Morphological findings of the tympanic plexus]

A morphological study of the human tympanic plexus was performed. The tympanic nerve patterns on the promontory were classified into two types. The first was the single nerve trunk type, the second the type of nerve which divides into anterior and posterior branches. A tubal branch and a caroticotympanic branch on the promontory were both present in about 90% of the ears studied. Many ganglion cells were distributed on the tympanic plexus. It was concluded that these ganglia were autonomic, based on the nature of their fine structure. We speculate that these ganglia are parasympathetic and that they modulate the functions of vasodilators and secretory glands in the mucosa of the middle ear. In addition, we conducted a fiber analysis of the tympanic nerve and the lingual branch of the glossopharyngeal nerve and made a comparison between them.     

The fine structure of the cochlear plexus

Summary Ultrathin sections and freeze-fracture replicas of the guinea pig cochlear plexus were studied under the electron microscope. Generally, the capillaries possess a continuous endothelial cell layer. The endothelial cells are connected by tight junctions. Occasionally, fenestrated capillaries can be found. Nonmyelinated nerves are intimately related to smooth muscle cells of arterioles as well as pericytes and endothelial cells of capillaries. The axonal varicosities contain clear synaptic-type vesicles. The cochlear plexus cells are connected by desmosomes, gap junctions, and tight junctions. The latter are thought to be part of the blood-perilymph-barrier in this region. There is evidence that the cochlear plexus derives from the meninges.Supported by grants of the Deutsche Forschungsgemeinschaft, Ja 205/6     

鼻内镜下鼻后神经丛解剖研究

目的 探讨鼻内镜下鼻后神经丛(PNNP)的构成及分布特点,为后续行鼻内镜下高选择性PNNP切断术提供解剖学参考。方法 利用5具(10侧)冰鲜尸头灌注标本,经内镜下中鼻道入路,解剖蝶腭孔周围区域内结构;利用5具人体标本解剖前接受的鼻窦CT扫描结果,经影像学工具测量相应结构间距离。利用内镜系统采集解剖图像,影像测量软件获取影像学数据,并由资深放射科医师盲法测量。在解剖过程中,寻找蝶腭孔周围区域重要解剖标志及各结构间的毗邻关系。去除腭骨蝶突及蝶骨鞘突骨质,开放骨性腭鞘管,暴露PNNP咽支,在腭鞘管前口外侧探查定位翼管神经。结果 PNNP出蝶腭孔后均存在3个主要分支与蝶腭动脉分支血管伴行,前下方有与蝶腭鼻后外侧支伴行的鼻腔外侧壁支,后上方有与上鼻甲动脉伴行的上鼻甲支,后内侧有与鼻后中隔动脉伴行的鼻中隔支,蝶腭神经节在翼腭窝内即发出咽支,未穿出蝶腭孔,通过腭鞘管进入鼻咽部,且翼管前口均位于腭鞘管前口的外侧。腭鞘管前口外侧壁至翼管前口内侧壁间距,内镜下测量值(5.90±1.12)mm,影像学测量值(6.30±1.06)mm。结论 通过解剖定位腭鞘管,开放骨性腭鞘管,暴露其中的PNNP咽支,探讨腭鞘管前口与翼管前口之间的位置关系及术中规避翼管神经及蝶腭神经节的安全操作范围,为变应性鼻炎精准手术治疗提供解剖依据。     

Management of brachial plexus tumors

Three cases are reported of brachial plexus tumors that presented as a lump in the neck. Problems that arise when faced with such a diagnosis are discussed. A suggested protocol of management of these cases is described. The possibility of a brachial plexus tumor should be included in the differential diagnosis of a patient presenting with a mass in the neck.     

Schwannoma of the cervical plexus: a case report

A case of 70 years old man with cervical plexus schwannoma is presented. The tumor was removed surgically using extracapsular technique. The differential diagnosis and surgical techniques are discussed. The pre-operative symptoms, impressions and post-operative neurological status were shown and discussed. The review of literature is presented.     

Schwannoma of the brachial plexus presenting as a cystic swelling

Schwannomas are benign nerve sheath tumours. A small percentage of these tumours arise from the brachial plexus. Cystic degeneration and hemorrhagic necrosis can occur in these tumours in up to 40% of the cases. Detailed preoperative evaluation and careful dissection during surgery will avoid post operative neurological complications. We report a case of schwannoma of the brachial plexus presenting as a cystic neck swelling which was successfully managed by us.     

Physical effects of the choroid plexus on the cochlear nuclei in man

Relatively deep invaginations on the surface of the dorsal cochlear nucleus (DCN) inside the fourth ventricle lateral recess were observed just below the choroid plexus. The ependymal cells and neurons in the affected areas of the DCN manifest coarse inclusions in their cytoplasm. The inclusions are rounded granules, approximately 2 micron in diameter, relatively evenly spread through cytoplasm of these cells. The inclusions are not lipofuscin or known, non-viral cytoplasmic bodies specific for certain diseases accompanied by degeneration of the nervous tissue. The inclusions are, however, observed in cells with relatively high lipofuscin content. The change in transportation of the nutrients and metabolites between the affected areas in the DCN, cerebrospinal fluid, and capillaries as well as metabolic impairments in the DCN may be a reason for the observed accumulation of inclusions and lipofuscin. These pathological changes may also be a reason for certain hearing disorders.     

Primary non-Hodgkin's lymphoma of brachial plexus.

We report the case of a 65-year-old man with non-Hodgkin's lymphoma (NHL) not only in the brachial plexus but also in the central nervous system and parotid gland. He was referred to our hospital for evaluation of a right parotid mass. He also presented with bilateral facial palsy and paralysis of the left superior limb. Computed tomography scan and magnetic resonance imaging revealed mass lesions in the right parapharyngeal space, the deep lobe of the right parotid gland. and the left brachial plexus. A gallium-67 citrate scan demonstrated abnormal uptake in the left brachial plexus. These symptoms and lesions improved during steroid therapy. However, the symptoms worsened again after steroid therapy was discontinued. We performed a right parotidectomy to confirm the diagnosis. Histopathological study revealed NHL. He was treated with combination chemotherapy, and most of the lesions and symptoms, except bilateral facial palsy, improved. Despite follow-up treatment, a brain metastasis occured, and he died 16 months after the onset of symptoms.     

臂丛神经鞘膜瘤的手术治疗

神经鞘瘤又名雪旺细胞瘤，是起源于神经鞘膜的良性肿瘤。臂丛神经源自C4-C8与T1，从近心端向远心端由3干形成3束，神经纤维互相交织组合，最后分为手臂功能神经，在解剖上比较复杂。临床上，臂从神经鞘膜瘤相对少见，许多外科医生往往对此病认识不足，容易导致误诊，并且在手术后出现手臂功能障碍。     

面神经周围微血管丛分布的临床研究

目的为尽可能避免医源性面神经麻痹，评估面神经水平段周围微血管丛是否可以作为耳显微或耳神经外科术中面神经的定位标志。方法从2002年7月至2005年7月，共311例因慢性中耳炎、周围性面神经麻痹以及外耳道闭锁合并中耳畸形者，分别行开放式鼓室成形术（291例）、面神经减压术（10例）和先天性耳道闭锁和中耳畸形手术（10例）。观察和评估水平段面神经周围的微血管丛作为术中定位面神经的手术标志的有效性。结果在全部病例中，有95．8％的病例（298例）手术中可满意地观察到水平段面神经周围微血管丛，位于面神经鼓室段表面，仅4．2％的病例（13例）难以在水平段面神经周围发现该微血管丛。用面神经微血管判断水平段面神经管阳性率的95％可信区间为93．6％～98．0％。结论围绕在水平段面神经周围或表面的微血管丛，可作为术中及早且直接定位面神经的手术标志，用它来迅速确定面神经水平段是可靠的。