经胼胝体、透明隔、穹窿间入路手术切除第三脑室颅咽管瘤疗效观察

目的观察经胼胝体、透明隔、穹窿间入路手术切除第三脑室颅咽管瘤的疗效。方法对48例第三脑室颅咽管瘤患者经胼胝体、透明隔、穹窿间入路行肿瘤切除术。结果肿瘤全切除36例,近全切除12例,无手术死亡者。结论经胼胝体、透明隔、穹窿间入路是切除第三脑室颅咽管瘤的首选入路,肿瘤全切除率高。     

两种改良微创手术治疗松果体区肿瘤效果分析

目的观察两种改良微创手术治疗松果体区肿瘤的效果。方法对26例松果体区肿瘤患者行微创手术，采用改良Poppen入路手术11例，其中横窦矢状窦夹角处约3cm×2cm的小骨窗7例，2cm×（4—5）cm跨矢状窦的横行骨窗4例；采用Krause入路手术15例，均经松果体区、帆间池进入三脑室。结果手术均顺利，行肿瘤全切除术21例、次全切除术3例、大部切除术2例，无死亡、感染及术后出血；术后并发小脑肿胀1例，行后颅窝减压，术后7d小脑肿胀消退；出现一过性缄默1例。结论改良Poppen入路和Krause入路用于松果体区肿瘤手术具有微创性、有效性、实用性，其中后者风险更小；肿瘤位于幕上、部分幕上兼幕下且向侧方生长较大者宜采用Poppen入路，幕下、长入三脑室和幕下兼幕上者宜采用Krause入路。     

经穹窿间锁孔入路行三脑室手术的可行性探讨

采用解剖学方法，在导航辅助下对16例尸头实施模拟锁孔入路手术，通过冠状缝前4Cm、后2cm范围内的6个2cm×2cm锁孔骨窗观察、比较其对三脑室的显露情况。结果顺利完成16例尸头的经穹窿间三脑室前、中和后锁孔入路手术，前锁孔入路能显露松果体区和三脑室后部，中锁孔入路能显露三脑室后大部和松果体区前下部，后锁孔入路能显露三脑室前大部，左右骨窗对三脑室显露无影响。认为经穹窿间三脑室锁孔入路技术上可行，可用于三脑室和松果体区域肿瘤的手术治疗。     

经颞下-小脑幕入路显微手术切除岩斜区肿瘤

目的探讨经颞下-小脑幕入路显微手术切除岩斜区肿瘤的疗效。方法回顾性总结采用经颞下-小脑幕入路显微手术切除的12例岩斜区肿瘤病例的临床资料。结果12例包括脑膜瘤7例、神经鞘瘤3例、胆脂瘤2例。肿瘤全切除8例,次全切除2例,大部切除2例。术后发生近期记忆障碍1例,肢体偏瘫1例,感觉性失语1例,治疗随访3个月后均痊愈。结论经颞下-小脑幕入路是切除岩斜区肿瘤的极佳入路,损伤小,并发症少,值得推广应用。     

脉络膜裂的显微解剖学特点及临床应用价值

目的 探讨脉络膜裂的显微解剖学特征和经脉络裂入路的临床应用价值.方法 对12个国人成人头颅湿性标本在4-10倍显微镜下进行侧脑室区域显微解剖,观察并描述脉络膜裂的显微解剖学特点.分别打开脉络膜裂体部、房部、颞部,观察达到第三脑室、松果体区、环池的路径解剖.结果 脉络丛位于侧脑室底部内侧.脉络膜裂是位于丘脑和穹窿之间呈C...     

侧脑室-脑池分流术

当鞍上型颅咽管瘤或三脑室肿瘤压迫形成梗阻性脑积水 ,且瘤体较大或 (和 )周围重要结构粘连紧密难以全切除 ,甚至肿瘤切除达不到缓解脑积水的程度时 ,此类患者虽可行侧脑室 枕大池分流 ,但需再次手术。为此 ,我们对上述无法全切的肿瘤 ,本着一个手术入路 ,完成多个手术目的的设想 ,于1973年开展了经侧脑室额角入路 ,一期完成肿瘤切除、透明膈造瘘和侧脑室 脑池分流术。经随访观察 ,此手术明显优于单纯肿瘤切除。1　分流装置的制备有两种分流装置应用无毒透明塑料薄膜 (聚丙乙烯 ,厚度为 0 0 2～ 0 0 3mm) ,做成 2～ 3层“蛋卷”式分流管…     

蝶骨嵴脑膜瘤基底部的处理20例分析

目的总结经翼点入路显微手术切除蝶骨嵴脑膜瘤的经验。方法对20例蝶骨嵴脑膜瘤的显微外科手术作回顾性分析。手术入路均为翼点入路,其中蝾骨嵴内1／3者7例。外1／3者13例,术中采取在硬膜外和在硬膜下先处理蝶骨嵴脑膜瘤基底部,阻断肿瘤基底部的血供,然后再在显微镜下行肿瘤切除。结果全切除16例,大部分切除4例,1例术后死亡,术后轻瘫4例,余恢复良好。结论采用翼点入路,熟练掌握术区显微解剖,先处理好肿瘤基底部,可明显减少术中出血,可提高显微镜下全切除肿瘤的切除率,减少术后神经功能障碍。     

经枕下天幕入路显微手术切除小脑上蚓部肿瘤（附7例报告）

目的观察经枕下天幕入路显微手术切除小脑上蚓部肿瘤的效果和可行性。方法对7例小脑上蚓部肿瘤患者,采用经枕下天幕入路显微手术切除术。结果本组中4例幕下型脑膜瘤均SimpsonⅠ级切除,2例血管母细胞瘤及1例毛细胞型星形细胞胶质瘤均得到全切除,均无死亡病例及并发症发生;术后随访6个月-5a,肿瘤均未见复发。结论经枕下天幕入路开颅简单,术野清晰,有利于小脑上蚓部肿瘤的切除。     

经纵裂胼胝体前入路显微全切除鞍膈脑膜瘤(附13例报告)

目的 提高鞍膈脑膜瘤手术全切除率，减少术后复发，有效治疗和预防术后并发症，降低病死率。方法 对13例患者采用改良手术入路，扩大病变部位的暴露范围，减少术中因牵拉所造成的脑损害，利用显微外科技术在分块切除肿瘤的同时．有效保护与病变关系密切的血管、神经、丘脑下部、垂体、垂体柄等重要结构。结果 13例均一次全切除肿瘤，随访1～8年，无肿瘤复发，除1例术前视力已完全丧失外．3例生活自理。9例均恢复正常。结论 经纵裂胼胝体前切除鞍膈脑膜瘤是较理想的手术入路，可一次全切除肿瘤，并能有效保护肿瘤周围的重要结构。微侵袭显微外科技术是其必备条件。     

额底纵裂入路手术治疗鞍上第三脑室底垂体瘤

目的观察经额底纵裂入路手术治疗鞍上第三脑室底垂体瘤的临床疗效。方法对24例鞍上第三脑室底垂体瘤患者行额底纵裂入路手术治疗。结果 24例术中见肿瘤位于鞍内鞍上并且突入第三脑室底,5例伴有脑积水。肿瘤全切16例,次全切6例,大部切除2例。术后随访6个月,16例肿瘤全切者病灶无复发,5例次全切者病灶无明显变化,1例次全切和2例大部切除者术后行伽马刀治疗。结论额底纵裂入路手术对于鞍上第三脑室底的垂体瘤是一种较为理想的术式。     

Ventricular cerebrospinal fluid melatonin concentrations investigated with an endoscopic technique

The role of melatonin in humans still remains unclear. Uncertainties persist about its effects on neurophysiology regarding its levels in human cerebrospinal fluid (CSF), as the bulk of knowledge on this subject mainly derives from studies conducted on animals. In this study, CSF was micro-sampled with a simple, new method from each cerebral ventricle of patients undergoing neuroendoscopy for hydrocephalus. Our purpose was to measure CSF melatonin levels and determine possible differences in its concentration among various significant areas in the cerebral ventricles (e.g. pineal recess, pituitary recess, lateral ventricle, fourth ventricle) and lumbar cistern. From 2002 to 2004, 10 hydrocephalic patients were operated on using a neuroendoscopic technique. The CSF specimens were investigated for melatonin concentrations (free plus protein-bound) after deproteinization; the measurement technique was high-performance liquid chromatography. The preliminary data obtained with this endoscopic micro-sampling technique (applied to humans for the first time) suggest that melatonin is more concentrated within the ventricles and its highest concentration is found in the third ventricle (IIIv), although the difference detected between the CSF of the IIIv and that of the pineal recess was not significant.     

24例第四脑室囊尾蚴病患者临床特征及显微手术治疗效果

目的　分析24例第四脑室囊尾蚴病患者临床特征，评估显微手术治疗效果。方法　收集2000年1月至2018年12月青海大学附属医院神经外科收治的24例第四脑室囊尾蚴病患者临床资料，对其临床特征、影像学表现、手术入路方式及效果、术后并发症等进行分析。结果　24例第四脑室囊尾蚴病患者中，男性15例，女性9例；年龄16～68岁，平均43.5岁。术前CT及MRI检查示患者双侧侧脑室、三脑室、中脑导水管明显扩张，第四脑室球形或囊形扩张。18例患者抗囊尾蚴抗体阳性；21例行粪便检查，其中3例检出虫卵。24例病例均行显微手术治疗，其中8例采用正中孔入路、7例采用正中孔?小脑蚓部入路、9例经小脑延髓裂入路；囊泡完整娩出17例，破裂5例，穿刺抽取囊液后再分离切除囊壁2例。术后患者脑室系统均明显回缩、颅内高压症状消失；19例（79.17%）恢复良好，小脑出现共济失调或症状加重5例（20.83%），前者经治疗1～2周恢复。结论　经小脑延髓裂入路安全、损伤小，是目前治疗第四脑室囊尾蚴病较好的手术入路。     

Neuroendocrine, immunohistochemical, and ultrastructural study of pineal region tumors

Abstract: Thirteen patients with tumors in the pineal region were submitted to pre- and post-operative blood sampling (08:00, 14:00, 20:00, and 02:00 hr) for three or four consecutive days. A single cerebrospinal fluid (CSF) sample was collected at surgery, and melatonin levels determined. In all patients, serum and CSF beta subunit of human chorionic gonadotrophin (βHCG), carcino embryonic antigen (CEA), and alpha-fetoprotein (AFP) levels were measured. Histology revealed four pineocytomas, one pineoblastoma, four germinomas, one immature teratoma, one pilocytic astrocytoma, one lymphoma, and one meningioma. Serum and CSF levels of serological biomarkers were normal, except for one of the germinoma cases. In most patients, alteration either in the circadian rhythm or in the melatonin concentration was observed before surgery. In benign neoplasms the circadian rhythm was conserved. In pineoblastoma, lymphoma, and three out of four germinomas, melatonin concentrations were undetectable. In one case of germinoma, melatonin levels were high, with the circadian rhythm being abolished. According to conventional histology, all germinomas were similar. Therefore, in a rare case of pineal germinoma with high melatonin levels, the tissue was subjected to an in depth investigation (immunohistochemical and ultrastructural) in order to determine the pathology and the possible differences from the other typical germinomas. Results were compared to those provided from other pineal neoplasms. Electron microscopy examination detected the presence of clusters of intermediate filaments and numerous electrondense granules only in the case of a germinoma producing melatonin.     

Two cardiac tumors with left ventricular location: myxoma and papillary fibroelastoma]

We report 2 clinical cases of cardiac tumors, myxoma and papillary fibroelastoma, with unusual ventricular location. The clinical manifestations of these entities are not well described. Usually the patients are asymptomatic even if they have a high risk for cardiac and systemic embolic events so that these neoplasms are recognized during life more often in patients evaluated for embolic events of unclear pathology. The routine use of echocardiography has increased the detection of these tumors in living patients. In the surgical treatment, the approach should allow minimal manipulation of the tumors, inspection of all four cardiac chambers to overlook if tumors are multifocal and provide adequate exposure for complete resection. In our experience, we used two surgical approaches, via the left ventricle and via the aortic valve.     

24例第四脑室囊尾蚴病患者临床特征及显微手术治疗效果

目的　分析24例第四脑室囊尾蚴病患者临床特征,评估显微手术治疗效果。方法　收集2000年1月至2018年12月青海大学附属医院神经外科收治的24例第四脑室囊尾蚴病患者临床资料,对其临床特征、影像学表现、手术入路方式及效果、术后并发症等进行分析。结果　24例第四脑室囊尾蚴病患者中,男性15例,女性9例;年龄16～68岁,平均43.5岁。术前CT及MRI检查示患者双侧侧脑室、三脑室、中脑导水管明显扩张,第四脑室球形或囊形扩张。18例患者抗囊尾蚴抗体阳性;21例行粪便检查,其中3例检出虫卵。24例病例均行显微手术治疗,其中8例采用正中孔入路、7例采用正中孔?小脑蚓部入路、9例经小脑延髓裂入路;囊泡完整娩出17例,破裂5例,穿刺抽取囊液后再分离切除囊壁2例。术后患者脑室系统均明显回缩、颅内高压症状消失;19例（79.17%）恢复良好,小脑出现共济失调或症状加重5例（20.83%）,前者经治疗1～2周恢复。结论　经小脑延髓裂入路安全、损伤小,是目前治疗第四脑室囊尾蚴病较好的手术入路。     

High melatonin concentrations in third ventricular cerebrospinal fluid are not due to Galen vein blood recirculating through the choroid plexus.

Melatonin has been implicated in several neurotropic effects, but few studies have investigated the bioavailability of melatonin in the brain. The discovery of periventricular sites of action adjacent to the third ventricle forced us to investigate the dynamics of cerebrospinal fluid (CSF) melatonin release and the source of this melatonin. Our first study demonstrated unequivocally that third ventricle CSF melatonin, like jugular plasma melatonin, accurately reflects the duration of the night and is rapidly suppressed by light. However, third ventricle CSF melatonin levels are 20-fold higher than nocturnal plasma concentrations. A further study showed that melatonin increased in plasma before third ventricle CSF, raising the possibility that melatonin is taken up from the blood after recirculation through the Galen vein. However, a final experiment suggested strongly that CSF melatonin is released directly into the third ventricle, as melatonin levels in the lateral ventricle were 7-fold lower than those in the third ventricle. Our study raises the possibility that there may be two compartments of melatonin affecting physiological functioning: the first in plasma acting on peripheral organs, and the second in the CSF affecting neurally mediated functions at a much higher concentration of this pineal indoleamine.     

Follow-up of invasive pituitary macroadenoma in 56 patients within a duration of 5 years

From June 1986 to September 1996, 56(30%) patients with invasive pituitary macroadenoma were studied retrospectively. We compared the clinical and endocrinological characteristics, neuroimaging findings, and surgical outcome of these patients in a period of follow up of 5 years. Twenty-one patients (38%) were found to have a prolactinoma, 8 patients (14%) had a GH-producing adenoma, and 27 patients (48%) had non-functional tumors. Pituitary apoplexy was found in 16 cases (29%). Their age ranged from 15 to 72 years and no sex difference (F:M = 27:29) was found. According to Hardy's classification, all the 56 tumors were invasive pituitary macroadenoma, of a tumor size more than 10 mm with sellar floor erosion partially or diffusely or paracarvenous sinus invasion. Those tumors were divided into grade III (tumor causing localized perforation of the sellar floor), and IV (tumor destroying entire sellar floor diffusely); the tumors were further subdivided into stage C (3rd ventricle grossly displaced), D (intracranial intradural extension) and E (tumors invading the cavernous sinus through the lateral dural envelope of the sellar). Eight out of 56 tumors belonged to grade III stage C, 18 tumors were grade III stage D, 8 tumors were grade IV stage D, and the other 22 were grade IV stage E. Fifty-one patients received transsphenoidal craniectomy for tumor removal, one patient took subfrontal craniotomy only and 4 cases received both. Most patients improved significantly in visual field and general quality of life after surgery. In this study, it was concluded that: 1) surgical intervention as quick as possible was proven advantageous, especially in patients with an invasive macroadenoma; 2) in cases with invasive pituitary macroadenomas, the patients, with grade III and IV tumors, had a longer symptom-free interval than those who refused surgical intervention and radiotherapy with the same grade tumor; 3) to achieve satisfactory late results, multidisciplinary treatment was necessary: post-operative radiotherapy ranging from 4500 to 6500 rads was done in 50 patients, endocrine therapy in 52 patients and adjunct bromocriptine treatment was done in 13 patients with prolactinomas; 4) symptomatic recurrence or elevated postoperative hormone levels occurred in 20(35%) cases. There was a high incidence of recurrence in 6(6/20) GH-secreting tumors, and in 8(8/20) prolactinomas with preoperative prolactin levels more than 200 eta g/dl.     

巨大垂体腺瘤的显微手术治疗

为提高巨大垂体腺瘤显微手术的疗效 ,回顾性分析 5 6例巨大垂体腺瘤患者的临床资料及治疗方法。依据肿瘤的生长方向及部位将 5 6例分为四型 ,据此分别采用经蝶、经额下、额下经蝶、扩大经蝶、扩大额下硬膜外、额下 -翼点等 10种入路进行显微手术。5 6例巨大垂体腺瘤全切 2 9例 ,近全切 2 0例 ,大部切除 7例。无死亡者。提示依据巨大垂体腺瘤的不同位置及生长方向选择适当的手术入路是提高全切率、降低死亡率及复发率的重要手段