椎管内胚胎残余组织肿瘤的显微手术治疗(附21例分析)

目的分析椎管内胚胎残余组织肿瘤（ITEO）的手术治疗技巧和注意事项。方法总结21例病人的神经影像学、手术治疗和病理检查资料。其中表皮样囊肿、皮样囊肿和畸胎瘤共15例，占71．4％。均采用显微手术切除病变，注意保护神经组织。2例术后给予放疗。结果肿瘤全切17例（81．0％），次全切除4例（19．0％）。术后神经功能均有不同程度的改善。随访7个月～5年，1例（4．8％）复发。结论采用显微手术全切病变是治疗ITEO的最好选择。不能全切者可行放疗，有助于防止肿瘤复发。     

高颈段椎管内肿瘤的诊断与手术治疗

目的 探讨高颈段椎管内肿瘤的诊断和手术治疗方法。方法 回顾性分析2004年7月至2007年3月在我科手术治疗的18例高颈段椎管内肿瘤病人的临床资料，对诊断和治疗经验进行总结。结果 肿瘤位于髓外硬脊膜下13例（其中哑铃形肿瘤2例），髓内3例，硬脊膜外2例。病理类型为神经鞘瘤10例，脊膜瘤4例，胶质瘤2例，脂肪瘤1例，节细胞神经瘤1例。18例均采用经枕下颈后正中入路，哑铃形肿瘤中有1例行二期手术，采用经颈外侧入路。肿瘤全切除14例（77．8％），部分切除4例（22．2％）。术后随访1～2个月，症状消失10例（55．6％），明显改善6例（33.3％），无变化2例（11、1％）。结论 高颈段椎管内肿瘤的诊断要依靠MRI检查，手术应持积极的态度，根据肿瘤的不同类型采取相应的手术方法，术后要加强对并发症的防治。     

椎管内肿瘤的显微外科治疗（附40例报告）

目的探讨椎管内肿瘤显微外科手术治疗方法和效果。方法对40例椎管内肿瘤（位于颈段8例，胸段16例，腰骶段10例，马尾区6例）患者的临床资料进行回顾性分析。结果38例肿瘤全部切除，2例肿瘤大部切除。随访2—5年，疼痛缓解率为88．6％（31／35），感觉障碍改善率76．3％（29／38），运动障碍改善率90．5％（19／21），括约肌功能改善率88．9％（16／18）。结论椎管内肿瘤以良性为多，重视显微外科技术的应用和脊柱稳定性的重建是提高其疗效的关键。     

椎管内肿瘤37例分析

目的：分析椎管内肿瘤的发病特点和临床表现。方法：对３７例椎管内肿瘤患者进行回顾性临床分析。结果：３７例均手术切除,术后随访６月～６年,无复发,无症状加重。结论：脊膜瘤好发于胸段椎管内,女性多见,神经鞘瘤好发于腰段椎管,男性多见,手术是治疗的有效方法。     

显微手术治疗椎管内肿瘤30例分析

目的探讨椎管内肿瘤的临床诊断与显微外科治疗方法。方法回顾性分析30例椎管内肿瘤患者的临床资料。结果术后病理检查证实：神经鞘瘤14例，神经纤维瘤8例，脊膜瘤4例，室管膜瘤、畸胎瘤、蛛网膜囊肿、胶质瘤各1例。肿瘤位于颈段15例，胸段9例，腰段5例，骶尾段1例。硬脊膜外肿瘤5例，髓外硬脊膜下22例，髓内3例。肿瘤全切23例（其中髓外肿瘤全切22例，髓内肿瘤全切1例），部分切除7例。出院时29例患者肌力得到明显恢复，20例肢体感觉障碍明显好转，1例症状加重。结论椎管内肿瘤大多为良性肿瘤，手术效果较好，宜早诊断、早手术。MRI检查和显微外科手术可极大地提高手术的疗效。     

成人椎管内先天性肿瘤的手术治疗

目的 探讨成人椎管内先天性肿瘤的临床特点及手术治疗方法。方法 回顾性分析2006年1月至2014年12月手术治疗的48例成人椎管内先天性肿瘤的临床资料。结果 肿瘤全切除11例,大部分切除21例,部分切除16例;无手术死亡病例。术后病理结果显示（表）皮样囊肿20例,脂肪瘤13例,畸胎瘤10例,支气管源性囊肿3例,肠源性囊肿2例。43例术后随访1~6年,平均2.8年;2例皮样囊肿复发,二次手术切除;25例症状改善,15例稳定,3例恶化。结论 对成人椎管内先天性肿瘤,手术不能强求肿瘤的全切,需尽量保护神经功能和维护脊柱稳定。     

椎管内肿瘤402例报告

目的 总结治疗椎管内肿瘤的经验。方法 回顾性分析过去２５年来我科对４０２例椎管内肿瘤的手术疗效结果。结果 本组椎管内肿瘤脊膜瘤１３６例（３３．８％）,神经鞘瘤１３０例（３２．３％）,室管膜瘤２８例（７％）,星形细胞瘤２１例（５．２％）,脂肪瘤１９例（４．７％）,血管瘤１１例（２．７％）,蛛网膜囊肿１０例（２．５％）及少见的肿瘤如淋巴瘤、先天性肿瘤、结核瘤等。肿瘤位于髓外硬膜内,占６８．６％,位于硬     

脑边缘系统肿瘤(附91例分析)

目的 探讨边缘系统肿瘤的临床病理特点以及显微手术治疗策略，特别是锁孔手术的可行性及其疗效。方法 对91例脑边缘系统肿瘤的临床特点、手术方法和病理特点进行系统的回顾性分析。对34例肿瘤直径2.5cm中的32例及57例〉5cm中的9例采用锁孔手术．包括改良翼点入路、眶上额下眉弓入路、发际内过中线横切口的锁孔手术；其余均采用传统开颅手术，如翼点入路，额下入路、纵裂入路等。结果 脑边缘系统肿瘤常见于中青年病人；癫痫发作常是首发或惟一的症状。肿瘤全切53例（58．2％），次全切38例（4l、8％）。术后病理结果示低级别胶质瘤79例（86．8％），海绵状血管瘤4例，间变性星形细胞瘤4例，神经胶质增生2例，动静脉畸形1例．胶质肉瘤1例。结论 脑边缘肿瘤以低分级胶质瘤和其他良性肿瘤为主，继发性癫痫发作是其主要临床表现。对部分肿瘤直径〈5cm的病人．应用锁孔手术可获得满意疗效。     

鼻腔神经组织肿瘤临床病理与预后

３１例鼻腔神经组织肿瘤临床与病理分析表明：该类肿瘤是鼻腔内比较少见的肿瘤，可见于各年龄组。病理分类：嗅神经母细胞瘤１８例，黑色素瘤１例，脑膜瘤６例，胶质瘤４例，神经鞘瘤２例。良性肿瘤需手术切除，预后良好，恶性肿瘤不需要手术彻底且术后加用放射治疗。对１３例恶性肿瘤进行随访，其１年生存率（１２／１３）为９２．３％，３年生存率（７／１３）为３２．８％，５年生存率（３／１３）为２３．０８％。结合临床表现分     

椎管肿瘤术中护理配合

椎管内肿瘤发生于脊髓、椎管内与脊髓临近组织的原发肿瘤或转移性肿瘤的总称。椎管肿瘤包括硬脊膜外肿瘤（神经鞘瘤、血管瘤、脂肪瘤）、硬脊膜下肿瘤（神经鞘、脊膜瘤）、脊髓内肿瘤（室管膜瘤、星形细胞瘤）。多发生在颈段、胸段。好发年龄20～50岁,男性大于女性。症状：疼痛多见,其次是运动功能障碍、感觉异常,直肠、膀胱功能障碍等。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.