酒精保存的硬脊膜桥接周围神经缺损的实验研究

本文报道用酒精保存的异体硬脊膜桥接大鼠10mm坐骨神经缺损,术后1～4个月行光镜、电镜、电生理、计算机图像分析等检测证实,异体硬脊膜能成功地修复10mm的大鼠坐骨神经缺损,再生神经成熟良好,恢复传导功能,其修复神经缺损的效果明显优于带蒂的骨骼肌桥接,硬脊膜能较快地被宿主组织取代而与神经外膜无明显分界。异体硬脊膜有可能作为新的神经修复材料而应用于临床。     

狗神经异体移植实验

文献报道异体神经用降低抗原性的方法处理后移植，轴突可以再生，所用方法有酒精浸泡、冻融、冷冻等［１３］，但这类实验中移植段不超过３ｃｍ，更长的移植段是否行尚不清楚。本实验研究狗５ｃｍ坐骨神经异体移植的效果，神经处理方法是冻融或加免疫抑制剂浸泡。材料和方法选用２１只成年杂种狗分５组，每只狗一侧坐骨神经进行移植，另一侧做正常对照。（１）自体移植，３只狗，把切除的５ｃｍ坐骨神经原位缝合；（２）异体未处理神经移植，３只狗，移植则仅从只１只狗取下的坐骨神经；（３）异体冻融处理神经移植，５只狗，神经取下浸入…     

不同种类的硬脊膜修复周围神经缺损的比较研究

为进一步探讨保存的硬脊膜修复周围神经缺损的可行性,本文报道两组大鼠10mm坐骨神经缺损,分别用同种和异种硬脊膜桥接修复,术后2、4个月的光镜、电镜、电生理、计算机图像分析等指标显示,两种硬脊膜修复周围神经缺损的效果差异无显著意义,异种硬脊膜早期炎症反应稍重,新形成的神经外膜较厚。     

雪旺氏细胞植入硬脊膜管修复周围神经缺损的实验研究

本文报道两组10mm大鼠坐骨神经缺损,分别用含雪旺氏细胞和不含雪旺氏细胞的硬脊膜管桥接修复,术后2、4个月行光镜、电镜、神经电生理和计算机图像分析检测,证实植入雪旺氏细胞者,再生神经生长及成熟较早,肢体功能恢复较快,雪旺氏细胞和硬脊膜管结合,对周围神经再生有更大的促进作用。     

受体血浆冷存异体神经桥接神经制损的形态学研究

目的 研究用受体血浆冷冻处理的异体神移植,以提高神经再生效果。方法 选用１６条家铬的双侧正中神经（３２条）,作成双侧正中神经缺损３ｃｍ的模型。（１）实验组：左前肢用受体血浆冷冻处理的同种异体神经缝接于神经缺损处。（２）对照组：右肢缺损处用冷冻处理的同种异体神经桥接。两组于术后７、２１、９０、１８０ｄ不同时间点,分别进行组织学观察和图像分析仪测定。结果 术后随时间的延长,实验组社经纤维再生数量明显较     

非神经组织桥接神经缺损的远期观察

对非神经组织桥接周围神经缺损的疗效进行远期观察．共治疗７例８条神经，正中神经３条，桡、尺神经各２条，胫神经１条。缺损长度为３～６ｃｍ，均采用非神经组织桥接。全部得到５～７年的随访，膜类管状物桥接的２条疗效优良，带蒂骨骼肌桥接的６条神经疗效差，这和肌细胞的组织结构可能阻止再生轴突的生长有关．我们认为膜类管状物桥接疗效较骨骼肌为好．     

骨骼肌包埋自体神经片段修复周围神经缺损的实验研究

作者设计用骨骼肌包埋自体神经片段修复周围神经缺损，试图克服单纯骨骼肌修复神经缺损中缺乏雪旺氏细胞的不足．选实验用大白鼠４０只．随机分成Ａ、Ｂ两组，每组２０只．造成坐骨神经缺损２ｃｍ，分别用骨骼肌包埋自体神经片段及单纯骨骼肌桥接．经２个月大体观察、镜下观察及电生理测定，证实骨骼肌包埋自体神经片段修复周围神经缺损所再生的神经纤维在直径、髓鞘厚度、数量及运动神经传导速度等方面均优于单纯骨骼肌桥接．     

异体硬脊膜修复指屈腱鞘的实验研究

为探讨应用异体硬脊膜及透明质酸钠对肌腱愈合及粘连的影响,我们设计了本实验研究。结果证实,异体硬脊膜与透明质酸钠联合应用组,术后无肌腱粘连;疗效明显优于异体硬脊膜组和透明质酸钠组。一、材料与方法１．动物与分组：取大白兔４８只,体重为２．５～３．５ｋｇ。...     

保存硬脊膜修复周围神经缺损的进一步研究

保存硬脊膜修复周围神经缺损的进一步研究黄德清，候春林，张文明，贾连顺用保存的硬脊膜修复周围神经缺损已取得初步结果［１］，为进一步确定硬脊膜合适的保存方法，本文进行了研究。材料和方法ＳＤ大鼠４５只，随机分为３组，每组１５只，戊巴比妥钠腹腔麻醉，将大鼠左...     

自体、异体雪旺细胞及其培养液植入羊膜基底膜修复神经缺损的比较研究

目的比较自体雪旺细胞（Ｓｃｈｗａｎｎｃｅｌ,ＳＣ）、异体ＳＣ、ＳＣ培养液对周围神经损伤后的再生作用。方法取４０只ＳＤ大鼠,将其坐骨神经切除１ｃｍ造成神经缺损。用羊膜基底膜桥接后,分成４组,在羊膜基底膜管中分别植入：（１）自体ＳＣ;（２）异体ＳＣ;（３）ＳＣ培养液;（４）生理盐水,为对照组。术后１个月和３个月,各组分别进行神经－肌电图和组织学观察。结果术后３个月,自体ＳＣ组、ＳＣ培养液组的运动神经传导速度比术后１个月增快１２．１％、１１．２％;运动诱发电位波幅比术后１个月增高１４．９％、４．７％;而异体ＳＣ组和对照组则呈下降趋势。组织学发现：术后１个月４组均有神经轴突长过桥接段。术后３个月自体ＳＣ组、ＳＣ培养液组神经纤维数量增多、轴突直径增粗、髓鞘形成较好。结论自体ＳＣ和ＳＣ培养液对周围神经的再生有很好的促进作用。机体对异体ＳＣ会产生排斥反应,暂不宜采用。     

保存硬脊膜预防椎管内术后粘连的实验研究

28只大白兔随机分为实验和对照2组,均切除L5椎板,造成12mm×5mm的硬膜囊裸露区后,实验组用酒精保存的同种异体硬脊膜覆盖,对照组不用任何间置物覆盖、术后2、4、8、12周时进行肉眼及光镜观察,8周时还进行硬膜外粘连等级评定及病理切片的计算机图像分析。结果显示,对照组硬膜外腔消失,逐渐形成致密粘连,实验组硬膜外间隙存在,粘连明显少于对照组,揭示保存硬脊膜可以有效的预防椎管内术后粘连。     

Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations

Facial muscle responses in patients with hemifacial spasm undergoing microvascular decompression operations were recorded. Two peripheral branches of the facial nerve were stimulated and the electrical responses of muscles innervated by these branches were studied to see how the lateral spread of activity that is known to be present in these patients was affected by decompressing the facial nerve. In some of the patients the hemifacial spasm ceased when the dura mater was opened, in some it ceased when the arachnoid was opened, and in others the spasm persisted until the offending vessel was dissected away from the nerve. The lateral spread of activity elicited by antidromic stimulation of a branch of the facial nerve was less affected by opening of the dura mater or arachnoid: it usually persisted until the blood vessel that had been compressing the facial nerve was removed and reappeared when the vessel that had been compressing the facial nerve was allowed to slip back onto the nerve. This seems to indicate that microvascular decompression of the facial nerve is effective in alleviating hemifacial spasm because it removes the actual cause of the disorder rather than simply causing local injury to the nerve as a result of the procedure.     

The innervation of the spinal dura mater: Anatomy and clinical implications

Summary The nerves supplying the spinal dura mater were studied in four human foetuses (16–22 weeks) with the acetylcholinesterasein toto staining method.The ventral spinal dura contains a dense, longitudinally oriented, nerve plexus, which receives its contributions from: (I) the sinuvertebral nerves, (II) the nerve plexus of the posterior longitudinal ligament, (III) the nerve plexus of radicular branches of segmental arteries.Dorsal dural nerves are much smaller in number, do not form an evident plexus and do not reach the medial region of the dorsal dura. The dorsal nerves are derived from the ventral dural plexus at the level of the intersleeval parts of the dura mater.The ventral dural nerves may extend up to eight segments, with a great amount of overlap between adjacent nerves. This may provide an anatomical substrate for the understanding of extrasegmentally referred dural pain. The curled bundles of nerve fibres of pathways (I) and (II) provide an adequate adaptation to displacements of the spinal dura mater during flexion and extension. Pathway (III) has not been described before. The described nerve plexuses may be of importance in elucidating the mechanisms of epidural therapies in back pain and peripheral vascular disease.     

The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy,even after application of autologous fat grafts

A considerable number of patients complain about pain after lumbar surgery. The spinal dura mater has been debated as a possible source of this pain. However, there is no information if laminectomy influences the nociceptive sensory innervation of the dura. Therefore, we quantitatively evaluated the density of SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis in an animal model of laminectomy. Twelve adult Lewis rats underwent laminectomy, in six of them the exposed dura was covered by an autologous fat graft. Further six animals without surgical treatment served as controls. Six weeks after surgery, the animals were perfused and the lumbar dura was processed immunohistochemically for the detection of CGRP- and SP-containing nerve fibers. In controls, the peptidergic nerve fibers were found predominantly in the ventral but rarely in the dorsal dura mater lumbalis. After laminectomy, the density of SP- and CGRP-immunopositive neurons significantly increased in ventral as well as in dorsal parts of the dura. Axonal spines could be observed in some cases at the site of laminectomy. The application of autologous fat grafts failed to inhibit the significant increase in the density of peptidergic afferents. Thus, we have provided the first evidence that laminectomies induce an increase in the density of putative nociceptive SP- and CGRP-immunopositive neurons in the lumbar dura mater ascribable to an axonal sprouting of fine nerve fibers. This effect was not prevented by using autologous fat grafts. It is conceivable that the neuronal outgrowth of nociceptive afferents is a cause of low back pain observed after lumbar surgery.     

Dura-based giant intracranial schwannoma in the middle fossa

A 49-year-old female presented with a rare giant schwannoma arising from the dura mater of the middle fossa manifesting as loss of left visual acuity. Magnetic resonance imaging revealed a heterogeneously enhanced giant mass in the left middle fossa. Surgery via the transsylvian approach confirmed the origin of the tumor between the left internal carotid artery and the trigeminal nerve in the lateral wall of the cavernous sinus. Elongated abducens nerve was confirmed, but no tumor adhesion to the abducens nerve was found. The tumor was closely attached to the dura mater of the middle fossa and the lateral wall of the cavernous sinus. The histological diagnosis was schwannoma. Both left oculomotor and abducens nerve pareses occurred immediately after the operation but gradually resolved over 3 months. The operative findings indicated that this schwannoma may have arisen from the meningeal branch of the trigeminal nerve in the dura mater of the middle fossa.     

The use of a human dura mater allograft for the repair of a contaminated abdominal wall defect: Report of a case

A case report of an infected full-thickness abdominal wall defect treated successfully with a human dura mater allograft is presented. A review of the literature and a discussion of prosthetic abdominal wall repair is also included. A 46-year-old woman presented with multiple small bowel perforations and a large abdominal wall defect due to a motor vehicle collision. A gamma-irradiated human dura mater prosthesis was used to repair the large abdominal wall defect which had been infected by a jejunal fistula. After more than 4 years of follow-up, the patient is free of complications, including wound infection, herniation, and ileus. The human dura mater allograft is thus considered to be a useful prosthesis for repairing potentially infected wounds.     

Origin of spinal subdural hematomas: a postmortem anatomical study

OBJECTIVE: Although the mechanism by which cranial subdural hematomas form is known, the formation of spinal subdural hematomas is less clearly defined. The aim of this study was to identify vessels that can be found in the dural sac and whose rupture might lead to the formation of spinal subdural hematomas. MATERIAL AND METHOD: The dura mater, subdural space, and the arachnoid mater were studied in samples of dural sac taken from the eleventh thoracic vertebra to the fifth lumbar vertebra. The samples were taken from 3 fresh cadavers. Some were fixed in glutaraldehyde, dehydrated, and metallized with gold for scanning electron microscopy. Others were fixed in glutaraldehyde, treated with osmium tetroxide, and embedded in an epoxy resin for observation under a transmission electron microscope. RESULTS: Small hematomas--some on the internal surface of the dura mater and others surrounding nerve roots--were found within a thin, translucent arachnoid mater. Vessels measuring up to 100 microm were found within the dura mater, between its inner and outer laminae. Venules and capillaries were observed in the subdural space and in the arachnoid mater. CONCLUSIONS: Vessels are present between the laminae of the dura mater, in the subdural space, the arachnoid mater, and in spinal nerve roots. The rupture of these vessels could account for the formation of spinal subdural hematomas.     

钛网椎管成形在脊柱融合术中的应用

目的　介绍一种治疗椎体爆裂性骨折椎板减压后脊柱融合的方法。方法　椎体爆裂性骨折病人 3 4例 ,均有不同程度的脊柱不稳及硬膜囊或神经根压迫。在进行后路椎板减压、经椎弓根内固定后 ,采用钛网椎管成形脊柱后路融合重建脊柱的稳定性。结果　全部病例经 1 2～ 1 8个月随访 ,内固定物无断裂 ,钛网在位 ,椎管成形良好 ,硬膜囊及神经根无压迫。 3 1例神经功能有不同程度的恢复。结论　钛网椎管成形脊柱融合术治疗椎体爆裂性骨折效果良好。此方法操作简单 ,安全 ,能够在恢复椎管形状、免除硬膜囊及神经根压迫的同时 ,进行植骨融合 ,增加脊柱的稳定性 ,易于推广应用。     

Diploic epidermoid cyst: case report

We report the case of a diploic epidermoid cyst in the left front-parietal bone of a 70-year-old woman. A skull x-ray showed an osteolytic lesion with a sclerotic border, and CT scan revealed a low/iso-density mass and the destruction of both inner and outer tables. MRI showed hypo-intensity on T1-weighted image, hyper-intensity on T2-weighted imaging and remarkably-strong intensity on the diffusion-weighted imaging. Gadolinium enhancement was seen in the tumor capsule and dura of the peripheral tumor. In the operative view, most of the bone edge was regular with a sclerotic border, but an irregular section was present. The tumor adhered strongly to the dura mater and periosteum. The tumor was totally extirpated with the peripheral skull, dura mater and periost. On the postoperative MRI, gadolinium enhancement of the nearby dura mater and disappeared. We have added a discussion of the radiological features of diploic epidermoid cysts.