颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

改良翼点入路显微切除鞍结节脑膜瘤

Objective To summarize the experience with modified transpterygoid craniotomy for microsurgical resection of tuberculum sellae meningiomas. Methods The clinical data were retrospectively analyzed in 26 patients with tuberculum sellae meningiomas admitted between January, 2001 and April, 2007 in our hospital to receive microsurgical meningioma removal using a modified transpterional approach. The basal part of the tumor was firstly coagulated and dissected to control the blood supply of the lesion. Through the cerebral cisterns in the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasiveness to the neighboring structures. Results Simpson grade Ⅰ resection was achieved in 11 patients, grade Ⅱ resection in 14 patients, and grade Ⅲ resection in 1 patient. The visual acuity and the optic field were improved in 23 patients, and remained unchanged in 1 patient after the operation. Two patients had postoperative visual acuity deterioration, which was improved after appropriate treatment. Seven patients developed diabetes insipidus after the operation, and gradually recovered after symptomatic treatments for about 10 days without fatal consequences. Follow-up for 6 months to 5 years found no recurrence of meningiomas in these patients. Conclusions The modified transpterional approach provides excellent exposure of the middle fossa, anterior cranial fossa, saddle and parasellar areas, and is effective for different types of tuberculum seilae meningiomas with increased total resection rate and reduced postoperative complications.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

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     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -