脊髓中央管隔膜形成与Chiari畸形并脊髓空洞

目的探讨显微外科治疗Chiari畸形并脊髓空洞的手术方法.方法 127例Chiari畸形并脊髓空洞经MRI确诊,采用小脑扁桃体下疝切除,并脊髓中央管开口隔膜切开术. 结果术中发现脊髓中央管开口隔膜形成;术后随访89例,MRI检查示,所有患者下疝的小脑扁桃体均消失,并存脊髓空洞明显缩小和消失.结论小脑扁桃体下疝,脊髓中央管开口隔膜形成是造成Chiari畸形并脊髓空洞的原因之一;小脑扁桃体下疝切除,脊髓中央管隔膜切开术是手术治疗Chiari畸形并脊髓空洞症的有效方法.     

Chiari畸形并脊髓空洞的治疗与小脑扁桃体下疝分型

目的探讨Chiari畸形并脊髓空洞手术中,下疝的小脑扁桃体下舌分型与切除的标准。方法术中显微镜下观察32例下疝的小脑扁桃体压迫延髓的部位及其关系,结合MRI,提出下疝的小脑扁桃体分型,并根据分型切除小脑扁桃体下舌,切开脊髓中央管开口隔膜或活瓣,恢复第四脑室内脑脊液循环通畅。结果小脑扁桃体分型：①根据压迫部位分为：后方型27例,侧方型4例,侧前方型1例;②根据小脑扁桃体下疝程度分为：单侧压迫型11例,双侧压迫型21例。术后随访28例,MRI检查示下疝的小脑扁桃体均消失,第四脑室内脑脊液循环通畅,脊髓空洞明显缩小和消失;术后病人临床症状大多改善。结论下疝的小脑扁桃体根据其分型并切除,可为手术治疗Chiari畸形并脊髓空洞提供标准及依据。     

小范围颅后窝减压治疗Chiari畸形并脊髓空洞

目的 评价小范围颅后窝减压术治疗Cbiari畸形并脊髓空洞的效果。方法回顾性分析97例Chiari畸形并脊髓空洞的手术经验。均行小范围颅后窝减压,骨窗约3cm×3cm,尽可能不切除C。后弓。直线切开硬脑膜并原位缝合,切除下疝小脑扁桃体,松解脊髓中央管开口并切开膈膜,疏通第四脑室脑脊液各输出道,使脑脊液循环通畅。结果术后完整随访45例,MRI复查示小脑扁桃体下缘均位于枕骨大孔水平线以上,脊髓空洞明显缩小或消失。结论小范围颅后窝减压术能改善Chiari畸形并脊髓空洞的术后症状。     

小范围后颅窝减压治疗Chiari畸形合并脊髓空洞症（附97例报告）

目的评价以更小的创伤治疗Chiari畸形合并脊髓空洞症的临床疗效。方法小范围后颅窝骨性减压窗范围一般在3cm×3cm以内,不切除C1后弓,切除下疝的小脑扁桃体,松解脊髓中央管开口隔膜,疏通第四脑室脑脊液各输出道,使脑脊液循环通畅。结果37例术后12d内MRI示下疝的小脑扁桃体下缘上升到枕骨大孔水平以上。长期随访48例,29例患者症状逐渐改善;14例症状稳定未加重;5例较术前加重,但MRI示脊髓空洞缩小。结论小范围后颅窝减压术能够改善Chiari畸形合并脊髓空洞患者的临床症状,可作为外科治疗Chiari畸形合并脊髓空洞症的一种术式。     

小脑扁桃体下疝切除术治疗Chiari畸形并脊髓空洞

目的评价小脑扁桃体下疝切除术治疗Chiari畸形并脊髓空洞的临床效果。方法本组Chiari畸形合并脊髓空洞患者10例均采取手术治疗。手术时有效范围后颅窝骨性减压,铣刀铣开小范围后颅窝骨瓣(3cm×3cm),不切除C1后弓,直线侧切开硬脑膜,切除下疝的小脑扁桃体,松解脊髓中央管开口隔膜,疏通第四脑室脑脊液各输出道,使脑脊液循环通畅,原位缝合硬脑膜,颅骨锁固定骨瓣。结果手术无死亡及病残病例。10例术后(12d内)MR示小脑扁桃体下缘上升到枕骨大孔水平以上,后颅窝内容积扩大。术后长期随访9例,随访时间6个月～2年,2例患者症状逐渐改善,6例稳定未加重,1例较术前略加重,但MR示后颅窝内容积扩大,脊髓空洞缩小。结论小脑扁桃体下疝切除术治疗Chiari畸形并脊髓空洞患者,术后后颅窝内容积扩大,第四脑室内脑脊液循环通畅,临床症状多有改善。     

Chiari Ⅰ型畸形合并脊髓空洞症的显微外科治疗

目的 研究ChiariⅠ型畸形合并脊髓空洞症的显微手术治疗方法。方法 枕下正中入路，咬开枕骨大孔后缘及寰椎后弓，显微镜下切开硬脑脊膜，软脑膜下切除下疝的小脑扁桃体，重建第四脑室正中孔与两侧小脑延髓外侧池交通、开放脊髓中央管口，修补硬脑脊膜。结果 36例手术均顺利完成，术后恢复平稳、无感染，无死亡。病人肌力。温、痛感觉及肌张力均恢复良好。下疝的小脑扁桃体均消失。随访MRI示，6例空洞症消失，脊髓接近正常；30例脊髓空洞腔明显缩小。结论 采用显微手术切除下疝的小脑扁桃体，开放脊髓中央管口，恢复枕大池结构和功能，是治疗ChiariⅠ型畸形合并脊髓空洞症的有效方法。     

小脑扁桃体切除并脊髓中央管口松解术治疗合并脊髓空洞的Chiari畸形

目的探索外科治疗合并脊髓空洞的Chiari畸形的新方法。方法采用切除下疝小脑扁桃体,并脊髓中央管口假膜切开术,原位硬膜缝合法。结果18例手术治疗,15岁以下儿童12例,术中发现均有脊髓中央管口(闩部)假膜;成人6例,3例有假膜形成。全部病例术后脊髓空洞消失或明显缩小。结论脊髓中央管口假膜是造成Chiari畸形脊髓空洞的原因之一,切除下疝小脑扁桃体并脊髓中央管口假膜切开术,是手术治疗合并脊髓空洞的Chiari畸形最根本的方法。     

枕大池重建术治疗ChiariI畸形合并脊髓空洞

目的 探讨枕大池重建术治疗合并脊髓空洞的Chiari I 畸形的临床意义.方法 对48例合并脊髓空洞的Chiari I 畸形病人行枕下正中入路,咬开下项线至枕大孔后缘及寰椎后弓,"Y"形切开硬脑脊膜和蛛网膜.对下疝小脑扁桃体显微镜下弱电流电凝或软脑膜下切除,开放正中孔直至第四脑室底,打通两侧小脑延髓外侧池,切开脊髓中央管口假膜.扩大修补硬脑脊膜及蛛网膜,重建枕大池.结果 术中发现28例有脊髓中央管口假膜.随访3～24月, 感觉及肌力均有不同程度的恢复, MRI复查8例脊髓空洞消失,40例明显缩小.结论 后颅凹减压、开放四脑室正中孔与两侧小脑延髓外侧池相通、切开脊髓中央管口假膜,是手术治疗合并脊髓空洞的Chiari I畸形的关键.     

枕大池重建术治疗Chiari Ⅰ畸形合并脊髓空洞

目的探讨枕大池重建术治疗合并脊髓空洞的Chiari Ⅰ畸形的临床意义。方法对48例合并脊髓空洞的Chiari Ⅰ畸形病人行枕下正中入路,咬开下项线至枕大孔后缘及寰椎后弓,"Y"形切开硬脑脊膜和蛛网膜。对下疝小脑扁桃体显微镜下弱电流电凝或软脑膜下切除,开放正中孔直至第四脑室底,打通两侧小脑延髓外侧池,切开脊髓中央管口假膜。扩大修补硬脑脊膜及蛛网膜,重建枕大池。结果术中发现28例有脊髓中央管口假膜。随访3～24月,感觉及肌力均有不同程度的恢复,MRI复查8例脊髓空洞消失,40例明显缩小。结论后颅凹减压、开放四脑室正中孔与两侧小脑延髓外侧池相通、切开脊髓中央管口假膜,是手术治疗合并脊髓空洞的Chiari I畸形的关键。     

后颅窝内容物内减压治疗Chiari畸形并脊髓空洞症

自2006年1月到2007年11月,作者对10例Chiari畸形并脊髓空洞,行小脑扁桃体下疝及脊髓中央管隔膜切除,使后颅窝内容积扩大,恢复脑脊液循环通畅,后颅窝骨瓣复位,称之为后颅窝内容物内减压。报告如下。     

Nervenkitt: notes on the history of the concept of neuroglia

The evolution of concepts concerning the identity and the functions of neuroglia is traced. Some of the main ideas in the works of Virchow, Deiters, Golgi, Lenhossék, Lugaro, Ramón y Cajal, del Río-Hortega, Achúcarro, Penfield, and others are highlighted.     

Ultrastructure of the caudal portion of the fourth ventricular roof in the mouse

A scanning and transmission electron microscopic study was done of the caudal portion of the fourth ventricular roof in the adult mouse. The caudal portion of the fourth ventricular roof was divided into two parts: choroid plexus and nonchoroid plexus roof. The plexus epithelial cells had numerous microvilli and were connected with each other with a tight junction, gap junction, or zonula adherens. The nonchoroid plexus roof was a thin neuroglial membrane with a continuous basement membrane, which we designated as "the membranous roof." The membranous roof was mostly composed of a single layer of paving ependymal cells supported by discontinuous pial cells. The ependymal cells were characterized by their squamous cell configuration, various numbers of microvilli and cilia, and a continuous basement membrane. They were connected with each other by gap junctions or zonulae adherentes, but they lacked tight junctions. Neither a cytoplasmic pore nor a wide intercellular cleft was identified. Neuronal and glial cell processes were occasionally observed. The aperture that is supposed to exist in the caudal, median portion of the fourth ventricular roof of the adult mammalian brains, called the foramen of Magendie in the human brain, was not found. Our observations suggest that the membranous roof itself would permit passage of the cerebrospinal fluid containing macromolecules via the interependymal cell clefts, implying that the foramen of Magendie would not be an anatomical aperture but a functional channel for the outflow of the cerebrospinal fluid.     

Neuropathy of the infrapatellar branch of the saphenous nerve in the differential diagnosis of knee pain

A 58-year-old woman complained of pain and paresthesia localized on the medial side of both knees. Neurological examination disclosed signs, referrable to a bilateral compression lesion of the infrapatellar branch of the saphenous nerve. Gonyalgia paresthetica should be taken into consideration in the differential diagnosis of knee pain and sensory disturbances.

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Sommario Una donna di 58 anni accusava parestesia e dolori localizzati alla faccia mediale di ambedue le ginocchia. Obiettivamente si rilevarono segni riferibili ed una compressione bilaterale della branca infrapatellare del nervo safeno. La gonalgia parestesica deve essere considerata nella diagnosi differenziale della sindromi dolorose del ginocchio.

     

Marc Dax and the discovery of the lateralisation of language in the left cerebral hemisphere

In 1836, Marc Dax presented a revolutionary conclusion based on both his clinical observations and reports from the literature: the localisation of language in the left hemisphere. Twenty-seven years later, his son, Gustave Dax, extended and enriched his work. Their involvement in 19th century neuropsychology is impressive and recognition should have been considerable. However, according to the vast majority of historians of neurology, neuropsychology and aphasiology, the priority in establishing the dominance of the left brain hemisphere for speech goes to Paul Broca in an undivided way. Is it possible that Marc Dax's and his son, Gustave Dax's works were entirely unknown? Were they known and utterly forgotten? Were they ignored? How did we get to know that they existed? The aim of the present paper is to try to answer those and other questions and to demonstrate that there is abundance of data pointing out that the priority of the discovery of left hemisphere dominance for speech ought to be, at least, shared by Dax and Broca.     

Force estimation processing as a function of the input--output relationship of the corticospinal pathway in humans

Static changes of the shoulder joint from 30 degrees adduction (ANT) to 30 degrees abduction (POST) in the horizontal plane reduce the gain of the input--output relationship of the corticospinal pathway to the abductor digiti minimi (ADM) muscle [F. Ginanneschi et al. (2005)Exp. Brain Res., 161, 374--382]. The present study examined force estimation under conditions in which the input--output relationship of the corticospinal innervation to ADM was modified by changing shoulder position as above. The input--output relationship was studied using transcranial magnetic stimulation. Estimates of force were assessed using a matching procedure; subjects first matched a target level (10--40% of maximum) on a screen by applying a reference (Ref) isometric contraction of ADM and then they reproduced the same level of force without visual feedback by a test contraction (Test). When Ref and Test contractions were performed at either ANT or POST (i.e. the same input--output), the respective force levels were closely matched. In contrast, when the Test and Ref were performed in POST and ANT, respectively (i.e. different input--output), subjects exerted more force than required. Errors were in the opposite direction when the Test and Ref were in ANT and POST, respectively. The present results suggest that the process of force estimation is based on the effort : tension ratio which is a direct function of the corticomotoneuronal input--output relationship. This notion may contribute to explaining the pathophysiology of central fatigue.     

Development of the olivocerebellar projection in the rat: II. Matching of the developmental compartmentations of the cerebellum and inferior olive through the projection map.

A transient biochemical parcellation has been observed by immunocytochemical methods, during the perinatal development of both the inferior olive and the cerebellum. In the present study, we sought a relationship between this developmental compartmentation and the organization of the olivocerebellar projection. In the inferior olive, a transient parvalbumin immunoreactivity restricted to the dorsal cap of the medial accessory olive is observed around birth. The climbing fiber projection of the dorsal cap was identified in the cerebellum of newborn rats based on its parvalbumin immunoreactivity. The pattern of this projection, restricted to lobules IX and X of the vermis, and to the flocculus, is indistinguishable from that of the adult medial accessory olive, which was previously described from axonal tracing experiments. The parvalbumin immunoreactive climbing fibers were followed between birth and postnatal day 7. In the caudal vermis, Purkinje cell subpopulations can be identified between embryonic day 20 and postnatal day three, on the basis of their differential immunostaining with an antibody directed against a specific peptide, PEP 19. In lobule X, the parvalbumin immunoreactive climbing fibers form two sagittal bands on each side of the midline, one medial and one lateral. The medial parvalbumin immunoreactive climbing fiber band is coextensive with a PEP 19 negative Purkinje cell cluster, indicating a clear relationship between the biochemical parcellations of the cerebellum and inferior olive.     

Perceptual Pragmatism and the Naturalized Ontology of Color

This paper considers whether there can be any such thing as a naturalized metaphysics of color—any distillation of the commitments of perceptual science with regard to color ontology. I first make some observations about the kinds of philosophical commitments that sometimes bubble to the surface in the psychology and neuroscience of color. Unsurprisingly, because of the range of opinions expressed, an ontology of color cannot simply be read off from scientists’ definitions and theoretical statements. I next consider two alternative routes. First, conceptual pluralism inspired by Mark Wilson's analysis of scientific representation. I argue that these findings leave the prospects for a naturalized color ontology rather dim. Second, I outline a naturalized epistemology of perception. I ask how the correctness and informativeness of perceptual states is understood by contemporary perceptual science. I argue that the detectionist ideal of correspondence should be replaced by the pragmatic ideal of usefulness. I argue that this result has significant implications for the metaphysics of color.     

Three-dimensional transcranial color-coded sonography for the examination of the arteries of the circle of Willis.

Because examinations of the intracranial vessels using conventional transcranial color-coded sonography (TCCS) lack spatial orientation and reproducibility, development of a three-dimensional (3-D) imaging technique is required. Three patients with middle cerebral artery (MCA) stenosis, three with suspected intracranial aneurysm, two with vascular malformation, and one healthy volunteer were investigated by 3-D TCCS using a magnetic spatial positioning sensor mounted on the transducer for simultaneous recording of the probe coordinates to create a volumetric data set. Three-dimensional transcranial color-coded sonography enabled good visualization of intracranial aneurysms and MCA stenoses. However, it failed to detect morphological details in vascular malformations. In conclusion, 3-D TCCS is a promising technique that opens new perspectives in depicting intracranial vessels and provides volume measurement of intracranial aneurysms.     

Supervision of mental health care in the Netherlands

Summary In the Netherlands the Inspectorate of Mental Health has to supervise the quality of mental health care that is given to its citizens. A shortage of inspectors hampers effective accomplishment of this task, and government budget cuts have increased this problem. Another obstacle is the absence of standarized methods of supervision and clear norms for medical practice. This paper describes the efforts of the Inspectorate to develop a new technique of supervision to solve this problem, the so-called frames of reference.     

Projections of the paraventricular and paratenial nuclei of the dorsal midline thalamus in the rat

The paraventricular (PV) and paratenial (PT) nuclei are prominent cell groups of the midline thalamus. To our knowledge, only a single early report has examined PV projections and no previous study has comprehensively analyzed PT projections. By using the anterograde anatomical tracer, Phaseolus vulgaris leucoagglutinin, and the retrograde tracer, FluoroGold, we examined the efferent projections of PV and PT. We showed that the output of PV is virtually directed to a discrete set of limbic forebrain structures, including 'limbic' regions of the cortex. These include the infralimbic, prelimbic, dorsal agranular insular, and entorhinal cortices, the ventral subiculum of the hippocampus, dorsal tenia tecta, claustrum, lateral septum, dorsal striatum, nucleus accumbens (core and shell), olfactory tubercle, bed nucleus of stria terminalis (BST), medial, central, cortical, and basal nuclei of amygdala, and the suprachiasmatic, arcuate, and dorsomedial nuclei of the hypothalamus. The posterior PV distributes more heavily than the anterior PV to the dorsal striatum and to the central and basal nuclei of amygdala. PT projections significantly overlap with those of PV, with some important differences. PT distributes less heavily than PV to BST and to the amygdala, but much more densely to the medial prefrontal and entorhinal cortices and to the ventral subiculum of hippocampus. As described herein, PV/PT receive a vast array of afferents from the brainstem, hypothalamus, and limbic forebrain, related to arousal and attentive states of the animal, and would appear to channel that information to structures of the limbic forebrain in the selection of appropriate responses to changing environmental conditions. Depending on the specific complement of emotionally associated information reaching PV/PT at any one time, PV/PT would appear positioned, by actions on the limbic forebrain, to direct behavior toward a particular outcome over a range of outcomes.