应用经岩骨乙状窦前入路治疗岩斜区肿瘤

目的探讨经岩骨乙状窦前入路在岩斜区肿瘤显微外科治疗中的应用。方法回顾性分析经岩骨乙状窦前入路显微手术治疗的岩斜区肿瘤患者10例,对其临床和影像学特征、手术入路及术后常见并发症进行研究。结果肿瘤全切10例,术后出现暂时性语言障碍、肢体肌力下降2例,出院时均恢复,皮下积液2例,治愈,出院时均达生活自理或恢复正常工作和学习。结论经岩骨乙状窦前入路操作简便、快捷,易于掌握,术后并发症少,是岩斜区肿瘤的较佳手术入路。     

经岩骨乙状窦前入路处理岩斜区肿瘤(附40例报告)

目的提高经岩骨乙状窦前入路处理岩斜区肿瘤的手术疗效.方法对采用经岩骨乙状窦前入路处理的40例岩斜区肿瘤病人的临床特征、手术方法、手术结果及术后并发症进行回顾性分析.以岩骨乙状窦交叉点和内淋巴囊裂作为磨除岩骨的定位标志,以减少岩骨内结构的损伤.结果肿瘤全切除27例,次全切除9例,部分切除4例.无手术死亡.术后主要并发症为脑神经损伤、脑组织水肿、肌力减退等.结论经岩骨乙状窦前入路是处理岩斜区肿瘤较好的手术方法.大多可全切除肿瘤.     

经岩骨乙状窦前幕上下联合入路切除岩斜区肿瘤

目的通过对31例岩斜区肿瘤显微外科治疗的分析，探讨幕上下经岩骨乙状窦前入路切除岩斜区肿瘤的优越性。方法分析1998年12月至2005年10月经不同手术入路显微外科切除的31例岩斜区肿瘤．总结其临床表现、神经影像学特征及握微手术方法、手术效果和术后处理。结果31例病人经乙状窦前入路手术15例，其中肿瘤全切除8例，全切率为533％，出现并发症9例（60．0％），死亡2例（133％）。经其它入路手术16例，其中肿瘤全切2例（12．5％），出现并发症10例（62．5％），死亡3例（18．8％）。与其他入路手术相比，经乙状窦前入路可明显提高肿瘤全切率（P〈0.05），而手术并发症率及死亡率无屁著性差别。结论与传统手术入路相比，经岩骨乙状窦前入路可充分显露岩斜区病变，手术全切除率明屁高于其它入路。     

经岩骨乙状窦前入路显微手术治疗岩斜区脑膜瘤

目的探讨经岩骨乙状窦前入路显微手术治疗岩斜区脑膜瘤的临床疗效。方法回顾性分析2010年9月至2013年9月经岩骨乙状窦前入路显微手术治疗的26例岩斜区脑膜瘤患者的临床资料。结果肿瘤全切除20例,近全切除4例,大部分切除2例。术后出现一过性失语6例、脑脊液耳漏2例,听力障碍6例,以及三叉神经、面神经和听神经症状加重4例,均经处理后好转。结论经岩骨乙状窦前入路治疗岩斜区脑膜瘤暴露充分,对颞叶和小脑牵拉轻微,损伤颅神经机会较小,有利于提高肿瘤切除程度和减轻术后并发症。     

经岩骨乙状窦前入路切除岩斜区肿瘤

目的：观察经岩骨乙状窦前入路切除岩斜区肿瘤患的临床疗效。方法：21例岩斜区肿瘤各部经岩骨乙状窦前入路显微手术肿瘤切除。结果：17例全切除，3例近全切除，1例大部分切除，术后死亡1例，死于肺部感染。结论：乙状窦前入路切除岩斜区肿瘤有对小脑及颞叶牵拉轻微，至肿瘤距离可缩短3cm，肿瘤基底部及血管容易处理等优点，全切除率高。     

应用经岩骨乙状窦前入路治疗岩斜区肿瘤

目的探讨经岩骨乙状窦前入路在岩斜区肿瘤显微外科治疗中的应用。方法回顾性分析经岩骨乙状窦前入路显微手术治疗的岩斜区肿瘤患者10例,对其临床和影像学特征、手术入路及术后常见并发症进行研究。 结果 肿瘤全切10例,开颅过程中无横窦和乙状窦破裂大出血;术后骨瓣解剖复位,无颅骨缺损;术区颞叶水肿致暂时性语言障碍、肢体肌力下降2例,出院时均恢复;皮下积液2例,皮下积液抽除后加压包扎,配合抗炎治疗治愈;未出现脑脊液漏、听力下降、颅内感染、严重的颅神经损伤及癫痫等并发症。结论经岩骨乙状窦前入路操作简便、快捷,易于掌握;术中避免静脉窦损伤,术区显露充分;颅骨解剖复位,术后并发症少,是岩斜区肿瘤的较佳手术入路,值得推广。

     

岩斜区脑膜瘤的显微外科治疗

目的探讨经岩骨乙状窦前入路显微外科治疗岩斜区脑膜瘤的手术特征及并发症。方法回顾性分析经显微手术治疗的12例岩斜区脑膜瘤资料。对肿瘤临床和影像学特征、手术入路、手术切除技巧及术后常见并发症的处理进行研究进行分析。结果全切除9例,大部切除3例。术后顽固性脑水肿2例,一侧肢体瘫痪1例,周围性面瘫3例,脑脊液耳漏2例,腰穿置管持续引流后痊愈。脑脊液鼻漏1例,腰穿引流后及耳咽管堵塞后痊愈。无死亡病例。结论经岩骨乙状窦前入路是处理岩斜区脑膜瘤的主要手术入路。颅底重建技术对于防止术后并发症起到了关键作用。     

岩斜区脑膜瘤的手术治疗与显微解剖研究

目的 探讨岩斜区脑膜瘤的最佳手术入路,以提高岩斜区肿瘤的手术疗效. 方法 收集南方医科大学南方医院自2009年4月至2011年10月收治的35例累及海绵窦的岩斜区脑膜瘤患者资料进行分析,患者均采用颞下经岩骨前部入路显微外科治疗;同时选择10例20侧解剖标本进行3种改良切口模拟微创颞下经岩骨前部手术入路研究;总结患者的影像学资料、临床表现及手术疗效,结合实验标本解剖数据分析不同手术入路优缺点. 结果 本组患者肿瘤全切28例,次全切6例,大部分全切1例;术后症状和体征完全消失17例,症状较术前减轻10例,颅神经损害症状同术前5例,出现新神经功能障3例.结合解剖学数据发现,3种改良切口对不同类型岩斜区肿瘤均可以达到良好的暴露. 结论 颞下经岩骨前部入路是岩斜区脑膜瘤的优先选择入路.     

岩斜区脑膜瘤的显微外科治疗

目的通过对234例岩斜区脑膜瘤显微外科治疗的分析,探讨岩斜区脑膜瘤的显微手术入路与治疗效果。方法总结234例岩斜区脑膜瘤的临床表现、神经影像学特征、显微手术入路及方法和术后处理。结果肿瘤全切除及次全切除192例(82.0%),死亡4例(1.7%)。结论岩斜区脑膜瘤的治疗采用手术治疗,根据肿瘤在斜坡的不同部位采用相应的手术入路,经岩骨乙状窦前入路目前是该部位肿瘤的首选手术入路,早期诊断、早期治疗,减少手术并发症,以达到治愈的目的。     

应用改良的经岩骨乙状窦前入路治疗岩斜区肿瘤

[摘要] 目的 探讨改良岩骨乙状窦前入路在岩斜区肿瘤显微外科治疗中的应用。方法 回顾性分析经改良岩骨乙状窦前入路显微手术治疗的岩斜区肿瘤患者10例,对其临床和影像学特征、手术入路及术后常见并发症进行研究。 结果 肿瘤全切10例,开颅过程中无横窦和乙状窦破裂大出血;术后骨瓣解剖复位,无颅骨缺损;术区颞叶水肿致暂时性语言障碍、肢体肌力下降2例,出院时均恢复;皮下积液2例,皮下积液抽除后加压包扎,配合抗炎治疗治愈;未出现脑脊液漏、听力下降、颅内感染、严重的颅神经损伤及癫痫等并发症。结论 改良经岩骨乙状窦前入路操作简便、快捷,易于掌握;术中避免静脉窦损伤,术区显露充分;颅骨解剖复位,术后并发症少,是岩斜区肿瘤的较佳手术入路,值得推广。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.