听神经瘤显微手术保留听神经功能及影响因素分析

目的　探讨听神经瘤显微手术保留听神经功能及其影响因素。方法　收集我院近 2年来 2 3例经枕下乙状窦后入路显微手术的初发听神经瘤资料 ,其中包括肿瘤大小、术前术后听力、肿瘤内听道底侵蚀及术后小脑损伤情况。结果　耳蜗神经解剖保留 1 9例 ,保留有效听力 2例 (占术前存在有效听力患者的 33 3 % ) ,有效听力丧失保留可测听力 1 0例。听力的保留与肿瘤大小、术前听力水平、肿瘤内听道底侵蚀、小脑损伤相关。结论　肿瘤的大小、术前听力水平、肿瘤内听道底侵蚀和小脑损伤是听神经瘤术后听神经功能保留的影响因素。     

小听神经瘤的局部解剖与显微手术

目的:1975年至1997年个人经治各型听神经瘤315例,其中属Ⅱ级单侧听神经瘤12例(Koos分级系统),肿瘤<2cm,语音接受阀(SRT)<50dB,语音分辨记分(SD)>60％作为选择听力及而神经功能的保持对象。方法:均由作者采用标准的病侧枕下经乙窦入路开颅。病人坐位、显微手术,高速电钻磨除内听道后壁,术中照相/磁带记录,术后分析所见。结果:术后10例保全了面神经及听神经,2例无改善,其中1例还有耳鸣。肿瘤与Ⅶ及Ⅷ神经的关系又可分为Ⅴ型,其中Ⅰ,Ⅱ,Ⅳ,Ⅴ级效果良好。手术困难的是Ⅲ型。结论:作者的研究再证实肿瘤大小及术前听力水平应作为企图保存听力的主要决策。     

听神经瘤显微手术治疗的体会

目的总结38例听神经瘤显微手术切除的体会及并发症的防治,以提高患者的疗效和术后生存质量。方法回顾性分析38例听神经瘤患者的临床资料。结果肿瘤全切32例(84.21%),次全切6例(15.79%),术后面神经保留33例(86.84%),听神经保留10例(26.32%),2例听力有所改善(5.26%),无死亡病例。结论听神经瘤大小与肿瘤全切除及面听神经保留等密切相关。熟练掌握显微解剖结构及娴熟细致的显微手术操作,积极预防术后并发症是提高听神经瘤手术效果的关键。     

大型听神经瘤的显微手术治疗

目的 探讨显微手术切除大型听神经瘤的入路和方法。方法 经枕下入路显微手术切除大型听神经瘤226例,其中锁孔手术93例。结果 肿瘤全切除193例,次全切除33例。术后死亡1例。术后出现肿瘤部位血肿4例。术中面神经解剖保留205例。177例出院后随访2月~13年,面神经House-Brachmann分级Ⅰ~Ⅲ级143例,Ⅲ级以上34例。结论 枕下入路是显微手术切除大型听神经瘤的有效入路,并能较好地保留面神经功能;强调术中监测,仔细、耐心操作以便保留面神经的功能;当肿瘤与面神经或脑干粘连紧时勿强求肿瘤全切;锁孔手术完全可以达到切除大型听神经瘤要求,损伤小。     

听神经瘤手术内听道处理及面听神经保护

目的探讨听神经瘤手术内听道内肿瘤的处理方法,并对显微解剖保留面神经的手术经验和技巧进行讨论,以提高肿瘤的全切率和面神经的保留率。方法回顾性分析经枕下乙状窦后-内听道入路显微外科手术治疗的听神经瘤49例,术前行CT内耳道薄层扫描,术中行面神经功能和脑干听觉诱发电位监测。对听神经瘤内听道处理的手术技巧进行分析。结果术中面神经解剖保留43例,面神经解剖保留率为87.8%,出院时功能保留35例(H-B分级,Ⅰ~Ⅱ级)。解剖未能保留6例,其中2例行面神经端-端吻合。肿瘤全切45例,全切除率为91.8%;近全切除4例。术后无死亡病例。结论熟悉内听道内面听神经与肿瘤的病理解剖关系,熟练掌握显微手术技巧并结合术中监测,对肿瘤全切除和面听神经功能保护具有重要的意义。     

大型听神经瘤显微手术切除及面听神经保留技巧

目的 介绍大型听神经瘤显微手术切除及面听神经保留技巧。方法 对51例大型听神经瘤采用乙状窦后入路显微手术切除。结果 所有51例病人均行肿瘤全切,面神经解剖保留率为96％。根据House-Brackmann面神经功能分级标准,20例（39％）术后3个月内面神经功能为Ⅰ-Ⅱ级,27例（53％）为Ⅲ－Ⅳ级,4例（8％）为Ⅴ－Ⅵ级。根据Gardener-Robertson听力分级标准,3例（6％）听力保留。无手术死亡、脑干和后组颅神经损害及其他严重并发症。结论 采用显微手术技术,绝大多数大型听神经瘤均可以在保留面神经解剖完整的前提下手术全切。     

乙状窦后入路显微手术切除大型听神经瘤的临床研究

目的 探讨经乙状窦后入路显微镜下切除大型听神经瘤的手术技巧,减少神经损伤和并发症. 方法 采用经乙状窦后入路显微手术切除大型听神经瘤21例,对肿瘤暴露、显微手术技巧、手术中特殊情况及并发症进行分析. 结果肿瘤全切除18例,次全切除3例,面神经功能保留17例,听力保留5例.术中出现心跳短暂停止1例,术后短期并发症4例,无死亡病例.结论 经乙状窦后入路显微镜下的切除大型听神经瘤是安全的手术方法 ,良好的手术技巧、对解剖的熟悉是全切肿瘤、减少神经损伤和并发症的关键.     

听神经瘤手术治疗探讨

目的 分析和探讨听神经瘤手术治疗技巧，以提高手术疗效。方法 回顾手术治疗31例听神经瘤，采用经岩乙状窦前入路20例，枕下乙状窦后入路11例，显微手术16例，术中可清晰辩识面神经26例。结果 全切除肿瘤29例，次全切除2例，术后死亡1例，面神经解剖保留24例，面肌功能保留8例。结论 两种手术方法均可全切任何大小听神经瘤，枕下乙状窦后入路因其对岩骨侵袭小、手术便捷、术后并发症少，应为听神经瘤手术首选入路。显微手术和术的经验及对桥小脑角显微解剖知识，对提高手术效果很有帮助。     

乙状窦后入路显微手术切除大型听神经瘤的临床研究

目的 探讨经乙状窦后入路显微镜下切除大型听神经瘤的手术技巧,减少神经损伤和并发症. 方法 采用经乙状窦后入路显微手术切除大型听神经瘤21例,对肿瘤暴露、显微手术技巧、手术中特殊情况及并发症进行分析. 结果肿瘤全切除18例,次全切除3例,面神经功能保留17例,听力保留5例.术中出现心跳短暂停止1例,术后短期并发症4例,无死亡病例.结论 经乙状窦后入路显微镜下的切除大型听神经瘤是安全的手术方法 ,良好的手术技巧、对解剖的熟悉是全切肿瘤、减少神经损伤和并发症的关键.     

乙状窦后入路显微手术切除大型听神经瘤的临床研究

目的 探讨经乙状窦后入路显微镜下切除大型听神经瘤的手术技巧,减少神经损伤和并发症. 方法 采用经乙状窦后入路显微手术切除大型听神经瘤21例,对肿瘤暴露、显微手术技巧、手术中特殊情况及并发症进行分析. 结果肿瘤全切除18例,次全切除3例,面神经功能保留17例,听力保留5例.术中出现心跳短暂停止1例,术后短期并发症4例,无死亡病例.结论 经乙状窦后入路显微镜下的切除大型听神经瘤是安全的手术方法 ,良好的手术技巧、对解剖的熟悉是全切肿瘤、减少神经损伤和并发症的关键.     

可逆性周围神经损伤特点分析(附7例报道)

目的:总结7例可逆性周围神经损伤的特点。方法:分析7例患者周围神经损伤的原因、临床表现和治疗结果。结果:7例患者中,桡神经损伤3例,原因分别为拄拐杖压迫、酒后头压迫、打网球。2例尺神经损伤,原因分别为弹钢琴、打字。尺神经合并正中神经损伤1例,原因为牵拉上肢引起。坐骨神经损伤1例,为坐硬物引起。结论:周围神经受到不严重的压迫、牵拉、疲劳损伤,不会轻易发生神经结构永久性破坏,往往在半年之内能够恢复。     

Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions

Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

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Sommario La sutura nervosa interfascicolare con innesti autoplastici è la tecnica di elezione per ripara le lesioni traumatiche dei nervi periferici, dato che essa garantisce un più preciso allineamento dei fascicoli e quindi una maggiore possibilità di reinnervazione del moncone periferico. Questa tecnica, come è stata descritta da Millesi, è stata adottata all'Istituto Neurologico di Milano in 30 pazienti, affetti da lesioni traumatiche dei nervi mediano, ulnare e radiale. Tutti i pazienti sono stati controllati a distanza di tempo variabile da due a sette anni dall'intervento. I risultati ottenuti sono paragonati a quelli di altre casistiche, ottenuti sia con la tecnica della sutura interfascicolare che con la sutura epineurale; viene anche discussa la tecnica microchirurgica e il momento ottimale per l'intervento.

     

Trigeminal motor nerve conduction: Deep temporal and mylohyoid nerves

This article describes nerve conduction studies of the deep temporal nerve (DTN) and the mylohyoid nerve (MHN) motor branches of the trigeminal nerve. These nerves were stimulated intraorally with a pediatric surface stimulator. Compound muscle action potentials were recorded over the temporalis and mylohyoid muscles with surface electrodes. Forty-two subjects were studied. In all subjects the MHN response was elicited bilaterally, giving an upper latency limit of 2.3 ms. The mean MHN amplitude was 4.9 mV (SD = 1.8 mV, minimum = 1.3 mV). The maximal side-to-side latency difference was 0.4 ms, and the maximal side-to-side amplitude difference was 2.2 mV. The DTN response was only elicited bilaterally in 25 (60%) subjects. The average DTN latency was 2.1 ms (SD = 0.3, maximum = 2.7 ms). The average DTN amplitude was 4.3 mV (SD = 2.0, minimum = 0.3 mV). The MHN responses were the least technically demanding, and were more consistently elicited than the DTN responses. These nerve conduction techniques should prove useful in patients with trigeminal nerve disorders. © 1996 John Wiley & Sons, Inc.     

肋间神经重复电刺激在激素冲击治疗重症肌无力中的应用

目的探讨肋间神经重复电刺激(IRNS)和膈神经重复电刺激(PRNS)对激素冲击治疗时重症肌无力(MG)患者呼吸受累的预测价值.方法治疗开始前3天内检测36例MG患者PRNS和IRNS,同时观察用力肺活量(FVC)、MG临床评分、治疗中临床呼吸症状变化.结果大剂量激素治疗后2～13天14例(40%)患者出现呼吸功能受累或原有呼吸困难加重,呼吸功能恶化患者与未恶化患者相比,上述参数及MG临床类型均有明显差异.Lo-gistic回归分析显示3Hz及5Hz的IRNS双侧波幅衰减均值超过30%时比不超过时发生呼吸困难或原有呼吸困难加重的相对危险度均为19.523.结论治疗中呼吸功能受累与上述指标及MG临床分型均有关系,IRNS可以预测是否发生呼吸功能恶化.     

Wallerian degeneration in human nerves: serial electrophysiological studies.

After nerve transection, the distal stump undergoes Wallerian degeneration (WD). Little information is available concerning sequential changes in nerve conduction measurements during WD in humans. Five patients with nerve injuries were studied temporally. Motor-evoked amplitudes were reduced by 50% at 3 to 5 days after injury; the response was absent by day 9. Sensory-evoked amplitudes were reduced by 50% at 7 days after injury; the response was absent by day 11. Sensory and motor nerves with shorter distal stumps showed earlier loss of amplitude than did those with longer distal stumps. Denervation potentials were seen 10 to 14 days after injury. Our results suggest that WD occurs earlier if the distal stump is shorter, and that motor-evoked responses are affected earlier than sensory-evoked responses. The time-lag between the loss of the motor-evoked response and the appearance of denervation potentials, the latter coinciding with reduction of sensory evoked responses, suggests that failure of neuromuscular transmission precedes axonal loss during WD.     

二氧化碳激光修复脑神经的实验研究

目的:观察激光对脑神经再生情况的影响,探讨激光吻合脑神经的可能性。方法:通过对10只家猫的动眼神经在颅内段切断后,以二氧化碳(CO_2)激光1.5W,光斑长0.5cm,宽0.3mm原位吻合修复,术后进行瞳孔功能、神经纤维直径、通过率等指标的观察。结果:14周后术侧瞳孔对光反射功能恢复良好,神经组织学观察轴突再生情况良好,神经纤维通过率达83.47％,未见有害情况。结论:CO_2激光可作为修复脑神经的良好工具。     

Selective deep peroneal nerve injury associated with arthroscopic knee surgery

We report 3 cases of isolated deep peroneal nerve injury as a complication of arthroscopic knee surgery. At the level of the knee joint, the deep and superficial peroneal nerves are usually joined as the common peroneal nerve. However, because of the fascicular structure, a partial nerve injury can result in an isolated injury to the deep peroneal nerve fibers. Due to the intraneural topography of the peroneal nerve, electrodiagnostic studies in a partial nerve injury may erroneously indicate a more distal lesion. © 1993 John Wiley & Sons, Inc.     

The development of a normalization method for comparing nerve regeneration effectiveness among different graft types

The inability to compare directly different nerve grafts has been a significant factor hindering the advance of nerve graft development. Due to the abundance of variables that exist in nerve graft construction and multiple assessment types, there has been limited success in comparing nerve graft effectiveness among experiments. Using mathematical techniques on nerve conduction velocity (NCV) autograft data, a normalization function was empirically derived that normalizes differences in gap lengths. Further analysis allowed for the development of the relative regeneration ratio (RRR). The RRR function allows researchers to directly compare nerve graft results based on the NCV data from their respective studies as long as the data was collected at the same post‐operation time. This function also allows for comparisons between grafts tested at different gap lengths. Initial testing of this RRR function provided confidence that the function is accurate for a continuum of gap lengths and different nerve graft types.     

Simultaneous gradual lengthening of both proximal and distal nerve stumps for repair of peripheral nerve defect in rats

We investigated nerve regeneration following the repair of a segmental nerve defect induced by direct end-to-end neurorrhaphy after simultaneous gradual lengthening of both proximal and distal nerve stumps in rats. A 15-mm-long nerve segment was resected from the sciatic nerve of each rat. The proximal and distal nerve stumps, respectively, were directly lengthened at a rate of 1 mm/day using a custom-made external nerve-lengthening device. After being lengthened for 14 days, both nerve stumps were refreshed, and direct end-to-end neurorrhaphy was performed. For a control, 15-mm nerve grafting was performed immediately after nerve resection. Nerve regeneration was evaluated by motor nerve conduction velocity, muscle contraction force, and histological studies at 6, 8, and 14 weeks after initial nerve resection in both groups. As a result, at 8 and 14 weeks, the motor nerve conduction velocity was significantly higher in the nerve-lengthening group than in the autografting group. In addition, at 14 weeks, the tetanic force and wet weight of the gastrocnemius muscle were significantly higher in the nerve-lengthening group than in the autografting group. Histologically, the mean axonal diameter of myelinated nerve fibers and the total number of myelinated nerve fibers were also significantly higher in the nerve-lengthening group than in the autografting group for each evaluation period. It appears that the simultaneous gradual lengthening of both proximal and distal nerve stumps might have potential application in the repair of peripheral nerve defects.