Cerebral paragonimus surgery

Paragonimus (Paragonimus) is also known as Paragonimus, and humans are the terminal host of paragonimiasis. Paragonimiasis is mainly prevalent in Southeast Asia, especially in the Korean Peninsula. There are scattered occurrences in the northeast, southwest and east China. After the adult matures in the lung, it has a strong ability to cross the tissue. In addition to walking through the lungs, it can also loose connect the tissue around the mediastinumcarotid artery along the wall of the carotid artery, rupture hole, and enter the intracranial formation. Cerebral paragonimiasis. The incidence of cerebral paragonimiasis is second only to the pulmonary paragonimiasis, and the lesion is consistent with the adult cranial approach, which is common to the medial temporal and occipital lobe, and the cerebellum is rarely involved. Adults can travel through the brain, even through the lateral ventricles and carcasses to the other hemisphere. Adults not only destroy brain tissue, but also a large number of eggs are deposited in the brain, causing necrosis and liquefaction of brain tissue, forming sterile abscess and granulation tissue, and extensive atrophy of late brain parenchyma. There is a history of raw laks or river crabs, and the eggs are found in the cockroaches and feces. The intradermal test of the paragonimiasis antigen is positive, and the enzyme-linked immunosorbent assay is positive for diagnosis. The clinical manifestations are mainly symptoms of increased intracranial pressure such as epilepsy, headache, vomiting, papilledema, and corresponding signs of nerve damage. In the encephalitis period, CT images can be seen in low-density areas with different sizes. The boundary is unclear. After strengthening, it is evenly flaky or nodular, with varying degrees of edema and mass effect. Round or elliptical calcification may occur in the brain of the chronic phase, and low-density lesions may be seen in the surrounding brain tissue, and the local cortex may have atrophy or enlargement of the ventricles. MRI checks that the T1-weighted image has a small dot-like high signal in the large low-signal region; the T2-weighted image surrounds the patchy irregular high signal outside the agglomerated low-signal and high-signal hybrid region; after the paramagnetic agent is enhanced, the original The T2 weighted image is agglomerated with low and high signal hybrid regions, and there are irregular small plate-like low signal regions, surrounded by large low signals. Treatment of diseases: brain paragonimiasis Indication 1. Pneumococcal occupying type, abscess and granuloma are relatively limited, the intracranial pressure is significantly increased, seizures are frequent, and other clinical symptoms are progressively worsened. 2. Multiple pneumococcal abscess, severe brain edema, threatening the lives of patients. Contraindications 1. Although the brain symptoms are more serious, but the intracranial pressure is not high, CT confirmed that the occupancy effect is not significant, and is associated with pulmonary symptoms such as chest pain, hemoptysis and sputum eggs positive. 2. Acute phase of meningoencephalitis. 3. Extensive brain atrophic lesions. Preoperative preparation Patients with significant increase in intracranial pressure, appropriate dehydration agents and hormone therapy, seizures frequently applied drug control. Surgical procedure 1. According to the CT or MRI of the preoperative head, the skull flap is made in the corresponding part of the lesion. 2. Dura mater and cerebral cortex can have different degrees of adhesion, bipolar coagulation and shearing. The dura mater is opened and turned to the sagittal sinus side. Due to the different pathological changes such as necrosis, liquefaction, granulation formation and fibrosis in the brain, the cerebral cortex loses luster, the color is gray, the sulci is deepened, the width of the cerebral gyrus is different, and the touch is harder than the normal cortex. Resistance, penetrate into the abscess can extract dark red, odorless thin pus. 3. Lesion resection 1 The granulomatous lesion located far away from the functional area can be resected along the cortex around the lesion. After the lesion is dissected, you can see different sizes of abscesses, different lengths of tunnels to communicate with each other, and may see adult and deposited eggs. 2 adjacent to the functional area of abscess-based lesions, full cut can aggravate functional damage, can avoid the functional area to open the abscess, absorb pus and pay attention to remove the adult, saline wash the abscess, often after surgery Good effect. 3 multiple lesions and involve important functional areas, or bilateral cerebral hemisphere involvement with increased intracranial pressure, non-surgical treatment is poor, and can not be removed, palpebral surgery such as subarachnoid decompression or decompressive craniectomy Improve clinical symptoms.