听神经瘤手术保留面神经的显微外科解剖

目的 :观察面神经在脑桥小脑角、内耳道的显微外科解剖 ,为听神经瘤手术保留面神经提供解剖依据。方法 :采用头颅标本 2 0例 ,对 4 0侧脑桥小脑角部位的面神经进行显微外科解剖观察。结果 :在桥延沟 ,面神经运动根在前庭蜗神经根内侧稍上方 ( 1 .98± 0 .1 0 ) mm,展神经根外侧 ( 8.76± 1 .4 2 ) mm,在舌咽神经根出脑干处的上方约 ( 8.1 5± 2 .1 8) mm。在脑桥小脑池 ,4 0侧面神经共有 62支营养血管 ,主要来自小脑前下动脉及其分支 ;在内耳道有营养动脉 1 7支 ,主要来自迷路动脉。 结论 :熟悉面神经在脑桥小脑角及内耳道的显微解剖 ,有助于听神经瘤术中定位面神经 ,提高面神经保留率。     

病态嗓音的计算机定量评估

观察各类喉病患者嗓音声学参数及声谱图特征,探讨计算机声学测试技术在病态嗓音评估中的应用价值。方法采用计算机嗓音声学测试系统对７８例正常成人及９８例喉病患者元音信号进行检测,对其主要声学诊断及声谱图特征进行分析,并与主观听觉评价结果进行了比较。     

A new respiratory rate monitor: development and initial clinical experience

The need for continous, noninvasive, and reliable respiratory rate monitoring during recovery from general anesthesia has long been recognized. Alternative principles can be grouped into those detecting the respiratory effort, and those detecting the actual result, i.e. the respiratory gas flow. The second category is of greatest interest for patient monitoring. In this paper, we report the development and initial clinical experience with a new acoustic air-flow sensor. By differential, multipoint detection of the air-flow in the mouth and nose region, the sensor can easily discriminate against different kinds of interference, including motion arterfacts. The sensor is nonexpensive, rugged, simple to apply, and inherently safe. An instrument with continous display of respiratory rate, and an audiovisual apnea alarm has been designed and built.The complete system has been tested on patients during recovery after general anesthesia. In 16 patients, the respiratory rate displayed by the instrument has been correlated against that visually observed. A good correlation was obtained. Minor discrepancies can be explained from the fact that visual observation corresponds to the respiratory effort, whereas the sensor detects the actual air flow. In 12 patients, 24 hour simultaneous recordings were made of respiratory rate with the new sensor, with simultaneous recording of the oxygen saturation and the heart rate with a pulse oximeter. It was found that the new sensor reliabley recorded respiratory depression and apnea. Such events may in some patients be as frequent as one incident per hour. One case of Ondine's curse provided clear evidence that pulse oximetry has a low sensitivity to respiratory disorders.     

Cerebellopontine angle pilocytic astrocytoma mimicking acoustic schwannoma

We describe a case of pilocytic astrocytoma of the cerebellum mimicking an acoustic schwannoma. The tumour protruded into the porus acusticus and enlarged the internal auditory meatus, which is a quite unusual characteristic of glial tumours. Received: 2 February 1999 Accepted: 21 April 1999     

Familial syringomyelia

Summary The clinical and neurological features of four siblings (2 , 2 ) affected by syringomyelia are described. A fifth sister was affected by an acoustic neurinoma. Since neither parent showed signs of syringomyelia, this is considered to be a datum substantiating the dysembryogenetic theory of the syringomyelia syndrome.We are grateful to Dr. M. Savoiardo for his many suggestions and for his interpretation of radiological features. We should like to thank Dr. L. De Lorenzi for allowing us to publish details about patients.     

Human acoustic neurinomas: Nervous system specific biochemical parameters

Summary A series of 24 human acoustic neurinomas from 24 patients has been assayed for several biochemical parameters characteristic of the nervous system. S 100 protein, 2, 3-cyclic nucleotide 3-phosphohydrolase activity, and the myelin lipids galactosylceramide and sulfogalactosylceramide (sulfatide). Myelin basic protein was not detected. These findings further support the neuroectodermal origin of the human acoustic neurinoma, and provide additional biochemical markers for further study.     

Basic fibroblast growth factor protects auditory neurons and hair cells from noise exposure and glutamate neurotoxicity

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A randomized controlled trial of a new fetal acoustic stimulation test for fetal well-being

OBJECTIVES: Our purpose was to determine (1) whether a fetal acoustic stimulation test results in more palpable fetal movement compared with a mock test (control) and (2) whether palpated fetal movements after a fetal acoustic stimulation test are accompanied by a reactive nonstress test.STUDY DESIGN: In a randomized controlled trial we studied women seen in the labor and delivery suite for various indications. Women were excluded for multiple gestation, <31 weeks' gestational age, treatment with magnesium sulfate or narcotics, or ruptured membranes. Informed consent was obtained from eligible women, who were then randomized to a test or control group. We placed an acoustic stimulator on the abdomen of each woman, but only the test group was stimulated. We assessed fetal movement by a grading system: 0 = no fetal movement felt by patient or tester, 1 = fetal movement felt by patient only, 2 = fetal movement felt by tester, 3 = visual movement seen by tester. A positive fetal acoustic stimulation test result was defined as one with any fetal movement felt or seen by the tester (grades 2 or 3). We then performed a nonstress test. We compared rates of a positive fetal acoustic stimulation test in the test and control groups with the χ² test. A p value <0.05 was considered significant.RESULTS: We randomized 297 women to the test group and 280 women to the control (mock test) group. Of women tested with the fetal acoustic stimulation test, 81% had fetal movement by palpation or visualization (grades 2 or 3) compared with 19% of the control group (p < 0.0001, odds ratio 19.29, 95% confidence interval 12.42 to 30.07). Of the test group, 283 (95%) had a reactive nonstress test and 14 (5%) had nonreactive tests; the control group had 267 (95%) reactive and 13 (5%) nonreactive nonstress tests. Of 242 patients in the test group with a positive fetal acoustic stimulation test, 236 (98%) had a reactive nonstress test. Of those in the test group with fewer than three contractions per 10 minutes, 164 (89%) had a positive fetal acoustic stimulation test. Of these, 162 (99%) had a reactive nonstress test.CONCLUSION: The fetal acoustic stimulation test evokes significantly more palpated or visualized fetal movement than in controls. Palpated or visualized fetal movement after acoustic stimulation was almost always accompanied by a reactive nonstress test. (Am J Obstet Gynecol 1997;176:1386-8.)     

瞬目反射正常值及初步临床应用

目的了解健康成人瞬目反射正常值及其临床应用价值。方法采用Ｅｖｏｌｕｔｉｏｎ型神经肌肉记录仪检测，表面电极直接刺激眶上神经，诱发瞬目反射（ｂｌｉｎｋｒｅｆｌｅｘ，ＢＲ）。在同侧眼轮匝肌记录出短潜伏期波（Ｒ１）和双侧眼轮匝肌记录出长潜伏期波（Ｒ２，Ｒ２’）。对２０名（４０侧）健康人和３０例患者（其中包括三叉神经疾病，面神经疾病及听神经瘤）进行瞬目反射测试。结果ＢＲ潜伏期健康成人平均值Ｒ１为１０．１ｍｓ，Ｒ２和Ｒ２’为３０．４ｍｓ和３０．７ｍｓ。患者组患侧ＢＲ各波潜伏期延长，与健侧和健康人相比较，经ｔ检验，Ｐ＜０．０１，差异有极显著性。结论测试结果表明该技术简单、可靠，对三叉神经、面神经疾病和听神经瘤的早期诊断能提供有价值的电生理测试结果。     

Acoustic Evoked Response Following Transection of the Eighth Nerve in the Rat

Summary ? Object. The auditory brainstem response (ABR) is the most widely used means of intra-operative monitoring of the integrity of the auditory nerve and brainstem pathways during surgery in the cerebellopontine angle (CPA). Reliability of this and other electrophysiological techniques has been questioned because of persisting potentials in direct nerve recordings despite complete eighth nerve section.  The study was designed to assess the extent to which an acoustic evoked response persists after the cochlear nerve is lesioned in the CPA of the adult rat.  Methods. The eighth nerve was exposed microsurgically via a lateral suboccipital approach without damage to surrounding structures. The auditory brainstem response to monaurally presented click stimuli was recorded using needle electrodes and a bandpass of 10 to 5000 Hz.  Findings. Complete sharp sectioning of the nerve in the CPA resulted in immediate disappearance of brainstem-generated potentials but persistence of a large primary, vertex-positive wave in all but one case. This response was also abolished in recordings three days later and after emptying the inner ear canal. Provided that the cochlea remained intact, two weeks later a single, vertex-positive potential in the latency range of wave Ia of the ABR reappeared, reaching its peak amplitude six weeks after sectioning of the nerve.  Conclusions. The short-latency electrical potential recorded following damage of the eighth nerve in the cerebellopontine angle can be mistaken for an indication that nerve function is still preserved. The evoked injury potential is probably the major contributor to this potential that resembles wave I of the ABR. Monitoring of functional auditory integrity must neither be limited to early components of the ABR, nor to the electrocochleogram (EcoG) and the peripheral compound nerve action potential (CNAP), respectively.