内镜辅助显微手术治疗桥脑小脑角胆脂瘤

目的 探索神经内镜辅助显微神经手术治疗桥脑小脑角胆脂瘤的实用性及效果。方法 对22例桥脑小脑角胆指瘤进行了神经内镜辅助显微手术切除．术中用0。和30。神经内镜观察各个死角。如果发现有肿瘤残留，在神经内镜辅助下行残留肿瘤切除。结果 术后临床症状、体征均明显改善或消失，均未发生无菌性脑膜炎和迟发性颅内出血等并发症。结论 神经内镜辅助显微手术治疗桥脑小脑角胆脂瘤，有利于提高手术疗效．降低手术并发症。     

神经内镜辅助显微手术治疗脑桥小脑角胆脂瘤

目的 探讨神经内镜辅助显微手术治疗脑桥小脑角胆脂瘤的治疗效果及技巧。方法 对21例桥小脑角胆脂瘤采取乙状窦后入路神经内镜辅助显微手术治疗。结果 显微镜下手术后应用神经内镜观察,21例均有肿瘤残留。神经内镜辅助下继续行残瘤切除,全切19例,次全切2例。无死亡及无菌性脑膜炎病例出现。18例患者随访3～36个月,均恢复正常生活。结论 在熟练掌握显微解剖结构的基础上,经乙状窦后入路神经内镜辅助显微手术治疗桥小脑角胆脂瘤,可提高肿瘤全切率,减少对脑干、各脑神经的牵拉和重要血管的损伤,有利于提高手术疗效,降低手术危险性。     

神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤

目的:探讨神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤的治疗效果及应用价值。方法:应用神经内窥镜辅助显微外科手术治疗桥脑小脑角区胆脂瘤20例,均采用乙状窦后入路。结果:显微镜下手术后应用0°、30°内窥镜观察,20例均有不同程度的肿瘤残留。神经内窥镜辅助下继续行残余肿瘤切除,全切18例,次全切2例。术后无死亡及无菌性脑膜炎表现。术后3个月,随访16例患者,均恢复正常生活。结论:经乙状窦后入路的神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤,可提高肿瘤切除率,减少对脑干及颅神经的牵拉和对重要血管的损伤,降低手术危险性及术后并发症,提高手术疗效,缩短住院时间。     

神经内镜辅助显微手术切除桥脑小脑角胆脂瘤

胆脂瘤是一种起源良性的肿瘤,由胚胎早期神经沟封闭时外胚层的剩件残留下来发展而成[1].好发于桥小脑角区(cerebellopontine angle, CPA).常规显微神经外科手术常因显微镜下存在死角,手术全切率较低.神经内镜辅助显微手术(neuroendoscope-assisted microneurosurgery, NEAM)克服了单纯显微神经外科的上述缺点,提高了手术全切率.我科于2007年1月至2009年12月在神经内镜辅助下显微切除桥小脑角胆脂瘤10例,效果满意,现报告如下.     

神经内镜辅助显微手术治疗桥小脑角肿瘤

目的 探索经乙状窦后入路电视神经内镜辅助显做手术治疗桥小脑角肿瘤的实用性及其优势。方法 对33例桥小脑角肿瘤采取乙状窦后入路神经内镜辅助显微手术治疗。结果 10例听神经瘤全切并保留面神经，22例胆脂瘤及1例脑膜瘤全切除，无术后并发症及死亡。结论 经乙状窦后入路神经内镜辅助显微手术治疗桥小脑角肿瘤，可提高手术疗效，降低手术危险性。     

神经内镜辅助显微外科治疗颅内胆脂瘤

目的：探讨神经内镜辅助的显微神经外科在治疗颅内胆脂瘤中的意义和手术方法。方法：应用神经内镜辅助的显微神经外科技术治疗颅内胆脂瘤45例。肿瘤以桥小脑角为原发部位并向周围扩展（包括颞下、鞍区、斜坡）37例,多部位广泛生长2例,脑室内2例,其它3例。在显微镜下尽可能切除可见的肿瘤部分,再用神经内镜寻找残余的肿瘤并切除。结果：在常规显微神经外科切除肿瘤后,38／45例（84％）仍有不同程度的残余肿瘤,在内镜下进一步切除,7／45例（16％）无残余肿瘤。43例有临床症状的病人中,39例（91％）手术后2周内症状缓解或恢复,4例无变化。1例（2％）术后发热,经1周治疗症状缓解。无术后脑积水和继发性颅内出血。对36例病人随访3－21个月,31／36例（86％）术后1－3个月生活完全自理,恢复正常工作。随访表明影像学恢复占53％,部分恢复占28％,恢复不佳占19％。影像学恢复不佳与部分肿瘤被膜残留有关。结论：神经内镜辅助显微神经外科切除颅内胆脂瘤（尤其是生长广泛的巨大肿瘤）,有助于提高肿瘤全切率,减少手术创伤,降低术后反应。     

神经内镜辅助下显微外科切除颅内胆脂瘤

一、临床资料与方法一般资料:本组共12例,其中男7例,女5例,年龄31~49岁,平均年龄41.6岁,肿瘤部位:桥脑小脑角4例,颞叶4例,松果体区、枕叶、小脑、侧脑室各1例。手术方法:采用德国的蛇牌神经内镜系统。手术径路:桥脑小脑角胆脂瘤采用经翼点入路,颞叶采用经颞入路,小脑胆脂瘤采用经枕下入路,侧脑室采用经脑室入路,松果体区经枕下幕上入路。二、结果所有病人行肿瘤全切除或次全切除。术后随访1~30个月,平均随访时间12个月。三、讨论1998年Nikoai将神经内镜手术分为内镜神经外科(EN)、内镜辅助下显微神经外科(EAM)及内镜控制下显微神经外科(E…     

“双镜联合”显微神经外科手术治疗桥小脑角脑膜瘤

目的 探讨神经内镜和显微镜“双镜联合”下显微神经外科手术治疗桥小脑角脑膜瘤的临床应用价值及优势.方法 回顾性分析经枕下乙状窦后入路显微神经外科手术治疗的39例桥小脑角脑膜瘤患者的临床资料.其中11例患者为“双镜联合”下手术切除肿瘤(双镜联合组),28例患者为单纯显微镜下手术切除肿瘤(显微镜组).结果 双镜联合组患者中肿...     

神经内镜辅助显微手术治疗颅内表皮样囊肿

目的:探讨应用神经内镜辅助显微神经外科手术治疗颅内表皮样囊肿的疗效。方法:本组共12例,均为颅内胆脂瘤,手术采用神经内镜辅助显微神经外科手术进行治疗,在显微镜下切除大部分肿瘤后,再用神经内镜进行探查,切除残余肿瘤。结果:术后临床症状、体征均明显改善或消失,均未发生无菌性脑膜炎和迟发性颅内出血等并发症。结论:神经内镜辅助显微手术治疗颅内表皮样囊肿,有助于提高肿瘤全切率,提高手术疗效,降低手术并发症。     

神经内镜辅助显微直视手术切除桥小脑角胆脂瘤

目的 总结桥小脑角(CPA)胆脂瘤显微直视手术辅以内镜处理显微死角部位的经验,以期提高CPA胆脂瘤的全切率.方法 回顾性分析自2007年1月至2009年7月手术治疗的34例CPA胆脂瘤,术前均经CT、MRI检查并经手术及病理证实.经乙状窦后入路,先在显微镜直视下分离切除所见肿瘤及其包膜,然后用内镜(0°和30°)观察显微镜死角是否有残余肿瘤,并在内镜下切除.同时以2004年1月至2006年12月收治的未用内镜辅助手术的CAP胆脂瘤36例作为病例对照.结果 内镜辅助手术经术后影像学检查,全切31例(91.18%),次全切除3例(8.82%),术后近期出现神经功能损害者2例(5.88%),无手术死亡.随访半年至一年半,均恢复正常工作和学习.对照组全切25例(69.44%),大部切除11例(30.56%),出现神经功能损害者9例(25%),无手术死亡.结论 在CPA胆脂瘤显微直视手术中,辅以内镜可以观察并切除显微镜死角内的残余肿瘤,从而明显提高手术全切率,有效防止肿瘤复发.     

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.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.