Spetzler-Martin Ⅲ级以上脑动静脉畸形综合治疗的临床研究

目的 探讨Spetzler-MartinⅢ级以上脑动静脉畸形（AVM）综合治疗的疗效。方法 回顾性分析1998年10至1999年4月采用血管内栓塞联合显微手术或立体定向放射治疗的9例Spetzler-MartinⅢ级以上脑AVM的临床资料。结果 9例脑AVM经血管内栓塞治疗后完全栓塞2例。大部栓塞2例，不全栓塞5例。其中4例栓塞后行手术切除，无死亡及手术所致并发症。5例栓塞后接受立体定向放射治疗，随访22-28个月，经MRI和MRA检查提示AVM闭塞3例。缩小2例；5例患中临床症状恢复良好4例，中度致残，生活能自理1例，无再出血和死亡病例。结论 血管内栓塞联合显微手术或立体定向放射外科是治疗Spetzler-MartinⅢ级以上脑AVM的最佳手段。     

儿童脑动静脉畸形急性出血40例临床分析

目的探讨儿童脑动静脉畸形急性出血的临床特点、治疗方法及预后。方法对厦门大学附属中山医院神经外科2006年1月—2016年1月收治的40例儿童脑动静脉畸形急性出血患儿的发病特点、临床表现、影像学特点、手术方法及预后进行分析。结果本组患儿中,以9～11岁患儿的比率最高(14例,35. 0%);男女比例为1. 56∶1。根据患儿脑血管造影的Spetzler-Martin分级采取不同的手术治疗方式,SpetzlerMartinⅠ-Ⅱ级者可选择3种手术方式:单纯手术切除、介入栓塞或伽玛刀手术; Spetzler-MartinⅢ-Ⅳ级者,脑内畸形血管团直径大于4 cm或有多支动脉供血者优先选择介入栓塞,然后二期清除颅内血肿并切除脑动静脉畸形。结论早期确诊,根据Spetzler-Martin分级采取不同手术治疗方式,预防脑动静脉畸形再出血,防治癫痫及早期恢复神经功能可以有效改善儿童脑动静脉畸形出血的预后。     

在复合手术室治疗脑动静脉畸形的初步探讨

目的 总结在复合手术室治疗脑动静脉畸形的经验。方法 2013年12月至2014年12月在复合手术室治疗27例脑动静脉畸形患者,均行手术切除,术中造影判断畸形团是否残留,其中3例一期行切除术和血管内栓塞术。结果 27例中,4例（14.8%）术中血管造影显示畸形团残留,再次切除后行术中造影,显示畸形团消失;一期行切除术和血管内栓塞术3例（均为Spetzler-Martin分级Ⅲ级以上）,术中出血明显减少,均完全切除畸形团。所有患者无造影相关的并发症。术后24例随访6个月至1年,失访3例;其中19例恢复良好,5例有轻度神经功能障碍。结论 在复合手术室治疗脑动静脉畸形能够提高疗效,降低手术相关并发症,为脑动静脉畸形治疗提供了一个新的安全有效的平台。     

脑动静脉畸形手术治疗与血管内栓塞治疗

目的通过对81例脑动静脉畸形(AVM)患者分别进行直接手术切除和血管内栓塞治疗的总结,探讨AVM治疗手段的可行性和有效性。方法(1)直接手术23例,均为AVM合并脑内血肿而行急诊开颅血肿清除术 AVM切除术。(2)58例行血管内超选择栓塞术(NBCA胶),栓塞前行二维或三维DSA检查。结果直接手术组,术后复查头部MRI或DSA示病灶全切除12例,部分切除6例并在术后联合血管内栓塞达到痊愈,治愈率52.2%,病残率26.1%,死亡率21.7%。血管内栓塞组,以最后一期栓塞后的DSA资料统计栓塞程度,有49例达到完全栓塞,8例畸形血管团减少50%以上,1例减少50%以下。结论对脑AVM破裂出血且危及生命的应行急诊开颅血肿清除术并尽可能切除畸形血管团。小型AVM、单支供血AVM或Spetzler-Martin分级Ⅲ级以下的病例,追求一期完全栓塞是有可能的;Ⅲ级以上的脑AVM,采用分次、分期血管内栓塞可减少并发症和明显改善症状。因此,治疗脑AVM手段的选择应根据患者的具体情况而定。     

复杂脑动静脉畸形的显微外科手术治疗效果分析

目的 探讨显微外科手术治疗复杂脑动静脉畸形的诊治要点。方法 回顾性分析苏州大学附属第一医院神经外科2011年1月—2021年1月通过单纯显微手术切除及复合手术治疗的38例复杂脑动静脉畸形患者的临床资料,根据Spetzler-Martin分级,Ⅲ级24例,Ⅳ级9例,Ⅴ级5例。畸形血管团平均大小为5.9 cm(3.5～12.3 cm),位于功能区27例,非功能区11例,术前行CTA、DSA及MRI检查,术后行CT、CTA或DSA检查,定期随访,格拉斯哥预后评分(GOS)评价神经功能障碍。结果 所有患者中,28例接受介入加手术综合治疗,10例接受单纯显微手术切除。术后影像学示,35例(92.1%)全切,3例(7.9%)较术前明显缩小。术后随访6～79个月,其中恢复良好34例(GOS=4～5分),中度残障2例(GOS=3分),重度残障1例(GOS=2分),死亡1例(GOS=1分)。结论 显微外科手术切除是治疗复杂脑动静脉畸形的有效方法之一,通过和血管内介入栓塞紧密结合,加之术前精准影像学评估,术中导航、荧光血流监测技术的应用及术中科学的显微操作,均是手术成功的关键。     

深部脑动静脉畸形的显微手术治疗

目的 探讨深部脑动静脉畸形(BAVM)的显微手术技巧及效果. 方法 吉林大学中日联谊医院自2001年1月至2008年6月对收治入院的70例深部BAVM患者采用显微手术治疗,其中70例患者脑部畸形血管团属小型(直径＜3 cm)31例,中型(直径3～6 cm)36例,巨大型(直径＞6 cm)3例;按Spetzler-Martin分级:Ⅰ级11例,Ⅱ级12例,Ⅲ级23例,Ⅳ级16例,Ⅴ级8例,对术中的显微手术技巧及术后疗效进行总结分析. 结果 70例患者深部畸形血管团术中均完整切除,27例复查MRI、8例复查DSA证实.1例Spetzler-MartinⅤ级患者术后发生正常灌注压突破.所有患者随访6个月～3年,均无复发及再次出血.8例术前脑疝患者术后3例重残,2例中残,3例生活能自理.10例癫痫患者术后服用抗癫痫药物症状得到控制.余患者术后未遗留明显神经功能障碍. 结论 深部BAVM血管构筑复杂,手术全切除最为彻底.高流量BAVM行术前栓塞及口服β受体阻滞剂,术中降低动脉压、延长麻醉苏醒时间,术后减少液体摄入及应用脱水疗法,可降低正常灌注压突破的发生率.     

复合手术在脑动静脉畸形治疗中的应用

目的 总结一站式复合手术在治疗脑动静脉畸形中的临床经验。方法 回顾性分析2014年4月至2017年11月采取复合手术治疗的24例脑动静脉畸形的临床资料,术前Spetzler-Martin分级Ⅲ级8 例,Ⅳ级14例,V级2例。14例术中先做治疗性供血动脉栓塞再进行手术切除,另10例直接行手术切除;全部病人均在切除病灶后行术中造影以评估切除程度。结果 24例畸形血管团全切除。20例术后恢复良好,4例术前昏迷病人术后意识障碍改善。没有死亡病人,未发生与介入相关的并发症。24例术后随访6个月至2年,16例行DSA、8例CTA检查;除1例存在部分病灶残留外,其余23例均无病灶残留或复发;日常生活能力分级Ⅰ级16例,Ⅱ级2例,Ⅲ级2例,Ⅳ级4例。结论 复合手术为脑动静脉畸形提供了一个新的外科治疗方案;该技术可简化多次介入以及显微手术的治疗过程,并且能够实时地对切除情况进行精准地评估,是一项安全有效的治疗方式。     

血管内栓塞治疗脑动静脉畸形的临床分析

目的探讨血管内栓塞治疗脑动静脉畸形的技术特点和临床治疗效果。方法经股动脉入路,将微导管头端进入畸形血管团内,缓慢注射Onyx栓塞剂。结果 23例脑动静脉畸形团直径在3.5～11cm,参与供血的小动脉1～4支,栓塞后畸形血管团完全消失者10例,血管团明显变小、瘘口消失、栓塞体积>60%者9例,<60%者4例。栓塞时间持续30～90min(平均50min),Onyx用量2～9.5mL(平均7mL),对未能完全栓塞的13例患者,建议配合立体定向放射治疗。术后24h内脑出血3例,术后住院期间出现脑梗死2例。结论血管内栓塞治疗脑动静脉畸形安全有效,可使部分Spetzler-Martin分级Ⅰ、Ⅱ级的患者达到完全栓塞的治愈效果,未能完全栓塞者也能为手术或立体定向放射治疗创造条件,扩展了可治愈病例的范围。     

幕上大中型脑动静脉畸形的显微外科治疗

目的总结幕上大中型脑动静脉畸形(AVM)的手术治疗经验,探讨其处理策略和手术治疗要点。方法对我科收治的72例幕上大中型脑AVM进行回顾性总结。按照Spetzler-Martin分级系统,Ⅱ级30例,Ⅲ级24例,Ⅳ级16例,V级2例。均经脑血管造影证实和显微手术切除,其中8例行术前栓塞。结果本组72例的畸形血管团均被全切除,无手术死亡。3例因术后术野出血再次手术,共12例出现新增神经功能障碍。51例获得随访,术前癫痫者18例中11例消失;术前无癫痫史者,33例中7例出现癫痫。结论在作出AVM的治疗决定时,既要考虑患者方面的因素也要考虑医生方面的因素,包括患者年龄、临床状况和Spetzler-Martin分级以及治疗小组的技术能力。我们认为,显微手术切除是大中型AVM的最主要和最有效的治疗手段;对有些大型AVM患者来说,术前栓塞是有帮助的。     

Onyx胶栓塞脑动静脉畸形31例

摘要 背景：在脑动静脉畸形的血管内栓塞治疗中,栓塞材料的选用在很大程度上决定血管内栓塞治疗的效果。Onyx胶是近年研制的一种新型液体栓塞剂,具有不粘管、弥散均匀及可控性好等优点。 目的：总结新型液态栓塞剂Onyx胶栓塞脑动静脉畸形31例的技术要点和临床疗效。 方法：应用Onyx胶栓塞脑动静脉畸形31例,均采用Seldinger技术在股动脉内置入6F动脉鞘,6F导引导管插入颈内动脉或椎动脉,Marathon微导管超选择进入畸形血管团内,采用“注胶-返流-停止-再注胶”技术长时间缓慢注射Onyx胶栓塞脑动静脉畸形。 结果与结论：栓塞后脑动静脉畸形闭塞40%~60% 8例,60%~90% 7例,90%以上(完全栓塞)16例。未能完全栓塞的15例中,4例接受手术治疗,其中3例痊愈,1例单侧肢体乏力,肌力Ⅳ级;6例患者术后辅以伽玛刀治疗,其中2例1年以后复查DSA显示脑动静脉畸形完全闭塞。提示Onyx可提高脑动静脉畸形的栓塞效果,但应正确采用栓塞技术和注意预防并发症。 关键词：动静脉畸形;Onyx胶;血管内栓塞治疗;并发症;生物材料 doi:10.3969/j.issn.1673-8225.2011.12.024     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

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     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.