听神经瘤临床行为与其磁共振信号和病理特征之问的相关性研究

目的分析听神经瘤的大小、生长速率及增殖与其磁共振信号、组织学特征之间的相互关系.方法回顾分析听神经瘤43例,依MR信号分为均匀、不均匀及囊性变,组织学包括Antoni A、Antoni B以及纤维化、含铁血黄素沉淀、黄色瘤样细胞.结果信号均匀的听神经瘤肿瘤较小、生长较慢、增殖指数较低,组织学以Antoni A结构占优;不均匀和囊性听神经瘤肿瘤较大、生长较快、增殖指数较高,以混合型结构占优;不均匀和囊性听神经瘤中含铁血黄素沉淀、黄色瘤样细胞以及不均匀听神经瘤的纤维化明显增多,它们均有统计学意义.结论较大的听神经瘤不仅MR表现为不均匀信号,而且组织学主要表现混合型结构,也可能有其他变化,主要是含铁血黄素沉淀和囊性变.     

听神经瘤的大小与其影像学组织学特征之间的关系

目的分析听神经瘤的影像学表现、组织学特征与肿瘤大小之间的关系。方法听神经瘤依磁共振信号分为均匀、不均匀及囊性变，组织学包括Antoni A、Antoni B以及纤维样变、含铁血黄素沉淀、黄色瘤样细胞。统计学分析影像学、组织学与肿瘤大小之间的关系。结果小听神经瘤影像学表现为磁共振信号均匀、组织学以Antoni A结构占优；相反大听神经瘤表现为不均匀和囊性变、组织学以混合型结构为主；另外，含铁血黄素沉淀、黄色瘤样细胞以及不均匀听神经瘤的纤维样变主要见于不均匀和囊性的听神经瘤，它们均有统计学意义。结论不均匀信号提示肿瘤较大、不仅以Antoni B和(或)混合型结构为主，而且与含铁血黄素沉淀和黄色瘤样细胞有关。     

囊性听神经瘤

目的 探讨听神经瘤囊变原因、细胞增殖及其临床治疗效果。方法 回顾分析16例囊变听神经瘤的临床资料,计算其生长速率,免疫组织化学（PCNA、Ki-67）检查,以计算细胞增殖指数。结果 本组病例10例面神经功能保留,其中4例神经功能正常（House-Brackmann评分1分）,4例部分保留听力;囊变听神经瘤的病理以Antoni B型结构占优;生长指数显高于非囊变,而细胞增殖指数显低于非囊变。结论 听神经瘤囊变主要是由肿瘤缺血或出血所致,MRI是诊断听神经瘤囊变的最好方法,其手术效果（面神经、听神经的保留）较好。     

囊性听神经瘤的诊断与治疗(附12例分析)

目的　总结听神经瘤囊性变性的临床诊断与治疗特点。方法　回顾性分析１２ 例囊性听神经瘤的临床资料。结果　听神经瘤囊性变性有部分囊变、大部分囊变及多囊结构。ＣＴ／ＭＲ 检查均可发现囊性改变，但后者更可靠。手术切除疗效满意。病理检查发现有典型Ａｎｔｏｎｉ Ａ、Ｂ结构。结论　听神经瘤的囊变可能与肿瘤生长所致的组织缺血有关。囊性听神经瘤手术可以获得较好的面听神经保留。     

听神经瘤的临床特征与其细胞增殖之间的相关性

目的分析听神经瘤临床特性与Ki-67、PCNA增殖指数之间的相关性.方法回顾性分析43例听神经瘤,计算其生长速率,Ki-67、PCNA免疫组织化学观察肿瘤增殖,Spearman等级相关回归分析年生长率与Ki-67、PCNA增殖指数之间的相关性.结果发现患者病程、肿瘤生长指数与增殖指数之间有显著的相关性,复发肿瘤的增殖指数显著高于非复发肿瘤,囊性肿瘤的增殖指数显著低于非囊性肿瘤,肿瘤直径＞3.5cm的增殖指数显著高于≤3.5cm者.结论本研究结果提示肿瘤增殖指数越高,肿瘤生长越快,肿瘤直径＞3.5cm的肿瘤更易增殖.     

垂体瘤继发黄色肉芽肿的临床特征分析

目的探讨垂体瘤继发黄色肉芽肿的临床特征及诊断、治疗与预后。方法回顾性分析5例经手术治疗的垂体瘤继发黄色肉芽肿患者的临床资料;并结合文献分析其病理特点、发病机制、临床表现、影像学特征及治疗措施。结果术前MRI检查示2例患者垂体瘤内有T₁WI和T₂WI高信号。5例患者均行手术治疗,术中见瘤内有黄色液态内容物者2例,术后组织病理检查有含铁血黄素沉着3例;术后出现暂时性尿崩3例,对症治疗后症状改善,1例患者需长期激素替代治疗。结论不同程度垂体前叶功能减退是垂体瘤合并黄色肉芽肿的临床特点。MRI示垂体瘤在T₁WI和T₂WI均有高信号囊变灶要考虑垂体瘤继发黄色肉芽肿的可能;影像学和病理学检查发现有含铁血黄素提示黄色肉芽肿可能与垂体腺瘤的多次少量出血有关;手术治疗可获得良好的预后。     

中国汉族家族性脑海绵状血管瘤：1家系谱回顾分析

目的　探讨汉族人家族性脑海绵状血管瘤的临床、影像学及病理特点。方法 对1家族性脑海绵状血管瘤家系进行临床、影像学和病理分析,并绘制家系遗传图谱。结果 该家系16人共4人发病,符合常染色体显性不完全外显遗传,临床以头痛、出血、局灶性神经功能障碍为主要表现,头颅MRITlWI多呈混杂信号,T2WI多为不均匀高信号为主的混杂信号,内部可见夹杂低信号,边缘为低信号环。镜下脑海绵状血管瘤由缺乏肌层和弹力纤维的大小不等的海绵状血管窦组成,病灶内可见玻璃样变、钙化或不同阶段的出血,病灶周围可有胶质增生带,病灶内部或周围含有含铁血黄素。结论 家族性脑海绵状血管瘤是常染色体不完全显性遗传病。头颅MRIT2加权像病灶周围含铁血黄素沉积的“铁环征”,是脑海绵状血管瘤的特征性MRI表现。其病理结构是其易反复少量出血及MRI影像表现复杂多样的主要原因。     

颅内神经鞘瘤的MRI

本文报导1985年3月至1986年6月施行MRI检查的14例颅内神经鞘肿瘤,包括听神经鞘瘤11例,三叉神经瘤2例,颈静脉鞘瘤1例.年龄28岁至79岁.男性5例,女性7例.其中2例为双侧听神经鞘瘤.全部病例均经手术组织学证实.14例中3例CT明确有囊性变.在MRI的T_1图像和T_2图像囊性部分信号强度与脑脊液是均一性的.这3例的实质性部分和其余11例的信号强度相同.14例中有12例在T_1图像以低信号—等信号强度为主体,其内部显示有形态不规则的极低信号区.这12例中有11例在T_2图像以高信号强度为主体,其内部有形态不规     

脑微出血临床意义的研究进展

<正>随着上世纪90年代磁共振梯度回波成像(GRE)技术及磁敏感加权成像(SWI)技术的出现及应用,脑微出血(CMBs)的检出率大大提高,使得CMBs为人所知并日益受到重视。CMBs是脑内微血管破裂或渗漏所致的一种脑实质亚临床损害,出血后含铁血黄素、脱氧血红蛋白、铁蛋白等沉积在微血管周围,T2WI-GRE对出血甚至微小出血后的残余痕迹,尤其是对含铁血黄素的沉积敏感性很高。CMBs产生的顺磁性血液分解产物导致局部磁场不均匀,引起信号丢失,在MR GRE上表现为圆形、质地均一、边缘清楚的直径约2~5 mm的局灶性信号缺失区,病灶周边无水肿;同时应排除由苍白球钙化、     

Bcl—2及Bax基因蛋白在听神经瘤组织中的表达及意义

目的评价Bcl-2及Bax基因蛋白在听神经瘤组织中的表达及意义。方法取库存石蜡包埋组织标本,40例听神经瘤分作复发组、囊变组及对照组,采用SABC法免疫组化半定量检测Bel-2及Bax蛋白在听神经瘤组织中的表达。结果Bcl-2阳性者27例,多见于AntoniA区;Bax阳性者26例,多见于AntoniB区。不同组间Bcl-2与Bax表达的相对构成有差别(x2=6.64,P<0.05)。结论Bcl-2/Bax蛋白表达水平的相对构成可能与听神经瘤临床生物学行为有关。     

Cystic acoustic neuroma.

To define the clinical characteristics of cystic acoustic neuroma, we retrospectively analyzed 22 patients with cystic acoustic neuroma and reviewed the literature with regard to clinical manifestation, imaging features, diagnosis, surgical procedures and prognosis. An acoustic neuroma was defined as cystic according to the following criteria: the presence of hypodense/hypointense areas on CT or MRI, the identification of cystic elements at operation and histological verification. At the end of surgery, the facial nerve was anatomically intact in 86.4% of cystic acoustic neuromas. Complete removal of the tumor was achieved in 18 cases (81.8%). We conclude that patients with cystic acoustic neuroma need prompt surgery with special attention paid to the preservation of the facial nerve.     

Facial neuroma masquerading as acoustic neuroma

Facial nerve neuromas are rare benign tumors that may be initially misdiagnosed as acoustic neuromas when situated near the auditory apparatus. We describe a patient with a large cystic tumor with associated trigeminal, facial, audiovestibular, and brainstem dysfunction, which was suspicious for acoustic neuroma on preoperative neuroimaging. Intraoperative investigation revealed a facial nerve neuroma located in the cerebellopontine angle and internal acoustic canal. Gross total resection of the tumor via retrosigmoid craniotomy was curative. Transection of the facial nerve necessitated facial reanimation 4 months later via hypoglossal-facial cross-anastomosis. Clinicians should recognize the natural history, diagnostic approach, and management of this unusual and mimetic lesion.     

Acoustic neuromas: management of 204 cases

This paper reviews the author's personal experience with the management of 204 patients with the clinical diagnosis of acoustic neuroma. Craniotomy was performed in 181 of these cases, all of whom were proven to have acoustic neuromas. The remaining 23 cases with the clinical diagnosis of acoustic neuroma did not have tumour surgery, mainly because of advanced age or concurrent disease, although some required shunts for hydrocephalus. The management of acoustic neuromas including the selection of surgical approach depends upon the patient's age and general health, the size and growth direction of the tumour, previous surgical attempts at removal, and the presence of hydrocephalus, a contralateral tumour, and serviceable hearing. Twenty-nine other cases with the clinical diagnosis of acoustic neuroma underwent craniotomy: 20 had petrous or tentorial meningiomas encroaching on the porus acousticus or growing in the internal auditory canal, six had neuromas of the seventh cranial nerve and three had arachnoiditis occluding the internal auditory canal.     

大型囊性听神经瘤的临床特点及显微手术治疗

目的 探讨大型囊性听神经瘤的临床特征,总结显微手术治疗经验.方法 对经显微手术治疗的24例大型囊性及50例大型实性听神经瘤进行回顾性对比分析.结果 囊性肿瘤全切17例(71%),次全切6例(25%),大部切除1例(4%),面神经解剖保留20例(83%).实性肿瘤全切45例(90%),次全切5例(10%),面神经解剖保留45例(90%).囊性肿瘤首发症状多不典型,病程短,脑积水发生率高.结论 大型囊性听神经瘤发展迅速,应及时手术治疗.应用显微外科技术,对与神经组织紧密粘连的肿瘤,采取次全切除的策略,有助于面神经的保护,提高临床效果.     

微创手术治疗听神经瘤的研究进展

中、小型听神经瘤的最佳治疗方案目前尚存争议。伽玛刀治疗的局限性使其不能成为治疗听神经瘤的首选方案,而随访观察也只是一种消极的态度,将会导致错失听力保护的最佳时机。本文通过对比伽玛刀和随访观察治疗的缺陷,综述微创手术治疗的优越性和术中注意事项,明确微创手术治疗是中、小型听神经瘤最佳、最正确的治疗方案。同时,从听神经瘤病理解剖特点出发,既听神经瘤是蛛网膜外肿瘤,而不是蛛网膜下腔肿瘤,对听神经瘤双层蛛网膜形成的机制进行阐述,对听神经瘤术中面听神经的保护方法和术中注意事项进行综述,以提高听神经瘤面听神经解剖和功能保护率。     

Cystic acoustic neuromas: surgical outcome in a series of 58 patients.

We aimed to analyze the clinical characteristics and surgical outcomes of surgically treated cystic acoustic neuromas, and to determine the prognostic significance of the presence of cystic components, by comparing surgical outcomes for solid and cystic tumors. A total of 58 patients (20.4%) with newly diagnosed cystic tumor were studied. The surgical outcome was analyzed in terms of extent of tumor removal, facial nerve preservation, morbidity and mortality; and was compared with that in patients with solid tumors. Facial nerve preservation rates were much better for solid tumors (82.7%) than for cystic tumors (67.9%). The extent of tumor removal was complete in 75.9% of patients with cystic tumors as compared with 90.2% for solid acoustic neuromas. Overall mortality was 8.6%. Cystic tumors differ from solid acoustic neuromas by having a rapid growth pattern, short clinical history and more frequent facial nerve involvement. They are associated with a poorer surgical outcome in terms of facial preservation and overall result.     

听神经瘤BCL-2蛋白及bcl-2/JH融合基因的研究

目的 评价石蜡包埋听神经瘤组织中ＢＣＬ－２蛋白表达及相关的ｂｃｌ－２（ｍｂｒ）／ＪＨ融合基因改变,以探讨ｂｃｌ－２癌基因在听神经瘤发病中的可能意义。方法 免疫组化检测石蜡包埋组织中ＢＣＬ－２蛋白的表达;提取石蜡包埋组织的ＤＮＡ,ＰＣＲ检测ｂｃｌ－２（ｍｂｒ）／ＪＨ融合基因。结果 本组４０例听神经瘤,ＢＣＬ－２蛋白表达阳性２７例（６７．５％）,ｂｃｌ－２（ｍｂｒ）／ＪＨ融合基因检出阳性１９例（４７．５％）．结论 听神经瘤中存在ＢＣＬ－２蛋白的高表达及ｔ（１４：１８）染色体易位,提示雪旺氏细胞凋亡抑制可能是听神经瘤发病的分子病理基础之一。