MRI下眦耳线与前联合-后联合线在矢状平面投射夹角的临床应用

目的 探讨眦耳线与前联合-后联合(AC-PC)线于矢状平面投射的夹角在神经外科立体定向手术中的意义及应用. 方法 采用3.0T多源MRI机扫描中国华南地区120例汉族成人健康志愿者的颅脑图像,计算眦耳线与AC-PC线在矢状平面投射夹角,并测量前后联合间径、外耳门中点至AC-PC平面垂直距离,分析比较3组数据在性别、年龄间的差异性,并对测得数据进行临床验证. 结果 华南地区正常汉族成人眦耳线与AC-PC线平均投射夹角为12.03°±1.11°,其中男性12.17°±1.06°,女性11.89°±1.14°;前后联合间径平均为23.74mm±0.95mm,其中男性24.35mm±0.64 mm,女性23.14 mm±0.95 mm;垂直距离平均为48.69 mm±4.03 mm,其中男性49.57 mm±3.10 mm,女性47.82mm±4.61mm.经临床验证,所得AC-PC平面与实际AC-PC平面偏差角度为1.56°±0.63°. 结论 在不同年龄、性别人群中眦耳线与AC-PC线在矢状平面投射夹角相对稳定,以眦耳线作为基线,结合所测夹角与垂直距离,可在体表勾画出AC-PC投影线,以此调整定向头架安装获得AC-PC平面具有较高的准确性与可重复性,亦可以作为华南地区汉族成人脑结构重要的参考值.     

Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy★ A randomized controlled trial

BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the     

Plasma thrombomodulin changes in acute cerebral infarction or hypertension patients*★ An observation for verification

BACKGROUND： Thrombomodulin concentration greatly increases in plasma when vascular endothelial cells are injured, and it is one of the specific molecular markers for endothelial injury. OBJECTIVE： To analyze the plasma levels of thrombomodulin after cerebral infarction or hypertension, and to compare levels with those from healthy control subjects. DESIGN： A case-controlled observation. SETTING： Yuquan Hospital of Tsinghua University. PARTICIPANTS： Patients with hypertension （n = 37） and acute cerebral infarction （n = 26） were selected from the outpatient and inpatient Department of Neurology, Yuquan Hospital of Tsinghua University from February 2003 to February 2006. The cerebral infarction group consisted of 24 males and 2 females, 36-77 years of age, with a mean age of 62 years. All patients fulfilled the diagnosis criteria for cerebral infarction, according to the diagnostic standards revised by the Second National Academic Meeting for Cerebrovascular Disease, and were confirmed by CT or MRI. The hypertension group consisted of 27 males and 10 females, 36-77 years of age, with a mean age of 56 years. These patients fulfilled the diagnostic criteria for hypertension set by WHO. In addition, 43 healthy physical examinees were selected as the control group, consisting of 23 males and 20 females, 35-67 years of age. Informed consent was obtained from all participants. METHODS： In the cerebral infarction group, thrombomodulin plasma levels were determined by enzyme-linked immunoabsorbent assay at days 1, 3, 7, and 14 after attack. Thrombomodulin plasma levels were determined only once in the hypertension group and the control group. The results from the cerebral infarction group were compared with those from the hypertension group and the control group. MAIN OUTCOME MEASURES： Level of thrombomodulin in plasma. RESULTS： All 63 patients and 43 healthy volunteers were included in the final analysis of results. （1） At 7 days after the attack, the plasma levels of thrombomodulin in the cereb     

Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population

High-resolution ultrasound has been used recently to characterize median and ulnar nerves,but is seldom used to characterize radial nerves.The radial nerve is more frequently involved in entrapment syndromes than the ulnar and median nerves.However,the reference standard for normal radial nerves has not been established.Thus,this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers,aged 18 to 75,using high-resolution ultrasound.The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus(midpoint between the elbow crease and axilla) were 5.14 ± 1.24 and 5.08 ± 1.23 mm2,respectively.The age and the dominant side did not affect the results,but the above-mentioned cross-sectional areas were larger in males(5.31 ± 1.25 and 5.19 ± 1.23 mm2) than in females(4.93 ± 1.21 and 4.93 ± 1.23 mm2,respectively).In addition,the cross-sectional areas of radial nerves were positively correlated with height and weight(r = 0.38,0.36,respectively,both P 0.05).These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis,treatment,and prognostic evaluation of peripheral neuropathies.     

Normal values of flash visual evoked potentials in rabbits: Differences between the sexes and the eyes

BACKGROUND: The wave form, latency and wave amplitude of visual evoked potentials (VEP) are obviously affected by the stimulative parameters, physiological status of the subjects and anesthetics, thus there are greater normal variations and individual differences. The features of flash VEP (F-VEP) are to be observed. OBJECTIVE: To observe and compare the differences of F-VEP latencies and wave amplitudes between eyes in rabbits, and investigate the correlation with sex and the side of eyes. DESIGN: A comparative animal experiment. SETTING: Department of Neurosurgery, General Hospital of Chinese PLA. MATERIALS: The experiment was carried out in the neurophysiological laboratory of the Institute of Neurosciences, General Hospital of Chinese PLA from September 2004 to February 2005. Thirty big-ear rabbits of clean degree, 15 males and 15 females, weighing 2.0-2.5 kg, were provided by the animal center of the General Hospital of Chinese PLA. METHODS: Viking-IV perioperative monitor and flash stimulator for special use were applied. The rabbits were anesthetized with intramuscular injection of compound ketamine. The recording electrode was placed at 3 mm anterior to exoccipital tuberosity (onion, Oz), and the reference electrode was placed at the ear edge of the same side. The stimulative frequency was 1.9 Hz, and the amplifier was 50 μV; The range of wave filter was 5 Hz for high pass and 100 Hz for low pass; The average overlapping was 200 times, and the analytical time was 250 ms. MAIN OUTCOME MEASURES: Comparison of F-VEP wave forms; F-VEP latencies and wave amplitudes. RESULTS: All the 30 rabbits were involved in the analysis of results. ① Comparison of F-VEP wave forms in rabbits: The F-VEP waves mainly manifested as positive-negative-positive (PNP). The F-VEP manifestations to light stimulations were extremely similar between left and right eyes, and the wave amplitudes of both eyes were obviously increased. ② Determinations of F-VEP latencies and wave amplitudes: There were no significant differences in the latencies and wave amplitudes of F-VEP between the two groups (P > 0.05), the latencies of P1, N1 and P2 waves of left eye were (32.59±2.01), (43.85±4.35) and (66.20±8.13) ms, respectively, and the wave amplitudes of P1, N1 and P2 waves of left eye were (16.45±10.22), (7.93±3.56) and (17.62±8.18) μV. F-VEP latencies were stable with small changes, whereas amplitudes had greater changes. CONCLUSION: ① The latency and wave amplitudes F-VEP were stable with good repetition. ② The latencies and wave amplitudes had no significant differences between males and females, as well as between left and right eyes. Further investigation should be undertaken on the animal and clinical field.     

应用微型机器人装置对难治性癫痫患者进行脑深部电极植入（英文）

OBJECTIVE The authors'group recently published a novel technique for a navigation-guided frameless stereotactic approach for the placement of depth electrodes in epilepsy patients.To improve the accuracy of the trajectory and enhance the procedural workflow,the authors implemented the iS ys1 miniature robotic device in the present study into this routine.METHODS As a first step,a preclinical phantom study was performed using a human skull model,and the accuracy and timing between 5 electrodes implanted with the manual technique and 5 with the aid of the robot were compared.After this phantom study showed an increased accuracy with robot-assisted electrode placement and confirmed the robot's ability to maintain stability despite the rotational forces and the leverage effect from drilling and screwing,patients were enrolled and analyzed for robot-assisted depth electrode placement at the authors'institution from January 2014 to December 2015.All procedures were performed with the S7 Surgical Navigation System with Synergy Cranial software and the iS ys1 miniature robotic device.RESULTS Ninety-three electrodes were implanted in 16 patients(median age 33 years,range 3~55years;9 females,7 males).The authors saw a significant increase in accuracy compared with their manual technique,with a median deviation from the planned entry and target points of 1.3 mm(range 0.1~3.4 mm)and 1.5 mm(range 0.3~6.7 mm),respectively.For the last 5 patients(31 electrodes)of this series the authors modified their technique in placing a guide for implantation of depth electrodes(GIDE)on the bone and saw a significant further increase in the accuracy at the entry point to 1.18±0.5 mm(mean±SD)compared with 1.54±0.8 mm for the first 11 patients(P=0.021).The median length of the trajectories was 45.4 mm(range 19~102.6 mm).The mean duration of depth electrode placement from the start of trajectory alignment to fixation of the electrode was 15.7 minutes(range8.5-26.6 minutes),which was significantly faster than with the manual technique.In 12 patients,depth electrode placement was combined with subdural electrode placement.The procedure was well tolerated in all patients.The authors did not encounter any case of hemorrhage or neurological deficit related to the electrode placement.In 1 patient with a psoriasis vulgaris,a superficial wound infection was encountered.Adequate physiological recordings were obtained from all electrodes.No additional electrodes had to be implanted because of misplacement.CONCLUSIONS The iS ys1 robotic device is a versatile and easy to use tool for frameless implantation of depth electrodes for the treatment ofepilepsy.It increased the accuracy of the authors'manual technique by 60%at the entry point and over 30%at the target.It further enhanced and expedited the authors'procedural workflow.     

Changes of insulin-like growth factor-Ⅱ and insulin-like growth factor binding protein-3 in cerebrospinal fluid of children with tuberculous meningitis

BACKGROUND: Recent studies have found that insulin-like growth factors (IGFs) and insulin-like growth factor binding protein-3 (IGFBP-3) have stronger neurotrophic and neuroprotective effects. But whether their levels in cerebrospinal fluid could be used as an auxiliary indicator in differentially diagnosing tuberculous meningitis and viral encephalitis is not yet clear. OBJECTIVE: To explore the changes of insulin-like growth factor-Ⅱ (IGF-Ⅱ) and IGFBP-3 in cerebrospinal fluid (CSF) of children with tuberculous meningitis and the significance of the changes. DESIGN: A non-randomized concurrent controlled study. SETTING: Department of Pediatric Internal Medicine, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS: Thirty children with tuberculous meningitis (14 males and 16 females) were selected from the Department of Pediatric Internal Medicine, the First Affiliated Hospital of Xinxiang Medical College from January 2005 to December 2006. Tuberculous meningitis was diagnosed according to their clinical manifestations, the history of close contact with tuberculosis, typical cerebrospinal fluid changes of tuberculous meningitis, positive tuberculosis antibody and effective antituberculosis treatment. There were 30 children (13 males and 17 females) with viral encephalitis, and viral encephalitis was diagnosed according to epidemiological history, clinical manifestations, conventional and biochemical changes of cerebrospinal fluid, and negative bacteriology judgment. Meanwhile, 30 children (13 males and 17 females) without infectious and central nervous system disease were selected as the control group. Informed consent was obtained from the parents of all the enrolled children. METHODS: ① The lumbar puncture operation was implemented immediately to obtain cerebrospinal fluid (3 mL). The contents of IGF-Ⅱ and IGFBP-3 were detected with immunoradiometric assay. The concentrations of glucose and protein in cerebrospinal fluid were determined with a dry-chemical method. The number of white blood cells was counted by Fushi Method. ② The Pearson correlation analysis was used to analyze the correlation of the contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid with the leucocyte counting and the concentrations of glucose and protein in cerebrospinal fluid. MAIN OUTCOME MEASURES: The contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid, and their correlation with the leucocyte counting and the concentrations of glucose and protein in cerebrospinal fluid. RESULTS: ① Contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid: The contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid in the tuberculous meningitis group were significantly higher than those in the encephalitis virus group and control group (P < 0.05). There was no significant difference in the contents of IGF-Ⅱ and IGFBP-3 in cerebrospinal fluid between the viral encephalitis group and control group (P > 0.05). ② Correlation: The IGF-Ⅱ and IGFBP-3 contents in cerebrospinal fluid were positively correlated with the protein concentration in cerebrospinal fluid (r =0.821, 0.855, P < 0.01), but negatively with the glucose (r =0.742, –0.605, P < 0.01). CONCLUSION: ① IGFs and IGFBPs are involved in the pathophysiological process of tuberculous meningitis, as well as the glucose and protein metabolism in cerebrospinal fluid. ② The IGF-Ⅱ and IGFBP-3 contents in cerebrospinal fluid can be used as the auxiliary indicators to differentially diagnose tuberculous meningitis and viral encephalitis.     

CT辅助下听眦线及鼻翼耳郭软骨下缘线对AC-PC平面的定位

目的探讨在双源CT辅助下测量听眦线及鼻翼耳郭软骨下缘线对AC-PC平面的定位情况,达到更加准确的在成人体表勾绘出AC-PC平面。方法通过测量我院326例接受立体定向手术的成人头颅的256层高分辨率双源CT扫描仪数据,输入手术计划系统,以获得听眦线及鼻翼耳郭软骨下缘线与AC-PC线在矢状平面投射夹角、前后联合间径长度、外耳道中点至平面垂直距离等常用参考值,以便获得扫描时精准的AC-PC平面。结果采用平行于听眦线进行的CT 2 mm层厚的扫描中,AC-PC点全都存在同一层面中;在以平行于鼻翼耳郭软骨下缘线进行的CT 4mm层厚的扫描中,AC-PC点全都存在同一层面中。听眦线与AC-PC的夹角为(1.6±0.7)°,相距(48.4±4.2)mm;鼻翼耳郭软骨下缘线与AC-PC的夹角(2.3±0.3)°,相距(15.8±2.8)mm,二者差异有统计学意义(P0.05)。结论听眦线及鼻翼耳郭软骨下缘线在现有的CT扫描基线中与AC-PC连线平行度均较高,临床上实用性均较强;二者相比较,鼻翼耳郭软骨下缘线可作为更理想的立体定向功能神经外科的CT扫描基线。     

Occurrence and influential factors of depression in patients with Alzheimer disease

BACKGROUND: The differential diagnosis between depressive pseudodementia and Alzheimer disease (AD) is a clinical problem, and it is more difficult to diagnose depression in AD. OBJECTIVE: To analyze the incidence and characters of depression in AD patients, and investigate the correlative factors. DESIGN: A randomized controlled study. SETTING: Beijing Geriatrics Hospital. PARTICIPANTS: From October 2005 to July 2006, 34 patients with probable AD were selected from the Department of Dementia, Beijing Geriatrics Hospital according to National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA) criteria for AD. There were 16 males and 18 females, aged 63-85 years. Meanwhile, 30 patients with other chronic neurological disorders (CND) were selected from our hospital as the CND control group, there were 16 males and 14 females, aged 55-85 years, including 18 cases of cerebrovascular sequela, 9 of Parkinson disease and 3 of migraineurs. Another 30 patients with chronic physical diseases (CPD) were enrolled as the CPD control group, there were 15 males and 15 females, aged 57-83 years, including 15 cases of chronic bronchitis, 8 of hypertension and 7 of diabetes mellitus. Besides, 30 physical examinees were enrolled as the healthy control group, including 15 males and 15 females, aged 55-80 years. All the subjects were informed and agreed with the detection. METHODS: ① All the subjects underwent the Hamilton rating scale for depression (HAMD) (24 items) assessment, and the total score < 8 points was regarded as no depression, 8-20 as mild depression, 20-35 as moderate depression, ≥ 35 as severe depression. ② All the AD patients were assessed with Cornell scale for depression in dementia (CSDD) (19 items), and the total score < 8 points was regarded as no depression, and ≥ 8 as depression. CSDD consisted of five subscales, including mood-related signs, behavioral disturbance, cyclic functions, ideational disturbance and physical signs, which were scored as 0-2 points respectively, and the abnormal rate of each factor was observed, the abnormal rate was the percentage of number of patients suffering from the symptoms in the subscales to the total number of patients. ③ The cognitive function of the AD patients was assessed with Mini-mental status examination (MMSE) (the total score ranged 0-30 points; ≤17 in illiterate, ≤ 20 in primary school and ≤ 24 in middle school and higher was regarded as cognitive deficit) and the daily living ability of the AD patients was assessed with ADL. MAIN OUTCOME MEASURES: ① HAMD scores in all the groups; ② CDSS scores and abnormal rate of factors in AD patients; ③ MMSE score and activity of daily life (ADL) score in AD patients; ④ Correlation between depression and correlative factors in AD patients. RESULTS: All the 124 subjects were involved in the analysis of results. ① The HAMD average score of the AD group was significantly higher than those of the CND, CPD and healthy control groups [(12.7±3.2), (5.5±2.5), (3.4±1.3), (2.6±1.7) points, P < 0.01]. ② In the AD group, the CDSS average score was (5.8±4.3) points, 41.2% (14/34) met the criteria for depression. The abnormal rates in order were 44% (15/34) for mood-related signs, 32% (11/34) for behavioral disturbance, 24% (8/34) for cyclic function, 12% (4/34) for ideational disturbance and 12% (4/34) for physical signs. ③ The factors of age, course, MMSE score and ADL score were finally excluded after a multiple regression (P > 0.05). There was a negative correlation between CSDD score and onset age (P < 0.05), sex was also obviously correlated with CSDD score (P < 0.05). CONCLUSION: The incidence of depression in AD is much higher with various manifestations. Female patients are the susc and earlier onset age is the risk factor for the presence of depression in AD.     

Functional MRI activation of primary and secondary motor areas in healthy subjects☆

BACKGROUND： Functional MRI （fMRI） demonstrates the localization of hand representation in the motor cortex, thereby providing feasible noninvasive mapping of functional activities in the human brain.
OBJECTIVE： To observe cortical activation within different cortical motor regions during repetitive hand movements in healthy subjects through the use of fMRI.
DESIGN： An observational study, with each subject acting as his own control.
SETTING： Department of Radiology, the First Affiliated Hospital of Nanchang University.
PARTICIPANTS： Seven healthy volunteers, 4 males and 3 females, aged 19 to 38 years, participated in the study. All subjects were right-handed, with no neurological or psychological disorders. Informed written consent was obtained from all subjects, and the study was approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University.
METHODS： The study was performed at the Department of Radiology between June-August 2005. A 1.5 Tesla Siemens MRI scanner （Symphony, Germany） was used to acquire T1-weighted structural images, which were oriented parallel to the line running through the anterior and the posterior commissures. Subjects were instructed on a task and were allowed to practice briefly prior to the imaging procedure. The motor activation task consisted of the right hand performing a clenching movement. The T1-W images were acquired from six alternating epochs of rest and activation from all seven healthy subjects. Data were collected with echoplanar imaging of brain oxygen level dependent （BOLD） sequence. Each series comprised six cycles of task performance （30 seconds）, alternating with rest （30 seconds） periods, and 3-second time intervals. The differences between active and baseline fMRI imaging were calculated using the student t-test. Differential maps were overlaid on the high resolution TI-W structural image for neuroanatomical correlation of activation areas.
MAIN OUTCOME MEASURES： The omega-shaped hand knob     

脑前连合和后连合立体定向MRI研究及其临床意义

目的 研究健康中国人腩立体定向标志前连合(AC)、后连合(PC),为立体定向功能神经外科捉供基础数据.方法 采集健康中国成人自愿者脑MRJ图像120例,男女各60例.在正中矢状面上分别测量AC、PC的宽度和AC-PC的长度(LI),采用统计学方法 分析LI与年龄的相关性及性别差异,并将颅长纳入比较.结果 LI的长度在19.70～25.65 mm之间,平均为(22.92±1.13)mm;AC、PC平均宽度分别为(2.30±0.37)mm、(1.60±0.31)mm;本组中国成人各年龄段组人脑LI长度与年龄无相关性,男性LI长度大于女性,差异有统计学意义(P＜0.05),将颅长纳入比较后,这种差异性消欠了:AC、PC的宽度与年龄无相关性,AC的宽度女性大于男性,PC的宽度性别差异无统计学意义.结论立体定向功能神经外科中AC-PC线是稳定的脑内结构测量参考线.     

听眦线与前后联合间线关系的核磁共振研究

目的探讨听眦线（OML）作为脑立体定向手术颅内靶点定位体表扫描基线的可行性。方法采用1．5T高清MRI图像测量105例接受立体定向手术的患者前后联合连线（AC-PC）与OML、大脑长轴、丘脑长轴的夹角,分析OML与AC-PC、大脑长轴、丘脑长轴的关系及其他体表参考线基线与AC-PC的关系。结果AC-PC与OML成向下（10．17±1．46）°夹角,大脑长轴与OML成向下（9．77±1．57）°夹角,丘脑长轴与OML成向下（9．84±1．64）°夹角,大脑长轴、丘脑长轴与AC-PC基本平行。结论OML为较理想的功能神经外科定位用体表参考线,具有标志明确、操作简单的优点。     

术中超声联合神经导航辅助显微手术切除颅内肿瘤的临床研究

目的探讨术中超声联合神经导航在颅内肿瘤切除手术中的作用和价值。方法选择16例颅内肿瘤患者,利用MRI介导的神经导航系统引导开颅,采取合适的皮层入路,应用显微神经外科技术切除颅内肿瘤,利用术中超声判断病变切除的程度和范围,随访患者术后情况。结果所有病灶均在神经导航引导下开颅,神经导航术前对病变定位准确率为100%,骨窗暴露满意;术中超声能纠正术前神经导航定位的漂移;在其引导下14例获得全切除,2例获得次全切除;术后1例有对侧肢体肌力下降,1例轻度运动性失语,无颅内感染及死亡病例。结论术中超声联合神经导航辅助显微神经外科手术能提高颅内肿瘤定位的准确性,减少手术副损伤,提高肿瘤全切率,是一种安全有效的方法 。     

颅内复杂动脉瘤的颅内外血管搭桥联合动脉瘤孤立术远期疗效评价

目的 探讨颅内外血管搭桥联合动脉瘤孤立术治疗颅内复杂动脉瘤的远期疗效.方法 采用改良Rankin量表(mRS)和日常生活活动能力(ADL)量表(Barthel指数),评价17例接受颅内外血管搭桥联合动脉瘤孤立术患者术后临床症状和13常生活活动能力改善程度,以及日常工作能力恢复情况.结果 17例患者入院时平均mRS评分为1.06 ±0.87、ADL评分91.10±10.30,分别施行颞浅动脉-大脑中动脉(8例)、颈外动脉-大隐静脉-大脑中动脉(5例)、颈外动脉-桡动脉-大脑中动脉(3例)和枕动脉-小脑后下动脉(1例)血管吻合或搭桥术,以及经翼点入路动脉瘤孤立术.共随访19～39个月,平均28.67个月,其中手术相关病残率为5.88%(1/17)、病死率5.88%(1/17),总体病死率11.76%(2/17);平均mRS评分1.07±1.16,ADL评分96.40±10.30.结论 对于难以通过手术直接夹闭或血管内栓塞治疗的复杂动脉瘤患者,采用颅内外血管吻合或搭桥联合动脉瘤孤立术可获得较好的结局.     

乙状窦前迷路后入路中岩斜区应用解剖研究

目的通过对乙状窦前迷路后入路应用解剖研究,为中岩斜区显露提供显微外科解剖学基础。方法在10例(20侧)国人成人尸头(经10%甲醛固定并血管经彩色乳胶灌注)上模拟乙状窦前迷路后入路,观察中岩斜区神经血管走行分布特点、神经和血管间关系,测量相关重要数据。结果中岩斜区显微结构主要包括三叉神经(Ⅴ)、外展神经(Ⅵ)、面听神经(Ⅶ、Ⅷ)、基底动脉(BA)及小脑前下动脉(AICA)。三叉神经颅内段长度、出颅部至正中矢状面距离、矢状面角度分别为(13.82±1.84)mm,(12.90±2.02)mm,19.1°±8.0°,外展神经分别为(16.86±3.22)mm,(10.04±1.78)mm,25.6°±12.6°,面听神经分别为(14.84±2.30)mm,(23.88±2.90)mm,70.2°±5.5°。结论乙状窦前迷路后入路适用于中岩斜区显露。中岩斜区显微解剖研究及相关测量数据可为提高该区手术安全度和成功率提供参考。     

术中磁共振联合显微镜下导航在难治性癫癎脑深部小病变切除术中的应用

目的探讨术中MRI联合显微镜下导航在难治性癫癎病人脑深部小病灶切除中的价值。方法回顾性分析10例脑深部小病灶难治性癫癎病人的临床资料,所有病人行弥散张量纤维束重建,并在术中MRI及显微镜导航下切除病灶,记录骨瓣的大小、手术时间、病灶移位距离、术中MRI扫描次数、术后癫癎发作情况及功能缺失情况。结果本组病人开颅骨窗（44.60±9.19）cm2,手术时间（3.99±0.81）h,病变移位距离（10.50±2.92）mm。病灶移位距离与骨瓣大小、手术时间无明显关系（P〉0.05）。所有病人术中MRI共扫描19次,病灶全部切除。5例病人术后出现肢体偏瘫及视野缺失,术后1年症状改善。术后1年随访癫癎控制疗效：EngelⅠ级5例,Ⅱ级2例,Ⅲ级2例,Ⅳ级1例。结论在伴有癫癎的脑深部小病灶切除术中,应用术中MRI可以及时纠正病灶移位,减少术后神经功能缺失,疗效肯定。     

采用立体定向MRI技术对健康中国人颅内脑脊液体积的研究

目的利用立体定向MRI数据和计算机技术对健康中国人颅内脑脊液体积进行研究。方法对120例健康成年自愿者按立体定向基线行轴位全脑MRI扫描，并利用计算机技术对其颅内脑脊液进行识别、分割、提取、匹配与测量，并对脑室进行三维重建。结果男性脑脊液体积为（163．89±34．98）mm^3，女性为（149．71±33．91）mm^3，两者之间无显著性差异（P〉0．05）；60岁以上者脑脊液体积较60岁以下者明显增加（P〈0．05）。重建的脑室系统结构清晰，表面光滑，可任意角度观察。结论脑脊液体积与性别无关，而与年龄有关，当年龄大于60岁时。脑脊液体积开始增加。     

基于多对比度磁共振血管壁成像技术对前循环症状性颅内外动脉粥样硬化斑块特征的对比研究

目的 基于多对比度MRI血管壁成像技术,比较颅内动脉、颅外动脉粥样硬化斑块的特征。 方法 回顾经3D多对比度头颈联合MRI血管壁成像检查确定存在前循环症状性颅内外动脉粥样硬化 斑块的患者资料。观察斑块分布情况;测量斑块负荷,包括斑块最大管壁厚度、长度、管腔狭窄程度; 分析斑块内成分,包括脂质坏死核、出血、钙化,对比分析颅内动脉和颅外动脉粥样硬化斑块的影像 学特征。 结果 在入组的45例患者中,共检出颅内、外动脉粥样硬化斑块203个,其中颅外动脉斑块156 个（76.8%）,颅内动脉斑块47个（23.2%）。颅外动脉粥样硬化斑块最大管壁厚度（[ 3.2±1.0）mm vs （1.9±0.4）mm,P <0.001]、斑块长度[10.7（7.5～13.7）mm vs 4.3（2.6～6.3）mm,P <0.001]大于颅内动 脉,而颅内动脉管腔狭窄程度[28.0%（20.0%～38.5%）vs 18.8%（10.8%～30.5%）,P <0.001]重于颅外 动脉。颅外动脉粥样硬化斑块内脂质坏死核的发生率高于颅内动脉（66.0% vs 21.3%,P <0.001）,而 斑块内出血的发生率颅内动脉高于颅外颈动脉（27.7% vs 13.5%,P =0.027）。 结论 在合并有颅内外动脉粥样硬化斑块的患者中,颅外动脉的斑块最大管壁厚度、斑块内脂质 坏死核的发生率高于颅内动脉,而管腔狭窄程度、斑块内出血的发生率低于颅内动脉。     

门齿中点与外耳道中点假想连线对经鼻蝶入路的定位作用简

目的探讨经鼻蝶入路手术的一种方便、实用的解剖定位方法。方法在14例（28侧）尸头标本上模拟经鼻蝶入路,尸头取正中后仰位,侧面观察使门齿中点与外耳道中点假想连线垂直于地面,鼻窥器平行于这一连线逐步深入进入鼻腔进行观察。在矢状位上验证这一假想连线对定位的准确性,同时测量相关解剖结构的数据。结果按照前述方法模拟手术,鼻窥器所撑开范围的头侧部分可见蝶窦的骨性开口,尾侧部分是蝶窦前壁;开放蝶窦后同样发现鼻窥器所撑开范围的头侧正是鞍底。尸头正中矢状位解剖证实手术的准确性。鼻前棘至蝶窦开口的距离为（56．65±4．20）m／n,鼻前棘至鞍底的距离为（71．30±4．56）mm。结论头颅侧面观门齿中点与外耳道中点的假想连线对经鼻蝶入路手术的方向性有重要的参考作用。