颈段哑铃形椎管肿瘤

哑铃形椎管肿瘤占所有椎管内肿瘤 5 7%～14 2 % ,而颈段哑铃形椎管肿瘤在颈段椎管肿瘤中比例则要高到 30 % [1,2 ] 。本院 1978年 5月至 1995年 10月共收治颈段哑铃形椎管肿瘤 35例 ,现将本组手术及随访结果报告如下。临床资料1.一般资料 :本组男 2 0例 ,女 15例。年龄2 2岁～ 67岁 ,平均 4 0岁。病程 1个月～ 5年平均18个月。2 .临床表现 :首发症状为手或上肢根性疼痛18例 ;有确定感觉障碍平面 2 9例 ;肢体活动障碍30例 :其中四肢瘫 15例 ,三肢瘫 7例 ,截瘫 3例及单瘫 5例 ;括约肌功能障碍 14例 :棘突及椎旁压痛 16例 ;颈部触及肿块 11例。…     

高位颈段椎管内肿瘤显微外科手术治疗

我院2000年1月～2003年6月在显微镜下手术治疗高颈段各种性质的椎管内肿瘤18例,其中硬膜下良性肿瘤11例,脊髓内恶性肿瘤7例,报道如下:1对象与方法1.1临床资料男10例,女8例;年龄2～64岁,平均52岁。病程3～36月。发病后均有不同程度的感觉障碍和运动障碍及疼痛、麻木,感觉分离6例,二便障碍者11例。髓外硬膜下肿瘤表现为上下肢单瘫者8例,多伴有根痛及感觉障碍症状,单纯根痛、麻木2例;脊髓髓内肿瘤中双上肢瘫重于下肢瘫者4例,感觉分离明显,其中四肢瘫累及肋间和膈肌运动障碍者2例,有明显呼吸困难和缺氧表现。1.2影像学检查均行MRI检查,其中髓…     

脊髓髓内肿瘤22例显微外科治疗

报告自 1994年以来我科开展显微手术治疗后 ,经术前ＭＲＩ检查和术后病理证实的 2 2例脊髓髓内肿瘤。临床资料与方法1 一般资料 :本组 2 2例髓内肿瘤 ,男 11例 ,女 11例。年龄 2～ 64岁 ,平均 31 4岁。病程 1个月至 10年。2 临床表现 :2 0例表现为不同程度的肌力减退 ,由于每位病人肌力损害的程度不一 ,以其损害程度最重的肌力为界 ,0～Ⅰ级 2例 ,Ⅱ～Ⅲ级 9例 ,Ⅳ级 9例。 2 1例患者有不同程度的感觉障碍 ,主要表现为节段性感觉障碍和感觉分离。以疼痛为首发症状的 7例 ,合并括约肌功能障碍 7例。3 肿瘤部位病理和ＭＲＩ表现 :2 2例髓内肿…     

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。     

半椎板入路在椎管髓外膜内肿瘤显微手术中的应用

椎管内肿瘤的传统手术方法是采用经后正中入路咬除棘突、韧带以及全椎板后切除肿瘤,该方法破坏脊柱后柱结构,降低脊柱的抗压强度,远期可影响脊柱的稳定性,导致脊柱后凸畸形[1].我院自2009年2月至2010年5月采用半椎板入路显微切除椎管髓外膜内肿瘤共42例,取得较好疗效,现对这些病例资料及临床随访情况进行总结分析. 资料与方法 1.一般资料:男18例,女24例,年龄16～65岁(平均45岁),病程3-25个月(平均15个月).肿瘤位于颈段12例,胸段7例,腰骶段23例;肿瘤累及1个节段25例,2个节段14例,3个节段3例;椎管内肿瘤36例,椎管内外(哑铃型)肿瘤6例;所有病例均有不同程度脊髓或神经根受压症状和体征,其中四肢无力3例,双下肢无力24例,单侧肢体无力10例;肢体麻木35例,胸腰部束带感10例,有感觉障碍平面23例;根痛15例;括约肌功能障碍8例.     

髓外硬脊膜下肿瘤的诊断和手术治疗

髓外硬脊膜下肿瘤约占椎管内肿瘤的51%,主要是神经鞘瘤和脊膜瘤,少数为先天性肿瘤[1]。我院2003年12月至2009年2月手术治疗髓外硬脊膜下肿瘤20例,现报告如下。一、对象与方法1.一般资料:本组20例,男性9例,女性11例,年龄35～76岁,平均年龄53.9岁。2.临床表现:首发症状:疼痛15例(75%),感觉障碍3例(15%),运动障碍2例(10%)。     

椎管内肿瘤的治疗体会

本文收集近 5年来收治的 41例椎管内肿瘤病人 ,均经术前ＣＴ或ＭＲＩ及术后病理证实 ,现报告如下 :1　临床资料及方法1 1　一般资料　 41例椎管内肿瘤中 ,男 2 5例 ,女 16例 ,年龄 15～ 73岁 ,平均 3 4岁 ,病程 3个月～ 12ａ。1 2　主要临床症状及体征1 2 1　疼痛 :为常见症状     

5例椎管内巨大脊神经鞘瘤的诊治分析

椎管内脊神经鞘瘤是临床常见肿瘤,它占整个椎管肿瘤的1/4,超过髓外硬脊膜下肿瘤的1/3[1]。我们通常把临床少见的、累及多个脊髓/椎体节段的脊神经鞘瘤理解为巨大型椎管内脊神经鞘瘤。我科自2002年1月～2005年1月,共收治5例巨大型椎管内脊神经鞘瘤,现报道如下。1临床资料1.1一般资料:本组男1例,女4例,年龄28～56岁,平均41.2岁。首发症状均有根性疼痛,病程1.5～4.5年,平均2.8年,均有长期按颈椎病、腰椎病治疗病史。住院时所有病例的根性疼痛症状均已缓解,病人主诉头痛、走路不稳2例,肢体麻木伴无力3例。5例都有肢体肌力下降和深、浅感觉减退,…     

非何杰金恶性淋巴瘤所致脊髓压迫症——附13例报告

非何杰金恶性淋巴瘤(LMNH)引起脊髓压迫症者罕见,与常见好发部位比较不及5%.本文报告13例,计男10女3,平均年龄57岁.临床上通常以疼痛起病(仅1例例外),表现为腰背痛及根痛(坐骨神经痛、肋间神经痛、颈臂神经痛).出现疼痛与神经障碍之间隔时限自数天至6个月不等.根痛往往不典型,不足以反映占位病变的特征,故每易招致误诊.病程至脊髓压迫后阶段,表现为松弛性或痉挛性截瘫、不全截瘫、下肢单瘫等.感觉障     

8例颈椎椎管哑铃型肿瘤手术治疗

颈椎椎管哑铃型肿瘤在颈段椎管肿瘤中占30％,以神经鞘瘤居多。我院自1999年7月至2003年6月,收治颈椎椎管哑铃型肿瘤8例,采用了不同的手术方式,现结合文献分析报道如下。1 资料1.1 一般资料:男5例,女3例,年龄28-51岁,平均43岁,病程1-5年,平均2.5年。临床表现均有不同程度脊髓症状包括运动、感觉、括约肌功能障碍,有神经根痛者5例。     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.