦角有占位損害，并伴有輕微幕上擴(kuò)展，右側(cè)頸內(nèi)動(dòng)脈造影可見 Bernasconi 動(dòng)脈擴(kuò)張，椎動(dòng)脈造影顯示右側(cè)大腦后動(dòng)脈的第一段和小腦上動(dòng)脈被抬高。 該患于 1985 年 4 月行經(jīng)巖骨小腦幕入路手術(shù)切除術(shù)， 腫瘤被全切， 此腫瘤起源于三叉神 經(jīng)根，并被包膜包裹，病理回報(bào)為良性神經(jīng)鞘瘤，術(shù)后沒有角膜營(yíng)養(yǎng)障礙，僅有右面部的感覺缺失和輕微的右側(cè)外展神經(jīng)麻痹。兩年后病人復(fù)查，唯一的后遺癥是第五對(duì)顱神經(jīng)的功能障礙。Hemifacial spasm caused by a

41、 venous angiomaThis 53-year-old woman, who had suffered for more than 2 years from muscle twitching on the left side of her face, was admitted to the neurosurgical ward in September 1995. Her symptom initially was confined to the orbicularis oculi muscle; however , 6 months after it appeared, it had

42、 spread to involve other muscles innervated by the facial nerve. Magnetic resonance imaging performed after gadolinium injection showed a caput medusae-like enhancement in the left cerebellar hemisphere. In the same area cerebral angiography demonstrated a characteristic venous angioma with drainage

43、 into the sigmoid sinus.Operation. A left retromastoid craniectomy was performed. The offending vessed was identified as the distal portion of the parenchymal segment of the angioma. It was located between the facial and auditory nerves. To avoid the possibility of venous infarcton, the vein was car

44、efully dissected away from the exit zone of the facial nerve. Small pieces of shredded Teflon were placed between the nerve and the vessel.Postoperative course. The patients spasm completely disappeared 1week after surgery without any neurological deficit.53 歲女性，主訴：左面部肌肉顫動(dòng) 2 年余， 1995 年 9 月入神經(jīng)外科病房。癥狀

45、起初局限于眼輪匝肌，然后 6 個(gè)月后波及面神經(jīng)支配的其它肌肉。注射gadolinium 的磁共振成像顯示左小腦半球有海蛇頭樣強(qiáng)化。在同一部位血管造影顯示特征性的靜脈血管瘤引流至乙狀竇。手術(shù)：行左乳突后顱骨切除。病變血管確定為血管瘤實(shí)質(zhì)的遠(yuǎn)端部分。位于面神經(jīng)和聽神經(jīng)之間。為避免靜脈性梗死的可能，小心的將靜脈從面神經(jīng)出口處剝離，在神經(jīng)和血管間放置些小 的聚四氟乙烯樹脂碎片。術(shù)后病程：患者痙攣癥狀于術(shù)后 1 周徹底消失，無任何神經(jīng)功能缺損。Case81 Traumatic atlanto-occipital dislocationA 12-year-old boy was struck by a c

46、ar while riding his bicycle and was thrown over the hood of the car. He landed 20-25 feet away from the rear of the vehicle. At the scene of the accident, the patient was combative and confused but was able to move and speak purposefully. His radial pulses were palpable and his airway was clear. Aft

47、er initial resuscitation and immobilization efforts, he was transferred to the hospital. Upon arrival at the Emergency Department, the patient had stable vital signs and Glasgow Coma Scale score of 12. his pupils were equal and reactive. He was still combative and confused but responded to some ques

48、tions appropriately. Physical examination revealed a deep scalp laceration in the left occipito-parietal region, a forehead hematoma, and a swollen, deformed, and tender left ankle. He hand marked weakness of the right upper and lower extremities and a positive babinskis sign on the right side. The

49、chest and abdomen were assessed as normal. Because of the head iniury, tracheal intubation was performed immediately to secure the airway. A lateral radiograph of the cervical spine revealed an atlanto-occipital dislocation without any anterior or posterior displacement. Among other radiographic stu

50、dies obtained, only those of the left ankle were significant, demonstrating a fracture of the tibial epiphysis. After a diagnostic peritoneal lavage, which was grossly negative for intraabdominal bleeding, MRI studies of the head and neck were obtained. No incracerebral or spinal tissue injury was n

51、oted.The left ankle wasplaced in a cast after the radiologic studies were completed. On the following day, atlanto-occipital fusion was performed with wiring and a bone autograft, and a halo vest was put on the patient. His neurologic condition improved dramatically postoperatively. At 10 days after

52、 admission, the patient was transferred to another hospital for rehabilitation with a completely norma mental status and no neurologic deficit other than a slight weakness of the right lower extremity and positive babinskis sigm on that side. On follow-up examination 2 months after the accident, the

53、 patient was found to have had a complete neurologic recovery.Case81:外傷性寰枕脫位 一名 12 歲男孩在騎自行車時(shí)被汽車撞到， 人被拋到了汽車的遮光板上， 落到了車后20-25 英尺的地方。在車禍過程中，患者情緒激動(dòng)，定向力差，但是可以移動(dòng)，能主動(dòng)說話，在現(xiàn)場(chǎng)復(fù)蘇和固定后，他被送往醫(yī)院，到達(dá)醫(yī)院急癥室后，患者生命體征平穩(wěn)，GCS評(píng)分12分，雙瞳等大光反射靈敏。患者仍然情緒激動(dòng)，定向力差，可回答一些問題，查體發(fā)現(xiàn)左頂枕部可見一處頭 皮裂傷，前額頭皮血腫，左踝部腫脹畸形，右側(cè)肢體肌力弱，右側(cè)巴氏征陽性，胸腹未見異常， 因頭部受外

54、傷，為通暢氣道，立即行氣管插管術(shù)。脊柱頸段側(cè)位片示寰枕脫位，無前后方移位，左踝片示脛骨下端骨折，診斷性腹腔灌洗，表明無腹腔內(nèi)出血，頭頸磁共振表明，無顱內(nèi)及脊 髓損傷，在放射線檢查后左踝固定，第二天應(yīng)用鋼絲自體骨行寰枕融合術(shù)，并用支具固定患者， 術(shù)后神經(jīng)系統(tǒng)癥狀明顯好轉(zhuǎn)，十天后，病人身體恢復(fù)正常，右下肢肌力略差，右側(cè)巴氏征陽性， 無其他陽性體征，轉(zhuǎn)到其他醫(yī)院治療，在接下來兩個(gè)月后的查體表明，神經(jīng)系統(tǒng)癥狀完全康復(fù)Case 53:cerebellopontine angle lipomaThe patient is a 33-year-old man with a 10-year history o

55、f decreased hearing in the right ear and a 1-year history of vertigo. A neurological examination demonstrated sensorineural hearing loss in the right ear. An audiogram revealed 8% discrimination in the right ear. Magnetic resonance imaging(MRI) demonstrated an 8-mm nonenhancing mass at the inferior

56、margin of the right cerebellopontine angle, which was hyperintense on T1-weighted images and hypointense on T2-weighted images. The computed tomographic(CT) scan demonstrated a non-enhancing hypodensity in the same region. Because of intractable vertigo, the patient underwent a right suboccipital cr

57、aniectomy for a presumptive cerebellopontine angle lipoma. The lipoma was found just below cranial nerves 7 and 8, adherent to the brain stem. Approximately 50% of the lesion was debulked. The patient did well postoperatively without new cranial nerve deficits. He did develop an aseptic meningitis t

58、hat responded to steroid therapy. Currently, the patient is doing well, is free from vertigo, and has an underlying right hearing deficit.患者，男， 33 歲，主訴：右耳聽力下降十年，眩暈一年。神經(jīng)科檢查右耳感覺神經(jīng)性耳聾，聽力曲線右耳僅有8% 辨識(shí)力， MRI 顯示在右橋小腦角下緣可見 8 毫米的非增強(qiáng)區(qū)， 在 T1 加權(quán)像高信號(hào)和T2 加權(quán)像低信號(hào)， CT 顯示在同一區(qū)域?yàn)槲丛鰪?qiáng)的低密度，由于頑固性眩暈，患者接受了枕下開顱橋小腦角脂肪瘤切除術(shù)，術(shù)中在第

59、7 、 8 顱神經(jīng)下找到了脂肪瘤，臨近腦干， 50% 的損害不可逆， 患者術(shù)后沒有新的顱神經(jīng)受損癥狀， 出現(xiàn)了無菌性腦炎， 應(yīng)用類固醇激素治療， 現(xiàn)在患者恢復(fù)不錯(cuò)， 眩暈癥狀消失，但右耳仍有聽力損害。Case 11Meningioma of the anterior skull baseA 58-year-old man was diagnosed as having a predominantly intracranial meningioma en plaque of the anterior skull base in the midline area, extending from the tuberculum sellae and planum sphenoidale to the crista galli. The tumor was exposed intr