神经导航在颅脑手术中的应用(附70例临床分析)

目的　探讨StealthStation神经导航系统在颅脑手术中的应用。方法　观察 70例颅脑手术中应用StealthStation神经导航系统的情况 ,包括测量注册准确性 ,参考头架的不同使用方法对导航准确性的影响 ,检测术中准确性及不同部位病灶的术中脑移位 ,并对导航在不同肿瘤手术中的作用进行分析。结果　平均注册误差和 10cm预期准确性分别为 ( 2 5 6± 1 0 0 )mm和 ( 2 45± 0 78)mm。有 5例因平均注册误差 >4mm加用表面注册 ,结果误差减至 ( 1 0 9± 0 2 4)mm。除了微血管减压术 1例和活检 3例 (术后均症状改善或不变 )外 ,其余 66例病人共 67个病灶 ,全切除 5 5个 ( 82 9% )、次全切除 6个( 9 0 % )、大部切除 6例 ( 9 0 % )。术中持续准确性SA1、SA2和SA3分别为 ( 2 3 8± 1 2 7)mm ,( 1 2 1± 0 98)mm和 ( 1 3 5±1 13 )mm。症状改善或不变 5 8例 ( 87 9% )、加重 6例 ( 9 1% )、死亡 2例 ( 3 0 % )。结论　StealthStation神经导航系统在颅脑手术中提供术中动态跟踪、实时导航 ,准确可靠 ,有助于病灶全切除及降低手术并发症的发生。     

神经导航术中脑移位的研究

目的定量研究不同神经导航手术中的脑移位,评价术中脑移位对神经导航手术定位准确性的影响。方法在73例颅脑手术中应用StealthStation神经导航系统指导手术操作,制作骨瓣前在骨窗外作对照参考点,然后分别测量硬膜、皮层和病灶移位程度,并分别对不同病理性质肿瘤的移位情况进行分析。结果平均注册误差(2.13±0.74)mm,术中持续准确性为(1.17±0.67)mm;所有73例的硬膜、皮层和病灶移位程度分别为(2.80±2.48)mm、(5.14±4.05)mm以及(3.53±3.67)mm。胶质瘤组的硬膜、皮层和病灶移位均是最大的,而海绵状血管瘤组以及颅底肿瘤组的移位明显低于胶质瘤组。结论术中脑移位是影响神经导航手术定位准确性的重要因素,对不同性质和部位病变术中脑移位的了解有助于指导手术操作。     

神经导航在颅内肿瘤手术中的应用（附106例报告）

目的报告使用StealthStation神经导航系统在颅脑手术中应用的经验.方法应用StealthStation神经导航系统指导106例颅内肿瘤手术进行回顾性分析.术中对导航准确性进行监测并对46例不同部位病灶进行术中脑移位检测.结果首次平均坐标误差和10厘米预期准确性分别为3.60±1.60mm和3.12±1.77mm,经去除或重新注册"不准确”的皮肤坐标后两者分别降为2.34±0.91mm和2.79±0.93mm.有5例因平均坐标误差＞4mm加用表面注册,其结果为1.09±0.24mm.106例病人共108个病灶,除了活检1例(0.9%)外,全切除92个(85.2%)、次全切除8个(7.4%)、大部切除7例(6.5%).术中准确性分别为1.22±0.90mm和1.29±1.30mm.术后症状改善或不变98例(92.5%)、加重6例(5.7%)、死亡2例(1.9%).结论StealthStation神经导航系统在颅脑手术中提供术中动态跟踪、实时导航,准确可靠,有助于病灶全切除及降低手术并发症的发生.     

神经导航在经小切口切除颅内表浅肿瘤术中的应用

目的评价神经导航系统在经小切口切除颅内表浅肿瘤中的应用。方法术前对37例病人(导航组)行MRI或CT连续薄层扫描,将影像学资料输入VectorVision2神经导航系统进行三维重建,标记肿瘤后,设计最佳手术入路和头皮切口。术中在导航引导下准确定位并切除肿瘤。以同期30例常规骨瓣开颅手术的大脑半球肿瘤病人(对照组)作为对照。结果导航组均准确全切肿瘤;注册误差0.5～1.6mm,平均(1.12±0.38)mm。导航组平均手术切口长4.9cm,骨瓣面积8.26cm2,出血64.5ml;对照组平均手术切口长13.7cm,骨瓣面积16.34cm2,出血214.1ml。结论与常规手术比较,神经导航引导下经小切口切除颅内表浅肿瘤具有定位准确,创伤小,手术时间短,失血量小及并发症少等优点,值得推广应用。     

神经导航在颅内微小病变锁孔手术中的应用

目的评价颅内微小病变锁孔手术中神经导航的应用价值。方法分析在神经导航引导下采用锁孔入路处理颅内微小病变(直径≤3 cm)30例(导航组),与同时期采用单纯显微手术治疗的25例(显微手术组)进行多指标对照。结果导航平均注册误差(2.10±0.52)mm。与单纯显微手术相比,导航组骨窗直径、头皮切口长度、术后并发症、住院天数差异具有统计学意义(均P<0.05)。随访1年。导航组和显微手术组病情好转或无变化分别为24例和18例,加重分别为5例和7例。导航组死亡1例。结论锁孔手术在神经导航系统辅助下治疗颅内微小病变疗效优于传统显微手术。     

DTI导航下颅内病变的显微手术

目的 探讨磁共振弥散张量成像（DTI）神经导航在颅内病变手术中的应用价值。方法 2015年1月至2015年12月DTI导航下切除颅内病变30例。结果 所有病变均准确定位,手术顺利,注册误差（2.11±0.37）mm,手术时间（222±60）min,术中出血（207±133）ml,均未输血。1例活检准确定位,术后未出现功能障碍;3例动脉瘤均准确夹闭,术后无神经功能障碍。其余26例28个病灶中,显微镜下全切26个,次全切2个,全切率为92.9%;术后复查CT或MRI示全切25个,次全切3个,全切率为89.3%。术后出现一过性功能障碍2例,出院时恢复正常;运动功能障碍及面神经受损各1例。结论 DTI导航系统安全、易于操作、容易掌握,有助于准确定位颅内病变,提高手术安全性,减少并发症。     

神经导航在颅内肿瘤显微手术中的应用

目的探讨神经导航在颅内肿瘤显微手术中的应用。方法应用神经导航系统完成28例颅内肿瘤手术并对其平均注册误差,术中病灶的精确定位,正常结构的保护及手术疗效进行回顾分析。结果28例平均注册误差为2.87±0.56 mm,术中病灶定位准确,全切除19例(67.9 %),次全切除3例(10.8 %),大部分切除4例(14.2 %),部分切除2例(7.1%),无手术死亡,术后神经功能保留良好。结论颅内肿瘤显微手术治疗应用神经导航技术,可以准确定位和切除病灶,保护神经功能和降低手术并发症的发生。     

神经导航手术252例临床应用

目的 介绍神经导航手术的临床应用经验。方法 在1997年9月至2001年9月连续进行的252例神经外科手术中,使用StealthStation神经导航系统指导手术操作。结果252例平均坐标误差为（2.12±0.89）mm,预期准确性为（2.74±0.99）mm。在239病灶切除术中,病灶全切除85.7％,术后症状改善或不变87.9％。在7例内窥镜手术中,5例囊肿行开窗术、2例胆脂瘤次全切除。7例活检和4例穿刺成功率100％。结论 神经导航准确、可靠,有助于提高手术疗效,降低手术并发症。     

电磁导航引导下颅内病变的手术治疗

目的探讨电磁神经导航系统在神经外科显微手术治疗颅内病变中的应用价值。方法回顾性分析46例应用电磁导航手术治疗的颅内病变病人的临床资料。结果手术全切32例,次全切除14例。术前准备时间平均15 min,术中导航平均误差2.11 mm。结论电磁神经导航系统具有安全、操作性强、易于掌握等优势,使用后可提高手术准确率,对取得手术成功大有益处。     

神经导航辅助经鼻蝶垂体腺瘤切除术的术中配合

目的探讨神经导航辅助经鼻蝶垂体腺瘤切除术的术中配合。方法对20例神经导航辅助经鼻蝶垂体腺瘤切除术的术中配合经验进行总结。结果20例中,前5例术前注册时间平均40rain;后15例注册时间平均15min,其中1例注册时间仅10min即完成。有4例由于手术医师使用导航仪不熟练,术中迷路无法辨认鞍底结构,请有经验的医师协助后,在导航仪引导准确定位鞍底后才顺利完成手术。结论神经导航手术能确保经鼻蝶入路切除垂体腺瘤手术的准确定位,避免手术误伤,提高疗效。熟悉导航仪设备和导航工具及导航手术过程,做好充分的术前准备是确保术中良好配合和顺利完成该导航手术的关键。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]