Cerebral schistosomiasis granuloma resection

The world's most popular schistosomiasis include: schistoma Mansoni, schistoma haematobium and schistoma Japonicum, which are prevalent in the Philippines and in the Yangtze River valley of China. Cerebral Schistosoma japonicum accounts for 1.24% to 4.29% of schistosomiasis in Japan, mainly including tumor type and miliary nodule type, both of which are about 8:1. Tumor-type lesions are mainly the result of deposition of eggs in the brain, mostly in a single lobe, single-shot; miliary nodular type scattered on the surface of the brain, one brain lobe or two lobe above. There is no consistent conclusion that the eggs reach the brain. There may be the following ways: 1 The eggs are directly from the adult parasitic sinus (such as the lateral sinus), and the eggs enter the parietal brain through the anastomosis; From the adult parasitic in the portal system, the eggs pass through the portal vein and the venous anastomosis the closed atrial sacral hole the left heart the arterial system into the brain; 3 the eggs from the vertebral vein to the brain, the vertebral vein and the abdominal cavity, the chest cavity And the pelvic vein is rich in anastomotic branches, and there is no venous valve. When the pressure of the portal system is increased, the eggs enter the vertebral vein through the anastomosis and reach the brain. Cerebral schistosomiasis is most common in the distribution of middle cerebral artery. There are a group of 78 cases of surgery, and the lesions located in the cerebral hemisphere account for 83.33%. The distribution of each brain lobe was in order of parietal lobe, frontal parietal lobe, occipital lobe, and frontal lobe, and cerebellum accounted for 12.82%. Treating diseases: cerebral schistosomiasis Indication 1. Cerebral schistosomiasis After regular medical treatment, the symptoms and signs of brain damage continue to increase. CT and MRI confirmed brain tumor-type lesions in the brain. 2. Patients with schistosomiasis have increased intracranial pressure, and imaging studies suggest that there are space-occupying lesions, and other types of lesions cannot be excluded. 3. Patients with cerebral schistosomiasis have frequent seizures, drugs are difficult to control seizures, anti-schistosomiasis treatment is ineffective, affecting work and life. The EEG of the epileptic foci is well defined and suitable for surgical resection. 4. Disseminated miliary lesions, extensive edema, poor conservative treatment, in order to reduce intracranial pressure, preserve vision and prevent cerebral palsy, feasible external decompression. Contraindications In the acute phase of the disease, localized lesions have not formed in the brain, or with diffuse lesions of the whole body, which is not suitable for surgery. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure 1. Make a corresponding skin flap according to the lesion site indicated by CT or MRI. 2. In patients with brain tumors, after the dura mater is cut, the color of the cerebral cortex in the lesion is yellow, and the cerebral gyrus loses its normal shape. It is fashionable to see small miliary nodules, which are harder to touch. The granulomatous lesions are yellowish white, medium in texture, mostly located between gray and white matter, and a few can be located in the deep white matter, and the mass can reach the size of the egg. Incision can be seen between the cheese-like necrotic material and the granulation tissue. After identifying the extent of the lesion, if it is far from the functional area, along the intersection of the lesion and the normal cerebral cortex, the bipolar electrocoagulation membrane and blood vessels are cut open, and the tumor-like lesion is removed to properly stop the bleeding. If epilepsy is the main symptom, EEG is localized before surgery, and epileptic foci are removed under cortical electrogram monitoring. Miliary nodular type is often scattered in one or more lobes, and often cannot be removed. If the cerebral edema is heavier, external decompression is needed. 3. After the tumor type lesion is removed, if the brain pressure is not high, the dura mater is tightly sutured, the bone flap is restored, and the scalp is sutured in layers. The drainage material was placed under the bone flap and removed 24 hours.