颅中窝脑静脉的显微解剖与影像学观察

目的通过颅中窝脑静脉的显微解剖、影像学观察及其对照研究,为经翼点和经眶颧手术人路中脑静脉的保护提供形态学基础。方法分别对30例（60侧）颈内静脉灌注蓝色乳胶的成人尸头湿标本、36例（60侧）DSA静脉相、25例（50侧）CT静脉造影（CTV）和25例（50侧）MR静脉造影（MRV）图像进行观测。结果以显微解剖观测结果作为评价标准,DSA、CTV和MRV分别能够观察到70％、52％和42％的颅中窝脑静脉;根据颅中窝静脉注入硬脑膜窦处位置的不同,其分为海绵窦型、蝶顶窦型、蝶岩窦型和岩上窦型,各型脑静脉能被影像学手段区分;影像学观测到的大脑中浅静脉数目和分型与显微解剖相比较,差异无统计学意义。结论术前影像学检查有助于经翼点和经眶颧手术入路的设计和术中脑静脉的保护。     

Regions with different evoked frequency band responses during early-stage visual processing distinguish mild Alzheimer dementia from mild cognitive impairment and normal aging

Although diagnostic procedures have been developed for detection of mild cognitive impairment (MCI) and mild Alzheimer dementia (AD), more valid noninvasive tools are needed. In this work, we apply a procedure based on the evidences that different evoked frequency band responses may emerge from different sources during early-stage visual processing in a mental state-specific manner, while subjects were passively viewing a visual stimulus. In this case, spatial differences should arise across mental conditions such as mild Alzheimer dementia, mild cognitive impairment, and normal aging. With the use of EEG source image we found three different neural patterns in aged individuals: (1) left hippocampus and midbrain in mild AD, (2) left lateral orbitofrontal gyrus, left nucleus accumbens, caudate nucleus, thalamus, posterior cinguli, right precuneous, right superior parietal lobe in MCI, and (3) right lateral-medial orbitofrontal gyrus, caudate nucleus, thalamus, right lateral occipitotemporal gyrus in elderly controls. Although preliminary, these results show remarkably robust differences that distinguish between an age-matched control group, a group with MCI, and a group with mild AD. Because the method applied in this work differentiates among clinical entities with varying severity of cognitive decline, it may eventually serve as an electrophysiological marker in the early detection of neurodegeneration.     

运用动脉自旋标记技术研究大脑中针刺效应的展望

动脉自旋标记(ASL)灌注成像是以动脉血作为内源性示踪剂、无创性观测血流灌注情况的磁共振检查新技术。它可对局部脑血流量(rCBF)进行绝对测量,弥补由于BOLD信号低所致结果可重复性差的缺陷,交叉验证当前针刺效应研究中BOLD–fMRI成像结果,使研究结论更具推广意义,为无创、实时、可视化地研究人脑中针刺效应提供了新的手段。本文对ASL技术的成像原理、应用于中枢神经系统的现状、与BOLD–fMRI技术的比较、在针刺效应研究方面的应用价值进行了总结。     

神经影像检查的新近进展

叙述有关神经外科影像检查的新方法,如CT、MR I、MEG、PET等及其扩展、派生的技术,对其诊断及评估都是有价值的,但要合理应用而不滥用。     

2型糖尿病认知功能障碍神经影像学研究进展

2型糖尿病(T2DM)认知功能障碍以记忆力下降为主要表现,是T2DM脑损伤的一种表现形式.目前通过神经影像学检查已可直接探测出T2DM患者脑损伤:脑部磁共振平扫发现T2DM患者记忆障碍与脑萎缩 (特别是海马萎缩)有关,通过弥散张量成像(DTI)可发现其存在广泛的脑白质连接异常; 功能性磁共振成像(fMRI)发现其海马和周围的脑区之间连接减少; 脑电图 (EEG)研究发现T2DM患者对刺激信号的反应时间延长、警觉性和注意力明显下降.这些神经影像学研究有助于进一步阐明糖尿病脑病机制.     

慢性进展性大脑中动脉主干闭塞的神经影像和脑血流

目的 探讨慢性进展性大脑中动脉主干闭塞患者的临床、神经影像和脑血流动力学改变.方法 对75例大脑中动脉主干闭塞患者行头颅核磁共振成像、CT和经颅多普勒超声检测.结果 65例（86.7%）出现脑缺血症状及体征.70例（93.3%）头颅核磁共振或CT显示不同类型脑梗死,最常见的是低灌注分水岭梗死和腔隙性脑梗死.60例（80.0%）闭塞侧大脑中动脉深度范围血流速度明显降低,70例（93.3%）闭塞侧大脑前动脉血流速度代偿性增快,45例（60.0%）闭塞侧大脑后动脉血流速度代偿性增快.结论 经颅多普勒超声和神经影像学检查有助于评估慢性进展性大脑中动脉主干闭塞患者的病情发展和预后,为了解颅内侧支循环代偿状况和更深入研究缺血性脑血管病的发病机制提供客观依据.     

针刺足临泣对偏头痛低频振荡振幅的影响

目的：应用功能磁共振明确针刺足临泣对无先兆偏头痛脑功能区域低频振荡振幅的特征性影响。方法：选取2015年1月至2016年2月北京中医药大学东直门医院神经内科和北京中医药大学东方医院针灸科门诊就诊的无先兆偏头痛患者19例作为研究对象，在针刺前后进行静息态功能磁共振成像，匹配的18例健康受试者进行一次无针刺的功能磁共振扫描作为对照。分析偏头痛患者和正常受试者脑功能区的低频振荡振幅值差异以及患者针刺前后低频振荡振幅值的变化。结果：与健康对照组比较，无先兆偏头痛患者低频振荡振幅值显著增强的脑区为海马、海马旁回、右侧颞上回等脑区，显著减弱的脑区为左侧楔叶、顶上回等脑区；与针刺前比较，针刺后低频振荡振幅值显著增强的脑区为右侧中央前回和中央后回，显著减弱的脑区为右侧楔前叶、额中回等脑区；与健康对照组比较，无先兆偏头痛患者针刺足临泣穴后低频振荡振幅值显著增强的脑区为右侧的中央前回、中央后回等脑区，显著减弱的脑区为左侧楔叶、楔前叶等脑区。结论:针刺足临泣穴对无先兆偏头痛多个脑区的功能活动异常的起特征性调节作用，这可能为针刺干预的疗效机制提供功能影像学支持。     

Intracranial intraparenchymal and intraventricular schwannomas: Report of 18 cases

Objective

Intracranial schwannomas of the brain, which are unrelated to the cranial nerves, are extremely rare. In this article, we present a series of eighteen cases of intracranial intraparenchymal and intraventricular schwannomas, which is the largest series to date.

Methods

During the 10-year period from January 2000 to October 2010, we encountered 2491 histologically established cases of intracranial schwannomas, of which only 18 were not related to the cranial nerves. Clinical profiles, radiological features, surgical procedures, intraoperative findings and outcomes were extracted from the patient records and neuroimaging data.

Results

No patients were preoperatively diagnosed with schwannoma. The diagnosis of schwannoma was made by pathological examination with H&E staining and immunohistochemical examination. The 18 cases with intracranial ectopic schwannomas account for 0.8% of all the intracranial schwannomas that were observed within the same time period at our hospital. The age distribution of the patients ranged from 7 to 78 years. There was a slight male predominance: 11 male and 7 female patients (M:F = 1.6:1). Headaches were the most common presenting symptom and were found in most cases. Common neuroradiological characteristics included peritumoral edema and intralesional cysts.

Conclusion

Intracranial intraparenchymal and intraventricular schwannomas are rare, benign neoplasms that cannot be preoperatively differentiated from other parenchymal tumors. Surgical excision is curative, and the long-term prognosis is good. Additional studies are needed to confirm the histogenesis of this schwannoma type.