内窥镜下侧脑室前角手术入路的应用解剖

目的 :为临床开展神经内窥镜下的侧脑室手术提供应用解剖学资料。方法 :对 2 1例成人尸头标本进行前角入路侧脑室的解剖观测 ,并对 9具新鲜尸头分别进行内窥镜下眉上前额入路及冠状缝前入路的解剖学观察。结果 :侧脑室前角、前下角到室间孔距离为 (3 0 .5± 2 .4)mm、(9.9± 2 .1)mm ,室间孔长、宽径为 (5 .4± 1.2 )mm、(2 .7± 0 .9)mm ,侧脑室在前角、室间孔以及侧脑室体中部的顶宽及内、外壁高度分别为 (18.7± 3 .1)mm、(15 .1± 3 .5 )mm、(2 4.0± 4.6)mm和 (16.0± 1.8)mm、(14 .0± 1.9)mm、(2 3 .1± 2 .5 )mm以及 (12 .1± 1.7)mm、(8.9± 1.3 )mm、(15 .2± 1.6)mm ,眉上及冠状缝前穿刺点到脑室、室间孔距离分别为 (2 9.5± 2 .5 )mm、(5 5 .3± 2 .6)mm和 (2 8.4± 2 .8)mm、(5 4.4± 3 .0 )mm。前额眉弓上入路及冠状缝前入路内窥镜下均可看清前角及体部结构 ,但硬镜下后者操作空间稍小 ,而软镜甚至可看清三角部结构。结论 :在内窥镜下前角入路进行侧脑室手术有一个理想的操作空间。     

内窥镜下经鼻蝶切除垂体瘤鞍区应用解剖

目的 :为临床开展神经内窥镜下经鼻蝶切除垂体腺瘤提供解剖基础。方法 :对 2 5例成人头部固定标本进行蝶鞍区的解剖测量 ,并对 9具新鲜尸头进行内窥镜下经鼻蝶至蝶鞍的解剖观察。结果 :鞍膈高度(5 .5± 0 .6)mm ,鞍膈孔前后径 (6.2± 1.3 )mm ,鞍膈孔左右径 (6.5± 1.5 )mm ,鞍膈孔前缘到鞍结节 (3 .4± 1.3 )mm ,鞍膈孔前缘到垂体柄 (2 .5± 1.1)mm ;视神经出视神经颅口宽 (5 .0± 0 .4)mm ,两侧内缘间距 (13 .7±2 .3 )mm ,视交叉前缘距视神经间沟中点 (6.8± 1.3 )mm ,视交叉宽 (11.5± 1.4)mm。结论 :神经内窥镜下经鼻蝶切除垂体腺瘤应熟悉蝶鞍底及窦内的解剖标志 ,并充分利用鞍膈等解剖结构有序地做肿瘤切除。     

神经内镜下侧脑室手术入路的应用解剖

目的研究神经内镜下侧脑室、第三脑室的重要解剖学结构,为神经内镜下治疗脑室病变提供应用解剖学基础。方法对10具成人尸头分别采用冠状缝前侧脑室前角、三角区及后角3种入路在神经内镜下观察脑室结构并测量数据。结果 (1)侧脑室前角入路可清晰显示侧脑室前角和体部,室间孔的Y形结构,且可以通过室间孔进入第三脑室。(2)冠状缝前穿刺点到侧脑室、室间孔距离为(28.7±2.6)mm、(55.1±2.8)mm,侧脑室前角到室间孔距离为(30.8±2.3)mm,室间孔长、宽径为(5.6±1.4)mm、(3.2±1.1)mm,中间块长径、宽径为(6.3±1.8)mm、(3.4±1.2)mm。(3)侧脑室后角及三角区入路可以观察到侧脑室体部结构及脉络丛。结论 (1)冠状缝前侧脑室前角入路是处理侧脑室、室间孔区及第三脑室病变的理想入路;(2)侧脑室后角入路是治疗侧脑室后角及三角区病变的理想入路;(3)侧脑室三角区入路应用价值低。     

内窥镜下侧脑室后角手术入路的应用解剖

目的 :为临床开展神经内窥镜下的侧脑室手术提供解剖学资料。方法 :对 2 1例成人头部防腐标本进行经后角入路侧脑室的解剖观测 ,对 9具新鲜尸头在神经内窥镜下进行后角入路侧脑室的解剖学观察。结果 :侧脑室后角到前角、颞角及室间孔的距离分别为 (86.0± 6.9)mm、(5 9.5± 6.7)mm、(5 7.3±5 .4)mm ,侧脑室三角部脉络丛球到室间孔距离为 (4 0 .5± 2 .3 )mm ,脉络丛球与室间孔之间侧脑室底弓形隆起的高度为 (9.9± 1.6)mm ,三角部的最大宽度 (9.1± 2 .1)mm ,三角部上、下方宽度分别为 (8.5± 2 .0 )mm、(9.3± 1.8)mm。神经内窥镜进行侧脑室后角入路手术时 ,硬镜下可看清侧脑室三角部及体部的后半部分 ,而软镜甚至可看清室间孔及前角结构 ,颞角结构硬镜下观察困难 ,软镜可看清局部结构。结论 :内窥镜下后角入路侧脑室手术可有一个理想的侧脑室后半部分的操作空间。     

中间块的观察和测量

中间块位于第三脑室,连接左右背侧丘脑,在X线和CT诊断方面是重要的标志。本文采用40例成人和25例小儿(0-1岁)的完整脑标本进行研究,其中43例脑是剖颅取得的。(一)中间块的出现率:在65例脑中,59例(91%)出现中间块,6例(9%)缺如。40例成人脑出现35例(88%),25例小儿脑出现24例(96%)。(二)中间块的形态:沿大脑纵裂和两侧小脑半球之间的裂隙,作脑的正中矢状切面。中间块断面呈椭圆形,长轴由前上方斜向后下方。35例成人中间块的长度为1.77±1.11mm,断面长径(断面长轴的长度)7.59±1.76mm,宽径4.59±1.15mm;24例小儿中间块的长度为1.41±0.67mm,断面长径6.98±1.92mm,宽径4.18±1.14mm。在3例脑,两侧背侧丘脑紧密相贴,中间块很短,断面长径和宽径较大,丘脑下沟     

神经内镜下经纵裂胼胝体侧脑室入路的应用解剖

目的　为临床开展神经内镜下经纵裂胼胝体侧脑室入路到达侧脑室及第三脑室手术提供应用解剖学基础。 方法　对10例成人尸头标本经纵裂胼胝体前部侧脑室入路在神经内镜下观察侧脑室、第三脑室结构并测量数据。 结果　（1）胼胝体厚度(6.1±1.2)mm,室间孔长、宽径为(5.6±1.4)mm、(3.0±　1.6)mm,中间块长、宽径（6.3±1.8）mm、（3.4±1.2）mm;（2）冠状缝前5cm引流静脉很少;（3）神经内镜观察侧脑室前角、侧脑室体部及室间孔的Y形结构,且可以通过室间孔进入第三脑室,进行较好的暴露和观察;（4）胼胝体切开1.5 cm,硬质内镜操作空间和观察范围受限,胼胝体切开2.0 cm时,适合神经内镜操作和观察。 结论　经纵裂胼胝体前部侧脑室入路按生理间隙进入,操作距离短,内镜直接指向室间孔,可同时显露对侧脑室,是处理双侧脑室、室间孔区及第三脑室病变的理想入路。     

确定脑连合间径的辅助标志—中间块

作者在30个脑标本上观察到:①中间块的出现率为80.0±7.3％;②其大小为5.6±1.1mm×3.6±0.8mm;③它的下缘位于连合间径上方0.9±0.9mm,两者相关不显著,④它的后缘位于通过原点的垂直轴后方0.3±0.1mm,两者呈负相关,直线回归方程为Y=2.51—0.50Xmm;⑤原点的位置约居第二脑室高的上3/4与下1/4交界处稍上方、两者呈正相关,直线回归方程为Y=1.37+0.64Xmm。据此,作者认为中间块可用来作为确定前后连合间径的一个辅助标志。     

经穹隆间第三脑室底锁孔入路的显微解剖

目的 探索经穹隆间第三脑室底锁孔入路的可行性和手术方法。 方法 设计经穹隆间第三脑室底锁孔入路(第三脑室底切口起自灰结节向后,经乳头体间,止于后穿质)。运用解剖学方法在导航辅助下在16例尸头标本上模拟经穹隆间第三脑室底锁孔入路手术,在手术显微镜下对手术显露进行观察,利用导航作解剖学测量。 结果 导航辅助下能顺利完成16例尸头标本的经穹隆间第三脑室底锁孔入路手术。冠状缝与矢状缝交点到室间孔上缘、丘脑间黏合、乳头体和中脑导水管上缘的距离分别为（68.4±4.6）mm、(66.3±6.0)mm、(86.3±5.3)mm、(82.0±7.6)mm,冠状缝与矢状缝交点到基底动脉末端分叉的操作距离为(91.8±5.0)mm。灰结节向后经乳头体间止于后穿质切开第三脑室底可获得长（9.5±2.6）mm的手术通道。术中经第三脑室底切口能清晰显露脚间池内的基底动脉末段、大脑后动脉P1段、P2段、小脑上动脉、后交通动脉以及它们的穿通支血管。向前解剖Liliequist膜可显露斜坡和鞍背,侧方可显露出动眼神经,向后显露出脚间窝。基底动脉末端分叉多偏于左侧（68.8%）,两侧大脑后动脉多向前外侧斜行（68.8%）。大部分大脑后动脉夹角上有1～4支小穿支血管自基底动脉末端分出。 结论 经穹隆间第三脑室底锁孔入路在技术上可行,深入研究可望应用于基底动脉末端动脉瘤的直接手术。     

大脑原点与第三脑室立体空间的关系

本文以前、后连合间径、大脑原点为标志,在第三脑室内建立三维坐标系统,以此坐标系统为基准、观测第三脑室的大小,第三脑室范围内一些主要径线与大脑原点关系的正常数值,探索大脑原点在第三脑室立体空间的具体位置。观察结果说明:①第三脑室长度与前后连合间径成7.15°夹角。②室间孔—松果体隐窝间径与前、后连合间径成10°夹角。③前,后连合间径与听视线(CM线)呈小锐角、以相差7°～8°为多数。④大脑原点位第三脑室高度的上4/5与下1/5交界处的部位。     

第5腰椎横突肥大综合征的解剖学研究

目的 为第5腰椎横突肥大综合征提供解剖学基础.方法 用第5腰椎、骶骨各390块,测量第5腰椎横突、椎间孔的上下径和前后径.结果 第5腰椎横突正常上下径为13.3±2.6mm,前后径12.4±2.5mm正常椎间孔前后、上下径.第5腰椎肥大的横突上下径为20.9±2.4mm,前后径30.9±3.3mm.第5腰椎横突肥大L5～S1椎间孔的前孔,左侧:上下径11.5±4.3mm,前后径10.5±2.7mm;右侧:上下径10.2±4.5mm,前后径9.6±3.0mm.结论 第5腰椎横突肥大,可引起L5～S1椎间孔的前孔狭窄,累及第5腰神经,为腰腿痛的原因之一.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The Beauty of the Network in the Brain and the Origin of the Mind in the Control of Behavior

Behavior is not adequately described as a stimulus-response process. It is initiated by the animal and is generated because of its expected outcome in the future. The outcome can be good or bad for the animal. The brain is in charge of the selection process. This is the basic function of the brain. Taking Drosophila as a study case, this paper discusses initiating activity, several examples of outcome expectations, trying out (the internal search for a suitable behavior), chaining of actions, and the functional roles of chance in action selection. It takes mental processes and states such as goals, intentions, feelings, memories, cognition, and attention as higher levels of behavioral control that have their origin in biological evolution.     

Adequate function of the cell: Interactions between the needs of the cell and the needs of the organism

The continuous maintenance of cell adequate function (cellular stress) is considered to be the main feature which characterizes the activity of a live cell. In accordance with the concept of cellular stress, the transition of the cell to the state of adequate funcitoning represents a dual commitment. The cell must function adequately to respond to the demands of the organism and to provide for its own needs. Thus, it is proposed that two systems exist for the regulation of the adequate function of the cell: one enabling the cell to respond to the demands of the organism, and the other providing for the needs of the cell itself. The hormonal system of the organism represents the first of these mechanisms, and I believe that another system exists for regulation of intracellular needs. Adequate function of the cell is determined by the regulative, controlling and defense mechanisms. The balance between the needs of the cell and of the organism should be a concern of physician, since it provides for the optimal function and health of the organism as a whole.     

On the development of the sympathetic chain and the adrenal medulla in the mouse

Summary The first visible primordia of the sympathetic chain appear in the anterior thoracic region and run caudally through 8 segments in an embryo of 11 gestation days. At 12 gestation days the trunk reaches from the base of the skull into the sacral region. During the following days the trunk develops into ganglia with interganglionic fibers.At 16 gestation days there is a well developed trunk with a cranial ganglion cervicale superior and a ganglion stellatum in the anterior part of the thoracic region. In the remaining sympathetic chain there are segmentally arranged ganglia but in this common pattern large differences are noticed.At the 13th gestation day the first signs of the adrenal medulla and the splanchnic plexus appear in the form of sympathoblasts ventral to the sympathetic chain. The migration of sympathoblasts into the primordia of the adrenal cortex goes on for 3 days while the migration to the splancnic plexus in the mesenchym ventral and lateral to the aorta goes on at least 2 more days.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.     

On the musculature of the gastro-intestinal tract of the guinea-pig

Summary The small intestine, caecum, colon and part of the stomach of guinea-pigs were studied by light microscopy, using semithin sections of plastic embedded specimens. The muscular coat is thicker in the duodenum than in the rest of the small intestine. The ratio between longitudinal and circular muscle is 1:4.6 in the duodenum and it increases regularly along the small intestine, to reach 1:2 in the terminal ileum. In the caecum, shape and sectional area of the muscle tissue were analyzed along the full length of the taeniae. In the caecal circular muscle there is a characteristic change in the arrangement of the muscle bundles from the regions in the centre of the haustrations to the regions of the grooves between haustrations or to those lying beneath a taenia. The functional significance of the taeniae is discussed in terms of an arrangement allowing reduction of the lumen of the organ (which at the level of the grooves between haustrations acquires a triangular outline) more efficiently than if the longitudinal musculature were spread over the entire surface of the organ. Haustrations are present also on one side of the wall of the ascending colon where there is no longitudinal muscle layer. In the descending colon the structure of the wall is examined in different functional states, namely in the regions between fecal pellets (constricted regions) and in the regions around a fecal pellet (moderately distended regions). The musculature increases considerably in thickness in the constricted regions (both muscle layers being actively contracted), while the mucosa and submucosa are thrown into prominent longitudinal folds. These folds produce occlusion of the lumen when the circular muscle has shortened by about 50%.     

On the origin of the corticotectal projections in the cat

Summary Stereotaxic injection of horseradish peroxidase into the superior colliculus produced retrograde labelling of layer V pyramides in the Clare Bishop area and the lateral bank of the suprasylvian sulcus, in area 17,18 and 19. Single labelled cells were also found scattered in the splenial, the suprasplenial, the lateral and the suprasylvian gyri. In the cruciate sulcus no labelled cells were observed. Autoradiographically, the lateral bank of the suprasylvian sulcus was also shown to give rise to fibres to the superior colliculus.