健侧颈7神经根移位术治疗痉挛性偏瘫的临床效果分析

目的探讨健侧颈7神经根移位术治疗高血压性脑出血术后遗留痉挛性偏瘫的临床疗效。方法回顾性分析2021年1—6月周口市中心医院神经外科收治的6例痉挛性偏瘫患者的临床资料, 其中5例为原发性高血压性脑出血, 1例为妊娠高血压性脑出血, 均行颅内血肿清除术治疗后遗留痉挛性偏瘫, 经康复训练无效后均行健侧颈7神经根移位术。通过改良Ashworth量表(MAS)分级评估患侧肢体的肌张力;采用简化Fugl-Meyer运动功能量表(FMA)评分评估患者的上肢运动功能;采用Berg平衡量表(BBS)评分评估患者躯体平衡功能;采用波士顿诊断性失语症检查量表(BDAE)分级评估患者的语言功能。结果 6例患者的手术均顺利完成, 术后健侧肢体肌力无改变, 但均出现健侧肢体麻木感(术后6个月内症状均消失), 5例出现健侧肢体乏力感(术后3个月内症状均消失), 4例出现颈部肿胀感(术后1周症状均消失), 无切口感染、呼吸困难及吞咽异物感等其他并发症发生。6例患者术前, 术后6、12个月的MAS分级、FMA评分、BBS评分的差异均有统计学意义(均P<0.05), 而BDAE分级的差异无统计学意义(F=3.71,...     

颈7神经根移位术治疗颈段哑铃型神经鞘瘤一例

患者　女 ,38岁。因左侧肢体麻木、无力并进行性加重入院。ＭＲＩ示Ｃ6 ～Ｔ1 哑铃型神经鞘瘤 ,椎间孔不大 ,但肿瘤从Ｃ7～Ｔ1 椎间孔突出于椎管外。首先一期切除椎管内肿瘤。椎管外部分二期切除 ,2次手术前左下肢肌力四级 ,左上肢环指、小指及肘部以下皮肤痛觉迟纯 ,大鱼际肌萎缩 ,拇指活动尚可 ,手术暴露出Ｃ5～Ｔ1 神经根后 ,见神经根根部膨大约1ｃｍ× 1ｃｍ× 3ｃｍ ,肿瘤与Ｃ8神经根粘连紧密 ,切除椎管外及椎间孔内肿瘤。因Ｃ8神经损伤后将影响建手的抓握肌力 ,于是将Ｃ8远端与切断的同侧Ｃ7神经近端 ,行端 端吻合。 2次术后病理均为…     

实时定量RT-PCR法检测健侧C7神经移位前后神经生长相关蛋白43的变化**★

背景：已有研究证实，周围神经损伤后大脑皮质会出现功能可塑性变化；神经生长相关蛋白43在发育中神经系统的表达特征提示，它与神经发育中突起延伸和突触形成有关，参与突触重建过程。 目的：实时定量RT-PCR方法检测实验动物健侧颈7神经根移位前后，不同阶段相应大脑皮质组织神经生长相关蛋白 mRNA 的相对表达量及动态变化,探讨周围神经修复与中枢神经可塑性的关系。 设计、时间及地点：随机对照动物实验，于2007-09/2008-12在上海市周围神经重点实验室和复旦大学实验动物科学部完成。 材料：成年SD大鼠108只，分为臂丛损伤未修复组(n＝48)、臂丛损伤修复组(n＝48)及对照组(n＝12)。 方法：大鼠左侧为实验侧，臂丛损伤未修复组在大鼠左侧取锁骨下横形切口，找到臂丛各神经根并造成全臂丛根性撕脱伤。臂丛损伤修复组同法将大鼠全臂丛神经根性撕脱后，取右侧锁骨下切口，显露健侧颈C7神经根备用；取左侧前臂尺神经通过皮下隧道桥接健侧颈7神经根与正中神经端端吻合。对照组为成年雌性正常大鼠，不进行任何处理。 主要观察指标：于术后1 d，3 d，1周，2周，1个月，3个月，6个月，10个月共8个时段及对照组取材，采用SYBR GreenⅠ实时定量RT-PCR法检测健侧颈7神经根移位术前后对侧(右侧)大脑前肢投射区域皮质组织生长相关蛋白43 mRNA相对表达量及动态变化。 结果：臂丛损伤未修复组对侧(右侧)大脑前肢投射区域皮质组织生长相关蛋白43 mRNA的相对表达量变化规律为术后第1天开始升高，第3天达到高峰，然后逐渐降低。术后1 d，3 d和1周与对照组比较差异具有显著性意义 (P < 0.05，P < 0.01)。臂丛损伤修复组对侧(右侧)大脑前肢投射区域皮质组织生长相关蛋白43 mRNA的相对表达量变化规律为术后第1天开始升高，第3天达到高峰，然后逐渐降低，至术后3个月再次升高，6个月达到高峰，然后逐渐降低。术后1 d，3 d，1周和6个月与对照组比较差异具有显著性意义(P < 0.05，P < 0.01)。 结论：臂丛损伤健侧颈7移位术前后相应大脑皮质生长相关蛋白表达变化与临床现象一致，提示生长相关蛋白在大脑皮质及突触可塑性方面发挥作用。     

不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效比较

目的分析不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效,并探讨手术效果影响因素。方法选取2011-01—2017-12平顶山市第五人民医院骨科收治的行神经移位修复术治疗臂丛神经根性撕脱伤患者94例作为研究对象,分别行健侧颈7神经移位术(32例)、肋间神经移位术(30例)及膈神经移位术(32例),收集患者基本资料,并对患者术后患肢肘关节功能及肌力恢复情况进行评估。结果3组患者肘关节恢复达到良以上分别为膈神经组21例(65.6%),肋间神经组20例(66.7%),C7神经组23例(71.9%),3组患者术后肘关节功能恢复情况比较,差异无统计学意义(P>0.05)。术后膈神经组、肋间神经组,C7神经组肌力≥Ⅲ级的例数分别为25例(78.1%)、22例(73.3%)、25例(78.1%),3组患者术后患肢肌力恢复情况无显著性差异(P>0.05)。3组术后肘关节功能恢复的影响因素存在差异。(1)膈神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P<0.05);(2)肋间神经组术后肘关节功能恢复情况与功能锻炼时间、损伤部位和神经移植长度等因素有关(P均<0.05);(3)C7神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度等因素有关(P<0.05)。与3组患者术后肘关节功能恢复情况均有关的影响因素为神经移植长度。3组患者术后肌力恢复的影响因素存在差异。(1)膈神经组肌力恢复情况与患者年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P均<0.01);(2)肋间神经组肌力恢复情况与年龄、功能锻炼时间和神经移植长度等因素有关(P均<0.01);(3)颈7神经组肌力恢复情况与年龄、功能锻炼时间及损伤-手术时间等因素有关(P均<0.01)。结论3种供体神经移植修复臂丛神经根性撕脱伤效果相当,但术后效果的影响因素不尽相同,因此根据患者具体情况选择最优的治疗方式,有利于提高手术有效率。     

神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的研究

目的 探讨神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的效果及对神经营养因子、细胞因子水平的影响。方法 选取2019年2月—2021年3月徐州医科大学第二附属医院脑梗死后偏瘫肩痛患者114例,以随机数字表法分为观察组、对照组,各57例。对照组采取神经松动术,观察组采取神经松动术联合经颅磁刺激,均治疗2周。酶联免疫吸附法测定血清脑源性神经营养因子（BDNF）、促生长因子-1（IGF-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、一氧化氮（NO）水平。结果 观察组治疗2周后总有效率为94.74%,高于对照组的75.44%（P＜0.05）;观察组治疗1和2周后视觉模拟评分量表（VAS）评分均较对照组低,Fugl-Meyer运动功能评定量表（FMA）-上肢部分、日常生活活动能力量表（Barthel指数,BI）评分均较对照组高（P＜0.05）;观察组治疗1周、2周后肩关节外旋、内旋、外展、后伸、前屈活动度均较对照组高（P＜0.05）;观察组治疗1周、2周后血清BDNF、IGF-1水平均高于对照组,TNF-α、IL-6、NO水平均低于对照组（P＜0.05）。结论 应用神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛患者可降低疼痛程度,提升肩关节活动度、上肢功能、日常生活能力,调节血清神经营养因子、细胞因子表达,提升疗效。国际神经病学神经外科学杂志, 2022, 49(6): 54-58]     

神经干细胞移植治疗中枢神经系统疾病的临床观察

我科于2006-10～2008-12为13例不同原因造成的脑损害患者做了神经干细胞脑内移植术,取得初步成效,现将研究及观察结果报告如下.     

肋间神经切断治疗剖胸术后胸痛临床观察

目的观察肋间神经切断在剖胸术后胸痛中的治疗作用。方法收集2009—2012年我科58例剖胸手术患者,随机分为2组,对照组25例行常规剖胸术,观察组33例在剖胸术后关胸时行肋间神经切断术,对患者术后3、7、14、21d疼痛程度进行评估(VAS法),对2组患者术后因镇痛所致并发症进行比较。结果观察组患者术后3、7、14、21d自觉疼痛程度减轻,与对照组比较,差异有统计学意义(P<0.05)。结论肋间神经切断对剖胸术后胸痛的作用明显,且操作简单,可显著改善患者术后的生活质量。     

神经内镜微血管减压术治疗原发性面肌痉挛临床观察

目的分析神经内镜微血管减压术治疗原发性面肌痉挛的临床疗效。方法选取我院收治的130例原发性面肌痉挛患者作为研究对象,随机分为对照组和观察组各65例,对照组给予常规微血管减压术治疗,观察组给予神经内镜微血管减压术治疗。观察2组复发情况、并发症发生率以及临床效果,并作对比分析。结果术后随访1a,观察组术后复发率和并发症发生率明显低于对照组,2组比较差异有统计学意义(P0.05);观察组治愈率98.5%,明显高于对照组的86.2%,2组比较差异有统计学意义(P0.05)。结论采用神经内镜微血管减压术治疗原发性面肌痉挛具有较高的临床应用价值,能够有效缓解患者病情,降低术后复发率和并发症发生率,效果显著,值得临床推广。     

术中磁共振影像神经导航手术的临床初步应用

目的:探讨术中核磁共振影像神经导航(intraoperative MR image-based neuronavigation)技术在神经外科手术的意义。方法:应用PoleStarN-20术中磁共振成像(iMRI)神经导航系统施行神经外科手术22例。对其临床资料、iMRI情况,及其对手术进程和手术结果的影响进行分析。结果:22例手术中,经鼻-蝶垂体瘤切除术10例,幕上开颅肿瘤切除术10例,幕下开颅肿瘤切除术2例。iMRI扫描次数从2～5次不等,平均2.6次。共有9例术中扫描发现有肿瘤残留,其中8例(36.4%),需做进一步的切除,最终肿瘤的全切率从60%提高到86.4%。无与iMRI相关的并发症。结论:iMRI神经导航技术的应用,为神经外科手术入路的选择、皮肤切口的设计、手术进程的指导及手术结果的实时判断提供了客观的依据,从而在提高手术的精确性和安全性的同时,提高了颅脑肿瘤的全切率。     

Super-selective cervical nerve root stimulation in contralateral C7 transfer: An intraoperative study

Objective

We designed this study using super-selective intraoperative cervical nerve root stimulation aiming to support decision making about complete or partial contralateral C7 (cC7) nerve root transfer in patients with multiple cervical root avulsion injury.

Corticomotor excitability of arm muscles modulates according to static position and orientation of the upper limb

Objective

We investigated how multi-joint changes in static upper limb posture impact the corticomotor excitability of the posterior deltoid (PD) and biceps brachii (BIC), and evaluated whether postural variations in excitability related directly to changes in target muscle length.

Methods

The amplitude of individual motor evoked potentials (MEPs) was evaluated in each of thirteen different static postures. Four functional postures were investigated that varied in shoulder and elbow angle, while the forearm was positioned in each of three orientations. Posture-related changes in muscle lengths were assessed using a biomechanical arm model. Additionally, M-waves were evoked in the BIC in each of three forearm orientations to assess the impact of posture on recorded signal characteristics.

Results

BIC-MEP amplitudes were altered by shoulder and elbow posture, and demonstrated robust changes according to forearm orientation. Observed changes in BIC-MEP amplitudes exceeded those of the M-waves. PD-MEP amplitudes changed predominantly with shoulder posture, but were not completely independent of influence from forearm orientation.

Conclusions

Results provide evidence that overall corticomotor excitability can be modulated according to multi-joint upper limb posture.

Significance

The ability to alter motor pathway excitability using static limb posture suggests the importance of posture selection during rehabilitation aimed at retraining individual muscle recruitment and/or overall coordination patterns.     

重组腺相关病毒载体在中枢神经系统转基因研究中的应用

重组腺相关病毒（recombinant adeno-associated virus,rAAV）作为转基因载体具有无神经毒性和低免疫原性等优点,因此在基因治疗的基础研究和临床应用领域倍受重视.在中枢神经系统（central nervous system,CNS）,以rAAV为载体已经成功转导了脑和脊髓的多个部位.随着国内外对rAAV载体研究的日趋深入,其优势已为学术界所公认,现已应用于数项CNS疾病临床前期的基因治疗,其有可能成为转基因治疗CNS疾病的最佳载体.     

Metastases in cerebellopontine angle from the tumors of central nerve system

The objective of this study was to analyze the characters of the cerebellopontine angle (CPA) metastases from central nerve system (CNS) tumors. Ten patients were reviewed for the period between 2008 and 2015. The clinical and neuroimaging features, and treatment outcomes were analyzed retrospectively. The average period during primary diagnosis through the diagnosis of CPA metastases was 42.4 months. Among the 10 cases, the primary tumors and metastases were found simultaneously in 3 cases, the metastases after primary tumor removal were found in 5 cases, and the metastases after stereotaxic radiosurgery were found in 2 cases. Only 4 patients presented with the symptoms and signs associated with CPA involving, one with hearing loss, one presenting facial paralysis, one suffering from tinnitus and one case with dizziness. There were 2 cases with the miliary metastases and 8 cases with massive metastases. There existed 3 cases with single CPA metastases, whereas 7 cases with multiple metastatic foci. Among the 8 cases of massive metastatic foci, 6 tumors presented the solid features and the other 2 cases exhibited cystic and solid features. In this cohort of cases, 4 cases were involved in the bilateral and 6 cases presented unilateral metastatic foci. The three CPA metastases were removed in this group, 6 case performed with radiotherapy, and 5 cases received chemotherapy. In the current group 5 patients have been dead, 3 patients kept stable and 2 cases experienced improvement. In spite of seldom previous reports regarding the metastases from CNS tumors occurring in the CPA are existent, this rare form of the disease should be considered in future evaluation as a differential diagnosis.     

Intercellular mitochondrial transfer in the brain,a new perspective for targeted treatment of central nervous system diseases

Aim

Mitochondria is one of the important organelles involved in cell energy metabolism and regulation and also play a key regulatory role in abnormal cell processes such as cell stress, cell damage, and cell canceration. Recent studies have shown that mitochondria can be transferred between cells in different ways and participate in the occurrence and development of many central nervous system diseases. We aim to review the mechanism of mitochondrial transfer in the progress of central nervous system diseases and the possibility of targeted therapy.

Methods

The PubMed databank, the China National Knowledge Infrastructure databank, and Wanfang Data were searched to identify the experiments of intracellular mitochondrial transferrin central nervous system. The focus is on the donors, receptors, transfer pathways, and targeted drugs of mitochondrial transfer.

Results

In the central nervous system, neurons, glial cells, immune cells, and tumor cells can transfer mitochondria to each other. Meanwhile, there are many types of mitochondrial transfer, including tunneling nanotubes, extracellular vesicles, receptor cell endocytosis, gap junction channels, and intercellular contact. A variety of stress signals, such as the release of damaged mitochondria, mitochondrial DNA, or other mitochondrial products and the elevation of reactive oxygen species, can trigger the transfer of mitochondria from donor cells to recipient cells. Concurrently, a variety of molecular pathways and related inhibitors can affect mitochondrial intercellular transfer.

Conclusion

This study reviews the phenomenon of intercellular mitochondrial transfer in the central nervous system and summarizes the corresponding transfer pathways. Finally, we propose targeted pathways and treatment methods that may be used to regulate mitochondrial transfer for the treatment of related diseases.     

A collagen-based nerve guide conduit for peripheral nerve repair: an electrophysiological study of nerve regeneration in rodents and nonhuman primates

When a peripheral nerve is severed and left untreated, the most likely result is the formation of an endbulb neuroma; this tangled mass of disorganized nerve fibers blocks functional recovery following nerve injury. Although there are several different approaches for promoting nerve repair, which have been greatly refined over recent years, the clinical results of peripheral nerve repair remain very disappointing. In this paper we compare the results of a collagen nerve guide conduit to the more standard clinical procedure of nerve autografting to promote repair of transected peripheral nerves in rats and nonhuman primates. In rats, we tested recovery from sciatic nerve transection and repair by 1) direct microsurgical suture, 2) 4 mm autograft, or 3) entubulation repair with collagen-based nerve guide conduits. Evoked muscle action potentials (MAP) were recorded from the gastrocnemius muscle at 4 and 12 weeks following sciatic nerve transection. At 4 weeks the repair group of direct suture demonstrated a significantly greater MAP, compared to the other surgical repair groups. However, at 12 weeks all four surgical repair groups displayed similar levels of recovery of the motor response. In six adult male Macaca fascicularis monkeys the median nerve was transected 2 cm above the wrist and repaired by either a 4 mm nerve autograft or a collagen-based nerve guide conduit leaving a 4 mm gap between nerve ends. Serial studies of motor and sensory fibers were performed by recording the evoked MAP from the abductor pollicis brevis muscle (APB) and the sensory action potential (SAP) evoked by stimulation of digital nerves (digit II), respectively, up to 760 days following surgery. Evoked muscle responses returned to normal baseline levels in all cases. Statistical analysis of the motor responses, as judged by the slope of the recovery curves, indicated a significantly more rapid rate of recovery for the nerve guide repair group. The final level of recovery of the MAP amplitudes was not significantly different between the groups. In contrast, the SAP amplitude only recovered to the low normal range and there were no statistically significant differences between the two groups in terms of sensory recovery rates. The rodent and primate studies suggest that in terms of recovery of physiological responses from target muscle and sensory nerves, entubulation repair of peripheral nerves with a collagen-based nerve guide conduit over a short nerve gap (4 mm) is as effective as a standard nerve autograft.(ABSTRACT TRUNCATED AT 400 WORDS)     

The distribution of cholecystokinin-8 in the central nervous system of turtles: An immunohistochemical and biochemical study

Immunohistochemical techniques, radioimmunoassay (RIA) and high performance liquid chromatography (HPLC) were used to: (1) determine the regional distribution and amounts of cholecystokinin-8 (CCK8)-like immunoreactivity in the turtle central nervous system, and (2) chemically characterize the CCK8-like material present in the turtle central nervous system. High levels of CCK8-like immunoreactivity were found in the turtle central nervous system, with the highest levels being present in the hypothalamus and neurohypophysis. Moderate levels of the CCK8-like material were found in all other regions of the turtle nervous system except the cerebellum, the olfactory bulbs and the dorsal ventricular ridge of the telencephalon, which contained low levels. The bulk (87%) of the CCK8-like material in turtle central nervous system co-eluted with CCK8-sulfate in gradient elution HPLC. The distribution of CCK8-like immunoreactivity (CCK8LI) observed using immunohistochemistry was consistent with the results of the RIA studies. Numerous CCK8LI-containing neurons and fibers were observed in the hypothalamus and neurohypophysis. Neurons and fibers containing CCK8 were, however, more sparsely distributed outside the hypothalamus. The immunohistochemical data provided evidence for the existence of two major CCK8-containing pathways in turtles that have been previously described in mammals: a pathway from the supraoptic and paraventricular magnocellular nuclei to the external zone of the median eminence and neurohypophysis and a pathway from dorsal root ganglia to the dorsal horn of the spinal cord. Overall, the present results, in conjunction with several previous studies, indicate that CCK8 has had a relatively stable evolutionary history as a CNS neuropeptide among land vertebrates. The molecular structure of CCK8 appears to have been largely (if not entirely) conserved, as has its concentration in many brain regions. A noteworthy exception to such conservatism in the localization of CCK8 is that the concentration of CCK8 in the telencephalon, particularly in the telencephalic cortex, is much lower in turtles than in mammals. The present results therefore suggest that CCK8 may not have become a prominent peptide in the telencephalic cortex (or its anatomical equivalents) until the evolution of neocortex in the mammalian lineage.