侧脑室-枕大池分流术的改进

后颅窝病变伴有梗阻性脑积水的患者．手术过程中原则是应尽量打通导水管，解除梗阻性脑积水，但在临床工作中常常有部分患者，导水管虽然打通，但术后仍存在梗阻性脑积水或再次出现脑脊液循环通路梗阻，需做二次分流术，或在手术中无法解除梗阻性脑积水。为防止上述情况发生，作者在手术中常规行侧脑室枕角一枕大池分流术。     

脑室积血伴急性梗阻性脑积水的诊治体会（附42例报告）

目的探讨脑室积血伴急性梗阻性脑积水的治疗方法,以期降低重症脑室出血的死亡率。方法根据CT结果早期行单侧或双侧脑室外引流术,术后予尿激酶脑室灌洗,拔管后行腰穿术放出血性脑脊液。结果手术治疗37例,脑室内积血清除时间：4～5d清除25例,6～10d清除12例,平均6d。存活30例,死亡7例。非手术治疗5例,全部死亡。结论尽早疏通脑室梗阻,改善脑脊液循环与脑微循环是脑室积血伴急性梗阻性脑积水救治成功的关键。侧脑室外引流术抽吸、引流血肿＋尿激酶脑室内灌洗＋腰椎穿刺脑脊液置换治疗脑室积血伴急性梗阻性脑积水,是一种安全、可行、有效的方法。     

腰穿引流脑脊液治疗高血压脑出血破入脑室的临床观察

高血压动脉硬化性脑出血大量破入脑室，临床上并不少见。其引起脑脊液循环障碍，导致急性梗阻性脑积水，颅内压升高明显，预后极其凶险，死亡率高，迄今为止缺乏临床易行，快速起效和术后并发症少的方法。我科自1997年5月至2005年2月在常规内科治疗的同时，进行反复腰椎穿刺（简称腰穿）引流脑脊液治疗，取得较好的效果。现报告如下。     

中国脑积水规范化治疗专家共识(2013版)

一、脑积水概念和分类 颅内蛛网膜下腔或脑室内的脑脊液异常积聚,使其一部分或全部异常扩大称为脑积水.单纯脑室扩大者称为脑内积水,单纯颅内蛛网膜下腔扩大者称为脑外积水.脑积水不是一种单一的疾病改变,而是诸多病理原因引起的脑脊液循环障碍.脑积水是由脑脊液循环障碍(通道阻塞),脑脊液吸收障碍,脑脊液分泌过多,脑实质萎缩等原因造成.临床中最常见的是梗阻性病因,如脑室系统不同部位(室间孔、导水管、正中孔)的阻塞、脑室系统相邻部位的占位病变压迫和中枢神经系统先天畸形.按流体动力学分为交通性和梗阻性脑积水;按时限进展分为先天性和后天性脑积水,急性和慢性脑积水,进行性和静止性脑积水;按影像学分为单纯性、继发性和代偿性脑积水;按病理生理分为高压力性、正常压力性、脑萎缩性脑积水;按年龄分为儿童和成人脑积水.     

结核性脑膜炎致梗阻性脑积水术后病情观察及护理

结核性脑膜炎是由于机体抵抗力减低结核杆菌通过血行播散透过血脑屏障引起的中枢神经系统疾病。由于蛛网膜下腔渗出液的积聚和粘连常导致脑脊液循环障碍而产生脑室扩大及脑积水。我科收治5例梗阻性脑积水(病理切片证实)通过手术治疗均达到预期的治疗效果，现介绍其术后临床观察及护理体会。     

导水管成形术后中脑导水管脑脊液动力学研究

目的利用磁共振相位对比电影成像法来探讨对导水管梗阻性脑积水患者行内窥镜下导水管成形术后脑脊液动力学变化情况。方法选用10名健康志愿者及21例成功进行神经内镜下导水管成形术的导水管梗阻性脑积水患者,利用磁共振相位对比电影成像法分别进行导水管流速测定,然后进行分组统计分析。结果以收缩期峰流速及到达峰值时间两个重要脑脊液循环动力学参数与健康志愿者进行统计学分析,t检验结果表明两者无统计学差异。结论内窥镜导水管成形术后导水管中脑脊液动力学与正常导水管脑脊液动力学相似,神经内镜下导水管成形术可以完全重建脑脊液正常生理循环。     

ECT在神经内窥镜诊断与治疗脑积水中的应用价值

目的探讨发射型计算机体层摄影术(emission computed tomography，ECT)在神经内窥镜诊断与治疗脑积水中的应用价值。方法选择1998～2002年经MRI检查确诊为脑积水的34例患，施行ECT检查。采用^99mTc-DTPA方法，于检查前8h禁食、水，经腰椎穿刺注入核素2mL(^99mTc，15mCi)，分别于注药后30min、3h、6h和24h摄取图像进行分析。结果34例患中梗阻性脑积水30例，交通性脑积水4例。正常情况下，ECT前后位像脑脊液动力学表现为典型的上行三叉影像。根据脑脊液流体动力学变化，不同类型脑积水ECT的影像学诊断标准：(1)梗阻性脑积水时上行三叉影像消失。(2)交通性脑积水表现为上行三叉影像圆钝，核素在脑表面和纵裂区蓄积且消散时间延长。结论ECT在不同类型脑积水的诊断、鉴别诊断和指导治疗方面具有重要意义。     

外伤性脑积水的治疗体会

目的 了解外伤性脑积水的病因及治疗方法。方法 总结分析98例外伤性脑积水，其中急性脑积水31例，慢性脑积水67例，分别行脑室外引流和脑室腹腔分流。结果 急性脑积水大多为梗阻性脑积水，而慢性脑积水多为交通性脑积水。结论 脑室腹腔分流是治疗外伤性脑积水的有效治疗方法，能明显改善颅脑损伤的预后。     

神经内窥镜第三脑室底造瘘术治疗梗阻性脑积水

目的 探讨对梗阻性脑积水患者采用神经内窥镜下进行第三脑室底造瘘的手术方法．分析手术成功与失败的原因。方法梗阻性脑积水原因分别为第三脑室后部肿瘤5例，中脑顶板胶质瘤2例，Chiari畸形2例，另12例为不明原因引起的导水管梗阻或狭窄。同位素^99Tcm-TPA脑池显像显示为非脑脊液吸收障碍性阻塞性脑积水。神经内窥镜从侧脑室经蒙氏孔进入第三脑室，在乳头体前方第三脑室底最薄处造一瘘口与脚间池相通。结果术后随访12～26个月，所有患者脑积水症状均缓解，脑室体积缩小。结论神经内窥镜行第三脑室底造瘘治疗非脑脊液吸收障碍性脑积水是一种有效的微创手术。     

磁共振3D-FIESTA序列在脑积水中的诊断价值

目的探讨磁共振三维稳态进动快速成像(3D-FIESTA)序列在脑积水中的诊断价值。方法40例脑积水患者均行磁共振常规序列及3D-FIESTA序列扫描并多平面重建,比较3D-FIESTA序列在脑积水鉴别诊断方面是否存在优势。结果 MRI常规序列扫描诊断交通性脑积水32例(75%)、梗阻性脑积水8例(25%);3D-FIESTA序列扫描诊断交通性脑积水23例(57.5%),梗阻性脑积水17例(42.5%),二者在鉴别脑积水类型方面有显著差异(χ~2=4.71,P0.05)。结论磁共振3D-FIESTA序列扫描在脑积水的诊断中具有可靠的临床价值,可以清楚显示脑脊液循环通路通畅情况,鉴别脑积水类型,为临床治疗提供更准确、更全面的影像学依据。     

Death of motoneurons induced by trophic deprivation or by excitotoxicity is not prevented by overexpression of SMN

The telomeric copy of the survival motor neuron gene (SMN1) is deleted or mutated in all spinal muscular atrophy (SMA) patients and these patients present mainly a loss in spinal motoneurons. Although studies performed in HeLa cells suggest that SMN may be involved in the biogenesis and possibly in recycling of spliceosomal small nuclear ribonucleoproteins (snRNPs), no link has been established between this function and the consequence of the absence of SMN in the specific loss of motoneurons. We attempted to answer the question of whether SMN plays a direct role in motoneuron survival by transducing cultured motoneurons with lentiviral vectors coding either for an antisense Smn mRNA or for full-length or truncated forms of SMN. We studied their effect on survival under different anti- or proapoptotic culture conditions. Our results show that increased levels of SMN are unable to protect motoneurons from death induced by trophic deprivation or by excitotoxicity. These results suggest that SMN is not a survival factor per se for motoneurons. In addition, overexpression of a truncated form of SMN shown to induce a modified subcellular localization and to exert a dominant-negative effect on snRNP biogenesis and RNA splicing in HeLa cells was ineffective in modifying both localization and survival in motoneurons.     

Stimulation of glucose analogue uptake by cerebral microvessel endothelial cells by a product released by astrocytes

Astroglial cells, both normal and neoplastic, secreted a product that stimulated glucose uptake by cerebral microvessel endothelial cells by 23% and 50%, respectively. Neither cerebral microvessel smooth muscle cells nor oligodendrocytes affected endothelial cell glucose uptake. The astrocytic product(s) did not affect glucose uptake by aortic endothelial cells. The effect on the cerebral microvessel endothelial cells increased with increasing time of exposure of the cells to the astroglial product(s), and required the constant presence of the astrocytic product to be maintained. The presence of a protein synthesis inhibitor during endothelial cell exposure to the astroglial conditioned medium blocked the stimulation of glucose uptake. Treatment of the astrocytic product with a protease destroyed its effectiveness. These results support the hypothesis that astrocytes induce the expression of at least one blood-brain barrier property by the cerebral microvasculature, and suggest that this induction may be produced by a protein released by the astrocytes.     

Antagonism by haloperidol of locomotor depression induced by small doses of apomorphine

Summary Administration of 0.025–0.1 mg/kg of apomorphine i.p. to mice produced a dose-dependent locomotor depression. Haloperidol, 0.025 mg/kg, produced locomotor stimulation, whereas 0.1 mg/kg caused locomotor depression. Pretreatment with haloperidol also reversed the depression caused by apomorphine. The functional antagonism is discussed in terms of a possible agonist-antagonist interaction on dopaminergic autoreceptors.     

Infertility by choice or by nature

Sexually active women have only recently had the ability to make a conscious decision to delay or refrain from bearing children. This is not only the result of the availability of effective contraceptive methods but also due to attitudinal changes in society and individuals. These reproductive choices may result, for some women, in conflict over the use of contraceptives, and the decision or timing of pregnancy. However, infertility imposed by nature in the form of inability to conceive, miscarriage or stillbirth removes the woman's sense of control over this important aspect of her life and frequently results in severe distress. The psychological issues surrounding these reproductive choices and events are reviewed and discussed.