经外侧裂-岛叶切除岛叶胶质瘤手术入路的显微解剖学研究

目的 通过尸头标本模拟经外侧裂-岛叶入路的相关解剖结构,为临床医师进行岛叶胶质瘤手术提供参考,从而在提高肿瘤全切率的同时能最大程度保护脑组织功能。方法 在10例尸头标本上进行外侧裂、岛叶、大脑中动脉区域的解剖研究,拍照并观察各重要结构的关系及测量相关参数。结果 岛中央沟与大脑表面的中央沟相齐平,将岛叶分为前半部分和后半部分,前半部分为3～5个岛短回,后半部分由2个岛长回构成。岛叶前半部分被额下回三角部、盖部和中央前回覆盖;岛叶后半部分的上方被中央后回、缘上回覆盖,下方被赫氏勒回覆盖。岛叶被上纵束环绕,上纵束联系额颞顶枕叶,钩束在岛叶下方连接额叶和颞叶。经侧裂暴露到达上界沟区域、前岛点,额眶部至少需要牵拉2.0 cm,牵拉时要避免对Broca区的损伤。暴露岛叶下界沟则需要牵拉颞叶2.5 cm,牵拉压迫过程中应注意避免损伤颞横回。结论 经外侧颞-岛叶入路可充分暴露岛叶,适合切除纯岛叶胶质瘤。对于其他类型岛叶胶质瘤,前岛点和前界沟位置容易暴露,后岛点及下界沟暴露更为困难。     

人大脑岛叶的影像解剖

目的 研究岛叶区域的影像解剖,为熟悉掌握岛叶解剖特点提供参考.方法 选择健康汉族成人志愿者200例(400侧),按年龄分为5组,每组40例,每组内男女各20例.对每位志愿者用1.5T MRI扫描仪进行扫描,应用Aquariusws软件手动勾画出各个解剖值,软件自动测算出其解剖参数值.结果 左、右侧前环岛沟测量均值(24...     

侧裂池蛛网膜结构及其与大脑中动脉分级关系的解剖学研究

目的研究颅内侧裂池蛛网膜层次及其和大脑中动脉(MCA)各级分支间的关系及其临床意义。方法取成人尸头6例(12侧),显微镜下观察外侧裂膜性结构层次及侧裂池构成,解剖MCA各支分布及其和膜性层次间的关系。结果侧裂池由外向内共有4层蛛网膜结构,分别是远外侧侧裂膜(FLSa)、外侧侧裂膜(LSa)、中间侧裂膜(MiSa,内层和外层)和内侧侧裂膜(MeSa)。12侧标本中,4层膜性结构均完整的6侧。FLSa通常菲薄,覆盖在侧裂浅静脉表面,和静脉外膜粘连紧密;LSa相对致密,构成了侧裂池的真正外侧壁,并分隔MCAM3和M4段;沿MCAM3段走行,有相对菲薄的MiSa浅层覆盖并将其固定在侧裂池内;在M2和M3段交汇处,见相对致密的MiSa深层,包绕M3段起始部,并将侧裂池分为前后两部,3侧标本中该层菲薄稀疏,呈网眼状;而在M1和M2段间有非常致密的MeSa,分隔侧裂池和颈内动脉池,5侧标本中,该膜菲薄呈网眼状。结论侧裂池蛛网膜的分层分布和MCA各级动脉关系密切,掌握其解剖特点有利于术中充分解剖侧裂池和颈内动脉池。其膜性分布的个体化差异,可能影响MCA动脉瘤的出血方式。     

大脑外侧窝池蝶部的显微解剖及其临床意义

目的 :研究大脑外侧窝池蝶部的显微解剖及其手术意义。方法 :在手术显微镜下观测 2 8侧标本大脑外侧窝池蝶部的解剖结构。结果 :大脑外侧窝池蝶部位于蝶骨嵴后下方及额、颞叶之间 ,顶壁为后眶回下面的软膜 ,底壁为颞叶上面 ,后极为上下壁软膜的反折线。池内侧端最宽大 ,57.%同颈动脉池间存在象片性的隔膜。池内静脉变异较大 ,大脑中浅静脉多行走于池的前上部 ,大脑中深静脉行于M1段后下面或穿行于池中。池内纤维小梁少者仅 1 0余条 ,多者纵横交错达 30～ 50条。 35 .7%池的上、下壁在M1段中 1 /3前方 ,通过短而密的纤维片膜相粘合。结论 :经翼点入路手术中 ,切开大脑外侧窝池前壁时 ,不易伤及M1段主干。大脑外侧窝池蝶部的列脉约 1 /4有蛛网膜鞘包裹 ,勿当作蛛网膜切断 ,可以其饱满的管状鞘膜索样鉴别。分开大脑外侧窝池蝶部上、下壁时 ,小区域粘合处宜沿切线方向锐性切开。大脑外侧窝池与颈动脉池间的隔膜不是池内侧端的可靠标志     

大鼠大脑中动脉的解剖及其在脑缺血模型中的应用

用４５只大鼠脑标本观测大脑中动脉的起始，行程，分支及分布情况，确定制仡中灶性脑缺血模型血管阻断部位。大鼠的大脑中动脉可分三段，中段相对较长，位置恒定，分支较少，表面骨质较薄，易于凿骨开窗，是制作脑缺血模型阻断血管的最佳部位。     

高脂血症对老年猕猴大脑中动脉及其中央支结构的影响

用高脂高胆固醇饮食喂养猕猴建立高脂血症动物模型，动物分为成年组，和老年组，造型期历时１６－２８个月。动物灌注固定后取双侧大脑中动脉及其中央支。扫描电镜观察血管内皮改变。结果发现成年猴大脑中动脉内皮细胞水肿，表面可见血细胞和纤维成份粘附。     

前岛叶皮层参与痛觉感受的研究进展

岛叶皮层(IC)对于疼痛的感知和感受起着至关重要的作用。前部岛叶皮层主要与疼痛引起的情感感受有关,而后部岛叶皮层与痛觉的感觉信息有关。本文主要综述前部岛叶皮层在疼痛感受及调节中的研究进展,并对其中可能参与调节的分子通路以及神经环路进行简要概括,以期深入阐明前部岛叶皮层在痛觉感受的作用。     

高脂血症对老年猕猴大脑中动脉及其中央支结构的影响

用高脂高胆固醇饮食喂养猕猴建立高脂血症动物模型,动物分为成年组(10～16岁)和老年组(20～23岁),造型期历时16～28个月。动物灌注固定后取双侧大脑中动脉及其中央支。扫描电镜观察血管内皮改变,结果发现成年猴大脑中动脉内皮细胞水肿,表面可见血细胞和纤维成份粘附。中央支病变稍轻,老年猴大脑中动脉内皮细胞水肿严重,细胞排列紊乱,并有局部破溃,内皮下结构裸露。中央支内皮破溃,甚至成片脱落,有血液成分粘附。实验结果表明高血脂可诱发脑动脉损害,并随年龄的增加而加重。     

大脑中动脉及分支的研究

随着显微血管外科的普及和提高,为颅内、外动脉吻合术闭塞性脑血管的外科治疗提供形态学资料。作者于1993年11月～1995年10月用成人脑标本,对大脑中动脉的位置、走行、分支类型、口径及吻合进行了观察和测量,并对临床应用意义进行探讨。 材料与方法 用成人50例(男32例,女18例)防腐固定的完整头部和脑标本,去颅后细心地剥离蛛网膜,掰开大脑外侧裂,然后用弯脚规,直脚规,游标卡尺等观察和测量大脑中动脉主干及分支的口径、类     

股神经周围筋膜及其毗邻结构的解剖

目的 探讨股神经周围是否存在完整的筋膜鞘以及股神经与周围筋膜的解剖学关系,为下肢外周神经阻滞麻醉的选择提供形态学依据。方
法选择5具10%福尔马林固定的两侧第1腰椎至大腿中段保存完整的标本进行研究,共10侧;其中8侧由远端向近端逐步注射乳胶后局部解剖观察,
1具标本即2侧经-35℃冷冻1周后制成横断面连续断层切片,行断层解剖观察。结果 本实验未发现股神经周围存在完整筋膜鞘。股神经周围有筋膜
样结构包绕,从近端向远端主要包括腰丛筋膜、腰大肌肌间隔、髂筋膜及疏松的脂肪组织。结论 大体解剖学观察股神经周围并不存在完整筋膜
鞘。     

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting-state functional connectivity and its predictive validity using machine learning

Individuals with post-traumatic stress disorder (PTSD) typically experience states of reliving and hypervigilance; however, the dissociative subtype of PTSD (PTSD+DS) presents with additional symptoms of depersonalization and derealization. Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting-state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed-based resting-state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (n = 84), PTSD+DS (n = 49), and age-matched healthy controls (n = 51). As compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (p < .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting-state connectivity patterns to discriminate between participant groups with high predictive accuracy.     

Conscious perception of errors and its relation to the anterior insula

To detect erroneous action outcomes is necessary for flexible adjustments and therefore a prerequisite of adaptive, goal-directed behavior. While performance monitoring has been studied intensively over two decades and a vast amount of knowledge on its functional neuroanatomy has been gathered, much less is known about conscious error perception, often referred to as error awareness. Here, we review and discuss the conditions under which error awareness occurs, its neural correlates and underlying functional neuroanatomy. We focus specifically on the anterior insula, which has been shown to be (a) reliably activated during performance monitoring and (b) modulated by error awareness. Anterior insular activity appears to be closely related to autonomic responses associated with consciously perceived errors, although the causality and directions of these relationships still needs to be unraveled. We discuss the role of the anterior insula in generating versus perceiving autonomic responses and as a key player in balancing effortful task-related and resting-state activity. We suggest that errors elicit reactions highly reminiscent of an orienting response and may thus induce the autonomic arousal needed to recruit the required mental and physical resources. We discuss the role of norepinephrine activity in eliciting sufficiently strong central and autonomic nervous responses enabling the necessary adaptation as well as conscious error perception.     

Anorexia nervosa and the insula

Anorexia nervosa is a serious illness with major physical and psychological morbidity. It has largely been understood in terms of cultural and environmental explanations. However these are insufficient to explain the diverse clinical features of the illness, nor its rarity given the universality of sociocultural factors. Over the last 20 years, there has been a steady accumulation of neurobiological evidence requiring a re-formulation of current causal models. We now offer a new empirically-derived hypothesis implicating underlying rate-limiting dysfunction of insula cortex as a crucial risk factor for the development of anorexia nervosa. Supporting evidence for this hypothesis is drawn from anatomical and clinical research of insula cortex damage in humans and neuroscientific studies of relevant clinical features including taste, pain perception and reward processing. This hypothesis, if sustainable, would be the first fully to explain the disorder and predicts promising novel treatment possibilities including Cognitive Remediation and Motivation Enhancement Therapies. The knowledge that the challenging behaviours, so characteristic of AN, are the result of underlying cerebral dysfunction, rather than being purely volitional, could help to reduce the stigma patients experience and improve the therapeutic alliance in this poorly understood and difficult to treat disorder.     

国人正常肝静脉流出道及其毗邻结构的解剖学研究

目的 观察和测量国人正常肝静脉(HV)流出道及其毗邻结构,为临床应用提供解剖学基础。方法 2014年3月—2015年3月,对57例正常成人尸体标本进行解剖,观测肝左静脉(LHV)、肝中静脉(MHV)及肝右静脉(RHV)汇入下腔静脉(IVC)的开口类型、开口的水平位置关系、开口上缘与膈肌裂孔的位置关系,比较LHV、MHV及RHV开口直径的大小及其开口上缘至膈肌裂孔的距离;观察膈肌裂孔形态及其与IVC之间的组织结构,比较膈肌裂孔长径、短径的大小。两样本之间比较采用t检验;多样本之间比较采用单因素方差分析,两两比较采用LSD-t检验。结果 57例肝脏标本HV的开口类型有4种:IVC壁有2个HV开口(LHV+MHV,RHV)占73.68%(42/57),有3个HV开口(LHV、MHV、RHV)占17.54%(10/57),RHV开口旁存在直接开口于IVC的肝右上静脉占5.26%(3/57),RHV开口处被条索样结构分隔占3.51%(2/57)。LHV、MHV及RHV开口的直径分别为(9.25±1.84)mm、(8.94±1.52)mm及(14.29±2.84)mm,RHV直径大于LHV及MHV直径(P值均<0.01)。49例LHV或共干(LHV+MHV)开口上缘高于RHV,占85.96%(49/57);8例与RHV开口上缘等高,占14.04%(8/57)。39例RHV和37例LHV、MHV开口位于膈肌裂孔下方,2例LHV+MHV共干开口上缘位于膈肌裂孔上方。位于膈肌裂孔下方的LHV、MHV及RHV开口上缘至膈肌裂孔的最短距离分别为(3.19±0.74)mm、(3.62±0.81)mm及(9.03±3.02)mm,RHV开口上缘至膈肌裂孔的距离大于LHV、MHV至膈肌裂孔的距离,差异均有统计学意义(P值均<0.01)。膈肌裂孔的长径和短径分别为(26.94±3.47)mm及(19.62±2.80)mm,裂孔长径大于短径(t=10.242,P<0.01),HE染色显示膈肌裂孔处的IVC管壁外分布大量纤维结缔组织。结论 正常成人HV汇入IVC的开口类型中以LHV及MHV共干最多见,其开口水平位置多高于RHV开口,少部分RHV开口被条索状结构分开;LHV及MHV开口至膈肌裂孔的距离更近,少部分LHV及MHV开口上缘位于膈肌裂孔上方;IVC与膈肌裂孔之间间隙由纤维结缔组织所充填,而非膈肌中心键直接附着。这些解剖特点将有助于HV流出道疾病的临床研究及治疗方案的选择。     

Anatomy of the tibiofibular syndesmosis and its clinical relevance

The purpose of the present study was to describe the anatomical structure of the tibiofibular syndesmosis. Dissection of the tibiofibular syndesmosis was performed on 30 cadaveric specimens of the ankle in adults. The stability of the tibiofibular mortise is ensured by three ligaments. The interosseous tibiofibular ligament forms a spatial network of fibers of a pyramidal shape filled with fibrofatty tissue. The anterior tibiofibular ligament consists of three parts: the upper one is the shortest, the medial one is the strongest and the lower part is the longest and the thinnest. The posterior tibiofibular ligament is a strong, compact ligament the lower margin of which literally forms the articular labrum for the lateral ridge of the trochlea of the talus. The so-called inferior transverse tibiofibular ligament, as this part of the ligament is sometimes characterized, cannot be considered as a separate ligament. Direct contact between the distal tibia and the fibula was found in 23 cases. Contact facets which were covered with articular cartilage were very small and located in the anterior half of the tibiofibular contact line. In the posterior part of the tibiofibular contact line a vertical V-shaped synovial plica attached by its lateral aspect to the fibula dipped between the two bones. In seven cases where there was no direct contact between the two bones this plica extended anteriorly to the anterior tibiofibular ligament. The findings show that in three quarters of cases the connection of the distal tibia and fibula is not a mere syndesmosis but also a synovial joint. The presented facts change traditional opinions on the structure of the tibiofibular syndesmosis and they should be reflected in the treatment of dislocation-fractures of the ankle as well as in case of so-called anterolateral ankle impingement.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at .

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Anatomie de la syndesmose tibio-fibulaire et son importance clinique

Résumé Le but du présent travail était de décrire la structure anatomique de la syndesmose tibio-fibulaire. La dissection de la syndesmose tibio-fibulaire a été réalisée sur 30 spécimens cadavériques de chevilles d'adultes. La stabilité de la mortaise tibio-fibulaire est assurée par trois ligaments. Le ligament tibio-fibulaire interosseux forme un réseau spatial de fibres, de forme pyramidale, dont les mailles sont remplies de tissu fibro-adipeux. Le ligament tibio-fibulaire antérieur est formé de trois parties; la partie supérieure est la plus courte, la partie médiale est la plus forte et la partie inférieure est la plus longue et la plus mince. Le ligament tibio-fibulaire postérieur est un fort ligament compact dont le bord inférieur forme littéralement un labrum articulaire destiné à la berge latérale de la trochlée du talus. Ce qui est classiquement appelé " ligament tibio-fibulaire transverse inférieur", comme on le dénomme parfois, ne peut être considéré comme un ligament séparé. Un contact direct entre l'extrémité distale du tibia et de la fibula a été trouvé dans 23 cas. Les facettes en contact, recouvertes de cartilage articulaire, étaient très petites et situées sur la moitié antérieure de la ligne de contact tibio-fibulaire. Sur la partie postérieure de la ligne de contact tibio-fibulaire, un repli synovial vertical en forme de V, attaché par son bord latéral à la fibula, plonge entre les deux os. Dans 7 cas où il n'y avait pas de contact direct entre les deux os, ce repli s'étendait vers l'avant jusqu'au ligament tibio-fibulaire antérieur. Nos constatations montrent que, dans trois quarts des cas, l'articulation entre la partie distale du tibia et celle de la fibula n'est pas une syndesmose pure, mais qu'il s'agit aussi d'une articulation synoviale. Les faits que nous présentons changent les idées traditionnelles sur les structures de la syndesmose tibio-fibulaire et ils devraient trouver des applications, principalement dans le traitement des luxations-fractures de la cheville, ainsi que dans les cas de ce que l'on désigne sous le terme de "conflit antéro-latéral de la cheville".

     

颈椎间孔韧带的解剖特点及其临床意义

神经根型颈椎病是临床常见疾病,可引起上肢感觉或运动障碍,其病因可能是神经根受到各种直接机械压迫[1]。神经根自硬膜囊发出后向外下方走行,经椎间孔出椎管,椎间孔内软组织增生、肥厚、粘连等病理改变均可使经过该处的神经根受到压迫,导致出现相应的临床症状如放射性上肢疼痛、麻木或无力等。想要更清楚地了解神经根卡压的机制,需要对颈椎间孔区域进行更加深入的解剖学研究。掌握颈椎间孔韧带的解剖特点有助于提高神经根型颈椎病的诊断和治疗水平,在该区域手术操作时尽可能地减少医源性损伤。有关胸腰椎(T1~5)的椎间孔韧带研究证明其韧带起到限制神经根移位并防止拉伤的作用[2~4]。然而,目前关于颈椎间孔韧带的研究尚少。本文结合国内外文献资料,对颈椎间孔韧带的相关知识作一综述。     

膝关节横断面解剖及临床意义

目的：明确膝关节横断面的解剖学特点，探讨其临床应用价值。方法：用火棉胶包埋技术对4侧成人尸体膝部进行水平位1～2mm厚的连续切片，观察膝部各结构在断面上的形态、位置和毗邻关系。结果：详细描述了膝部各结构的横断面表现。结论：膝关节横断面可较好显示膝部结构的位置关系，对膝关节疾病的影像学诊断具有重要价值。     

结节间沟及其毗邻结构断层解剖学研究

目的本文旨在研究肱二头肌长头脱位的机制以及相关手术方法提供结节间沟和其毗邻结构的解剖学基础。方法成人尸体肩关节部标本3例,制成1.0～1.5 mm厚的水平位、矢状位、冠状位火棉胶连续切片。结果①肩胛下肌肌腱发出之后沿肩关节囊前方走行,在小结节前侧,与关节囊紧密结合,横过结节间沟,扩展到大结节外侧面与冈上肌肌腱指点相融合。②肱二头肌长头通过结节间沟部分表面由肌腱腱鞘所包绕。③结节间沟出口平面,喙肱韧带内侧分支和盂肱上韧带形成复合体结构,加强肱二头肌长头内侧。结论①肩胛下肌肌腱不止于小结节,而是越过结节间沟表面和冈上肌肌腱止点融合;②喙肱韧带和盂肱上韧带是防止肱二头肌长头脱位的重要的结构之一;③手术治疗此种损伤造成的肱二头肌长头脱位应重建其解剖学结构,以防止再脱位的发生。     

Taste representation in the human insula

The sense of taste exists so that organisms can detect potential nutrients and toxins. Despite the fact that this ability is of critical importance to all species there appear to be significant interspecies differences in gustatory organization. For example, monkeys and humans lack a pontine taste relay, which is a critical relay underlying taste and feeding behavior in rodents. In addition, and of particular relevance to this special issue, the primary taste cortex appears to be located further caudally in the insular cortex in humans compared to in monkeys. The primary aim of this paper is to review the evidence that supports this possibility. It is also suggested that one parsimonious explanation for this apparent interspecies differences is that if, as Craig suggests, the far anterior insular cortex is newly evolved and unique to humans, then the human taste cortex may only appear to be located further caudally because it is no longer the anterior-most section of insular cortex. In addition to discussing the location of taste representation in human insular cortex, evidence is presented to support the possibility that this region is better conceptualized as an integrated oral sensory region that plays role in feeding behavior, rather than as unimodal sensory cortex.