Functionally navigated transcranial magnetic stimulation to evoke lingual pressure in stroke survivors with dysphagia and healthy adults: a proof of concept trial

ABSTRACT

Background

Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) directly facilitates lingual pressure generation.     

CTA三维重建结合外视镜在颅颈畸形教学中的应用

颅颈畸形手术涉及复杂的解剖变异,手术风险高,操作难度大,传统的教学方式受制于抽象的讲解,学习者很难对颅颈畸形解剖,手术方案及过程有直观的认识。本研究将CTA三维重建导航和术中外视镜操作技术引入颅颈畸形手术教学实践中,术前通过CTA三维重建在导航仪软件上了解颅颈畸形变异情况,规划手术方案。术中采用外视镜操作,所有学生戴上3D眼镜观看手术。将无法直观显示的、抽象的解剖结构以三维立体图像对学生进行展示。使传统被动抽象的教学方式变成直观形象生动的学习方式。增强了神经外科临床专业研究生对颅颈畸形手术解剖认识,提高了手术操作的积极性,缩短了培养时间。     

颞下经小脑幕锁孔入路解剖与临床应用

目的通过神经导航下颞下经小脑幕锁孔入路的解剖和手术方案研究,探讨该入路临床应用效果。方法应用成人头颅标本12例(24侧),模拟颞下经小脑幕锁孔入路,观察暴露的岩斜区解剖结构;利用神经导航技术定位标本岩骨内部结构,最大限度磨除岩尖,观察斜坡鞍后区,上、中斜坡区等结构;利用该入路切除11例临床颅底肿瘤,探讨该入路的安全性和实用性。结果颞下经小脑幕锁孔入路可完全暴露鞍旁区,通过海绵窦外侧壁的手术三角可对累及海绵窦内外病变进行直视手术;神经导航辅助下耳蜗、内听道等结构定位准确,头颅标本岩尖磨除后耳蜗内侧缘岩尖剩余最大骨质平均厚度(0.8±0.19)mm,内侧视角较非导航入路增加(8±2.5)°,后外侧视野增加了(25±3.2)°,获得(3.3±0.4)cm2硬膜显露,明显扩大了后颅窝的暴露范围。临床病例资料肿瘤全切除6例,次全切3例,大部分切除2例,手术时间与既往相比缩短1~1.5 h,术后新增脑神经损害症状或原有脑神经损害症状加重3例,无长期昏迷及手术相关死亡病例。结论神经导航辅助下颞下经小脑幕锁孔入路,能最大程度暴露蝶岩斜区病变,有利于提高肿瘤的全切率和术后疗效。     

椎基底动脉分支远端动脉瘤的治疗方法探讨

目的：探讨椎基底动脉分支远端动脉瘤的治疗方法与策略。方法33例患者经全脑血管造影术证实为椎基底动脉分支大脑后动脉、小脑上动脉、小脑前下动脉与小脑后下动脉之远端动脉瘤,分别为8例、6例、9例、10例。其中血管内栓塞治疗29例,直接行开颅动脉瘤夹闭术2例,数字减影血管造影（DSA）与磁共振成像（MRI）三维影像融合数据输入神经导航,在神经导航指引下行开颅动脉瘤灼闭手术1例,1例因血管内栓塞治疗失败未进行手术治疗。结果所有病例无手术相关死亡,2例患者行弹簧圈栓塞术,术后1 d 患者再出血死亡,1例栓塞未成功又未行手术患者病情好转出院,余30例患者未发生术后再出血。结论椎基底动脉分支远端动脉瘤多数手术治疗难度大,应首选血管内栓塞治疗。     

多参数影像技术在脑活检手术的应用

目的探讨多种影像学技术共同确定脑活检手术靶点的临床应用价值。方法回顾性分析20例脑内病变并行活检手术的病例资料。术前均行18F-脱氧葡萄糖（18F—FDG）PET、CT和MRI检查。术前将PET、CT和MRJ图像进行融合,综合确定活检部位,术中在多参数影像引导下完成脑内病变活检术。结果术后病理诊断：胶质瘤15例（WHOIV级5例,Ⅲ级4例,Ⅱ级6例）,淋巴瘤3例,生殖细胞瘤1例,血管炎性病变1例。PET确定的活检部位与MRI相符9例,单纯依赖PET确定活检部位7例．综合确定活检部位4例。术后病人均未出现新的神经功能损害。结论多参数影像辅助技术可帮助确定脑内病变活检部位,得到准确病理诊断．为下一步治疗奠定基础。     

Tractographical model of the cortico‐basal ganglia and corticothalamic connections

The cortico‐basal ganglia and corticothalamic projections have been extensively studied in the context of neurological and psychiatric disorders. Deep brain stimulation (DBS) is known to modulate many of these pathways to produce the desired clinical effect. The aim of this work is to describe the anatomy of the main circuits of the basal ganglia using tractography in a surgical planning station. We used imaging studies of 20 patients who underwent DBS for movement and psychiatric disorders. We segmented the putamen, caudate nucleus (CN), thalamus, and subthalamic nucleus (STN), and we also segmented the cortical areas connected with these subcortical areas. We used tractography to define the subdivisions of the basal ganglia and thalamus through the generation of fibers from the cortical areas to the subcortical structures. We were able to generate the corticostriatal and corticothalamic connections involved in the motor, associative and limbic circuits. Furthermore, we were able to reconstruct the hyperdirect pathway through the corticosubthalamic connections and we found subregions in the STN. Finally, we reconstructed the cortico‐subcortical connections of the ventral intermediate nucleus, the nucleus accumbens and the CN. We identified a feasible delineation of the basal ganglia and thalamus connections using tractography. These results could be potentially useful in DBS if the parcellations are used as targets during surgery. Clin. Anat. 29:481–492, 2016. © 2016 Wiley Periodicals, Inc.     

神经导航引导经皮穿刺三叉神经半月节射频热凝治疗三叉神经痛的研究

目的 探讨神经导航引导下经皮穿刺三叉神经半月节射频热凝术在治疗三叉神经痛中的应用.方法 选取我科神经导航引导下经皮穿刺三叉神经半月节射频热凝治疗的156例患者资料.所有患者术前均经头部3D-CT薄层连续平扫,并将影像资料导入SteahhStation Tria Plus手术导航系统,图像经三维重建后,确认患侧卵圆孔作为靶点,在导航实时引导下进行卵圆孔穿刺,并行电生理测试,再次确认靶点的位置无误后,进行射频热凝治疗.结果 所有患者顺利穿刺成功,射频热凝术后,患者原有的面部疼痛均明显缓解或消失,术前患者VAS评分为9.67±0.47,术后VAS评分为0.22±0.57,差异有明显的统计学意义,且所有患者术后均无严重并发症.结论 神经导航引导下经皮穿刺三叉神经半月节射频热凝术是一种微创,安全和疗效显著的三叉神经痛外科治疗手段.     

Clinical use of a neuronavigation system in hemangioblastoma resection of posterior cranial fossa

Abstract

The aim of this study was to retrospectively evaluate the effectiveness of the Stryker Leibinger neuronavigation system in surgical resection of hemangioblastomas of the posterior fossa. The study included 16 cases of solid hemangioblastoma of posterior cranial fossa treated since we began using Stryker Leibinger neuronavigation system-assisted microneurosurgery in 2003. These cases were compared on the basis of time, blood loss, and complications to 19 similar cases of solid hemangioblastoma that underwent conventional microneurosurgical resection prior to 2003. All patients in the experimental (neuronavigation-assisted) group underwent surgical resection without complications while the control groups' resections all involved blood loss related to the longer operation time. Neuronavigation also resulted in a clear field of surgical vision and clear lesion boundaries, making it easier to remove lesions and reduce accidental injury of adjacent normal structures. The application of navigation technology is very valuable for solid hemangioblastoma operations not only by shortening operative time, thereby significantly reducing operative blood loss, but also by making surgical excision easier, reducing damage to adjacent normal structures, and decreasing surgical complications and mortality.