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1.
近年来 ,随着神经影像学及以微电极导向为核心的神经电生理技术的不断进步 ,使立体定向功能神经外科得到了快速发展。它能将靶点的解剖定位提高到功能定位 ,高选择性地毁损某核团中的特定细胞。此即所谓“细胞刀”技术的概念。本文就该技术的概念、结构、工作原理、临床应用及评价等方面作一综述。  相似文献   

2.
掌握颅内病变的定位技术,是神经外科医师手术的基础,也是影响神经外科手术成败的关键因素之一.无论是骨瓣开颅手术,还是立体定向、神经内窥镜、"锁孔" (key hole)技术等,都需依靠颅内结构或病变的精确定位的个性化选择手术方法,以利引导手术入路[1].在传统的神经外科手术中,医师是根据颅内病变的影像学资料,凭借解剖学基础和经验来确定病变的位置及与周围结构的关系,为了避免定位的偏差,常常需要做一个较大的头皮切口和骨窗,并减慢手术操作速度以利寻找病变、避开重要的神经、血管结构,这种操作远远不能达到当代微侵袭神经外科的标准.因此,寻找一种既精确、可靠,又简单、快捷的定位方法,已成为神经外科领域需要探索的课题.随着影像学技术的发展,以及电子计算机、立体定向技术以及神经导航系统的应用,在很大程度上有利于神经外科疾病定位诊断技术水平的迅速提高,成为最重要的诊断与治疗手段,是当代神经外科医师应具备的基本技能之一.  相似文献   

3.
脑立体定向技术发展趋势   总被引:1,自引:0,他引:1  
立体定向技术是一种比较特殊的神经外科技术,而立体定向和功能性神经外科,由于在内容上的重叠和不可分割,长期以来,导致二者相提并论。开展立体定向和功能性神经外科工作是Horsley和Clarke1908年,真正用于临床是1947年Spiegel和Wycis,随CT、MRI、DSA、PET等影像学发展,特别是与计算机结合,衍生出立体定向放射外科,1986年Robert又创造了无框架立体定向系统———又称神经外科导航系统,目前又出现fMRIiMRI与导航技术,极大地丰富了神经外科技术手段。到了21世纪神经外科进展,不再是单纯停留在切除病灶基础上,还要考虑到脑功能缺失的改…  相似文献   

4.
细胞分子神经外科--神外科的新领域   总被引:5,自引:1,他引:4  
神经外科从只凭肉眼进行手术的大体神经外科(macroneurosurgery)发展到手术显微镜引进到手术中的显微神经外科(microneurosurgery)走过了一个漫长的过程。随着科学技术的发展,一些高科技手段和设备相继被引进到神经外科疾病的治疗中来,例如神经内窥镜、立体定向技术、微导管技术、立体定向放射、计算机科学以及这些技术的综合,如内窥镜辅助的显微外科、影像导航、机器人技术等,使神经外科发展到以显微外科为主线的微侵袭神经外科时代,使得神经外科医生有可能以对神经组织微小的损伤来治疗神经外科疾病。这一概念和内容意味着神经外科已发展…  相似文献   

5.
<正>由中国人民解放军总医院神经外科承办的"第六届全国功能神经外科学术会议",将于2015年5月8-10日在北京举行。本次大会以立体定向技术新进展,运动障碍性疾病、精神疾病、癫疒间、疼痛和颅神经、周围神经疾病以及立体定向放射外科等功能神经疾病为主题进行广泛交流。并在目前最前沿的脑功能网络技术、神经调控技术、电生理记录与刺激技术、多模态影像融合技术、神经外科机器人手术技术以及远程遥控治疗  相似文献   

6.
立体定向神经内窥镜的应用   总被引:2,自引:0,他引:2  
作为神经外科微侵袭显微手术的典型代表,立体定向技术和神经内窥镜技术的发展已经历了近一百年的历史。近年随着计算机影像学三维成像技术的不断成熟,光学仪器和光源照明技术的不断改进,立体定向神经内窥镜的结合应用已成为一门微侵袭显微神经外科的新兴技术。  相似文献   

7.
昆明三博脑科医院成立于2014年,在首都医科大学三博脑科医院外派专家团队的支持下,同年功能神经外科成立。在全国著名功能神经外科学术带头人栾国明教授的带领下,周健、关宇光、任杰等北京专家长期在院坐诊、手术。目前由任杰副院长全面负责科室建设、管理,昆明三博脑科医院功能神经外科逐渐形成以功能神经外科为核心,同时容纳神经内科、神经电生理、神经心理、神经康复病床的具备实际意义的多学科协作病房。病区配备了多台尼高力128导脑电分析仪、肌电图及诱发电位分析仪、术中脑电及肌电监测设备、Elekta射频仪、Leksel立体定向头架以及无框架立体定向手术机器人(Robot of Stereotactic Assistant,ROSA)等。  相似文献   

8.
立体定向神经外科发展动向与趋势   总被引:5,自引:1,他引:4  
立体定向神经外科(stereotac ticneurosurgery)的发展经历了一个漫长的时期,其技术原理现已广泛应用于神经外科各个领域。立体定向(stereotactic)一词源于希腊语,stereo-意为三维空间,-tactic系指安排处理。立体定向神经外科系采用空间定位装置,确定颅脑内靶点并施术于此的一种手术方法。由于颅脑内可提供一系列稳定的定位参考点,影像学检查又便于引导对相应靶点进行手术操作,因而这种方法十分适用于神经外科。纵观立体定向神经外科的发展,不仅有利于我们掌握现今所应用的一些相关先进技术,而且有助于我们理解医学发展动向、开拓神经外科治疗的新领域。  相似文献   

9.
随着电生理技术、神经影像学、立体定向与神经调控技术的发展,功能神经外科疾病的诊疗范畴不断地深入与扩大,已成为发展最迅速、最有活力以及最具前景的分支学科之一。功能性神经外科疾病主要包括癫痫、运动障碍性疾病、颅神经疾患、痉挛状态、周围神经外科疾病以及顽固性疼痛等。本文主要围绕以上疾病的外科治疗策略和展望作一述评。  相似文献   

10.
脑立体定向技术临床应用新进展   总被引:6,自引:3,他引:3  
脑立体定向技术的创立已有 10 0多年的历史了。其发展历程经过三个主要阶段 ,即 :①脑机能定位的动物实验研究阶段 ;②借助X线脑室造影定位治疗锥体外系疾病的临床应用阶段 ;③脑、神经解剖成像(CT或MRI)引导的三维定位临床治疗神经外科多种疾病的新阶段。现就其发展状况评述如下 :一、立体定向技术发展的初期 -脑机能定位的动物实验阶段早在 1889年 ,莫斯科大学解剖学教授Zernov就研制成功世界第一台脑立体定向仪。该立体定向仪采用球体极线坐标原理设计 ,用经、纬线测算颅内靶点 ,供脑解剖功能定位实验研究与人脑手术用 ,当时…  相似文献   

11.
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  相似文献   

12.
BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.  相似文献   

13.
2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。  相似文献   

14.
目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。  相似文献   

15.
《Clinical neurophysiology》2020,131(1):243-258
Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.  相似文献   

16.
目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。  相似文献   

17.
18.
Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.  相似文献   

19.
Introduction: An important consideration in treating acute mania is the promptness with which a chosen therapy can bring symptom amelioration. This article reviews the available published data from controlled, blinded studies regarding the latency of responses to antipsychotics in patients with acute mania.

Methods: Articles for this review were obtained from a search of the Medline database (1966–1999), using the following keywords and phrases: antipsychotic, atypical, bipolar disorder, mania, neuroleptic, typical. The bibliographic sections of articles gleaned from this search were used to direct further inquiries.

Results: Although information regarding the onset of action of antipsychotics is limited, we discovered data for four typical and three atypical antipsychotics. Drugs with the fastest onsets include haloperidol, risperidone, and olanzapine, with onsets appearing in 2–6 days. Chlorpromazine and thiothixene were at the slowest end of the continuum, with onsets of 2 weeks or longer. Data regarding pimozide are mixed, with some studies showing an onset equivalent to that of the 'fast' compounds and others showing one similar to that of the 'slow' compounds.

Conclusions: Choice of therapy should consider not only efficacy and safety, but also onset speed. Atypical antipsychotics appear to offer safer, faster, and more effective therapies.  相似文献   

20.
Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.  相似文献   

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