垂体窝及其毗邻结构手术相关显微解剖学研究

目的为临床神经外科提供鞍区,尤其是垂体窝边界及其毗邻结构的解剖参数与观察研究。方法用20例汉族成人尸头湿标本、漂白干颅骨15例进行精确显微解剖测量、观察及拍照。结果两前床突间距为(25.2±0.58)mm(20.3～30.0mm);前后床突间距(12.5±1.21)mm(8.1～17.5mm);两后床突间距(12.8±0.87)mm(8.0～17.0mm)。颈内动脉内侧缘与垂体外侧缘间距为(3.8±1.25)mm(2.3～7.1mm)。海绵窦内侧壁为垂体硬膜囊袋的一部分。正常情况下约有20%的垂体侧面向其外侧的海绵窦膨出。结论该显微解剖学研究提供了垂体区的重要解剖参数及其重要毗邻间隙与结构,为临床鞍区肿瘤、尤其是垂体瘤及海绵窦肿瘤的术前诊断、入路选择提供参考。     

鞍区的显微解剖学研究

目的 为临床神经外科提供鞍区显微解剖和解剖参数。方法 用汉族成人尸头湿标本、漂白干颅骨各30例,在显微镜下进行显微解剖观察并测量。结果 鞍区重要的解剖学结构有:①骨性标志有鞍结节、前后床突、视神经管、鞍底、蝶窦内视神经管隆起和颈内动脉隆起;②相关硬膜结构有鞍膈、海绵窦和海绵间窦;③相关蛛网膜结构有颈动脉池、视交叉池;④重要的神经血管结构有垂体和垂体柄、视神经和视交叉以及Willis环及其分支。结论 该显微解剖学研究提供了鞍区的重要解剖结构和解剖参数,对鞍区的临床手术具有重要价值。     

经鼻蝶窦手术入路相关的血管显微解剖学研究

目的研究经鼻蝶窦手术入路相关血管的显微下解剖特点。方法10具动静脉灌注染料的成人新鲜尸头上,5具行正中矢状位切开,5具模拟经鼻蝶窦手术入路,分别在显微镜下观察手术路径上血管的走行特点,与垂体和周围重要组织结构的相互关系,测量相互之间的距离。结果鼻中隔后动脉上支至蝶窦开口下极的距离为（3.91±0.82）mm（2.85～5.15）mm,鼻中隔后动脉下支至蝶窦开口下极的距离为（6.16±1.23）mm（4.42～8.28）mm。颈内动脉海绵窦段分为5段,有3个动脉分支。颈内动脉前曲段的内侧缘距垂体中线的距离为（11.94±1.90）mm（9.02～14.86）mm,后曲段的内侧缘距垂体中线的距离为（7.96±2.07）mm（5.64～11.58）mm。结论蝶腭动脉、海绵间窦、颈内动脉海绵窦段的分支－垂体下动脉是经鼻蝶窦手术入路中容易引起出血的血管,尤其是颈内动脉海绵窦段是最重要的解剖结构。术前要有充分的准备,术中仔细的显微操作,以免发生大出血这一严重并发症。     

海绵窦区颅神经血供的显微解剖及临床应用研究

目的海绵窦区显微手术的不断开展，迫切需要海绵窦区颅神经血供的显微解剖资料。方法借助手术显微镜对40例福尔马林固定的成人头颅的颈内动脉（internal carotidartery，ICA）海绵窦段分支及颅神经血液供应进行了显微解剖研究。结果动眼神经和滑车神经的近段主要由小脑幕动脉供血、外展神经近段主要由脑膜背侧动脉分支供血。三者的远段主要由海绵窦下动脉前支供血；三叉神经半月神经节及远端分支主要由海绵窦下动脉供血。结论海绵窦下动脉是供应所有入眶颅神经最重要的供血动脉，在海绵窦区进行显微手术时，保护好各颅神经的血供是减少术后颅神经损伤、获得良好疗效的关键。     

眼动脉显微解剖学研究

目的　为颅底显微外科手术提供显微解剖学基础。方法　应用 2 0例成人头颅湿标本 ,在放大 5×2 5倍手术显微镜下 ,对眼动脉的起源、行程及分支进行显微解剖学研究。结果　 90 %眼动脉起源于颈内动脉床突上段 ,其中大部分起自颈内动脉上壁的内三分之一。 5 %眼动脉起源于颈内动脉海绵窦段。另 5 %眼动脉起源于脑膜中动脉。眼动脉分为颅内、管内及眶内 3段 ,眶内段依据其与视神经关系又被分为 3段。眼动脉的主要分支为视网膜中动脉、睫状后动脉、泪腺动脉及筛前、后动脉。结论　熟悉眼动脉的起源、行程及分支的显微解剖可避免术中损伤眼动脉。     

扩大经鼻蝶入路的海绵窦内颈内动脉和脑神经显微解剖研究

目的：研究扩大经鼻蝶入路海绵窦内颈内动脉和脑神经的显微解剖特点,为切除颈内动脉外侧肿瘤提供解剖形态学基础。方法：在7具成人尸头模拟扩大经鼻蝶手术入路,观察颈海绵窦段颈内动脉和脑神经的解剖关系,并测量相关解剖参数。结果：海绵窦段颈内动脉有两个重要分支：海绵窦下动脉和脑膜垂体干。海绵窦下动脉起源颈内动脉水平段中央外侧,垂体下动脉起源于脑膜垂体干。内展神经在海绵窦段颈内动脉的外侧,向眶上裂方向走行。颈内动脉与动眼神经、滑车神经、展神经和视神经入眶上裂处的平均距离分别为3.4 mm、3.4 mm、3.9 mm和4.5 mm。结论：熟悉展神经和海绵窦下动脉在海绵窦内的解剖关系,有助于经扩大经鼻蝶入路手术切除肿瘤时对其的保护。     

床突间隙的显微解剖学研究

目的 为临床上磨除前床突后形成床突间隙提供显微解剖学数据。方法 在手术显微镜下对10例（20侧）成人尸头的前床突及床突间隙进行显微解剖观测。结果 （1）前床突是锥形骨性结构，其长、宽、厚分别为（9.39±1．23）mm、（12．25±2．40）mm、（5．29±1．21）mm。（2）床突间隙为磨除前床突后形成的锥形空间，间隙基底部上、下、内、外侧边长度分别为（9．32±1．18）mm、（5．32±1．18）mm、（7．70±1．31）mm、（11．18±2．51）mm，间隙高为（10．05±1．40）±。床突间隙可以提供0．8-1．0cm^3的显露空间。（3）颈内动脉床突段位于颈内动脉上、下环之间，直径为（4．23±0．59）mm，长度为（2．84±1．06）mm。（4）前床突气化率为2／20。（5）Ⅱ、Ⅲ、Ⅳ、Ⅴ1、Ⅵ脑神经、颈内动脉床突段、颈内动脉床突上段起始部紧贴前床突走行，其间隔以相应的硬膜层。结论 床突间隙增加了手术操作空间。颈内动脉床突段为海绵窦内结构。形成床突间隙时，注意对前床突毗邻结构的保护。     

海绵窦MRI解剖与三维重建研究

目的研究海绵窦MRI影像解剖学特点,对颈内动脉和垂体、垂体腺瘤实施MRI三维重建。方法对25例海绵窦正常者,分别进行平扫、常规增强扫描和动态增强扫描,采用eFilm软件对MRI影像资料进行研究;在海绵窦MRI解剖结构辨别的基础上,采用StealthStation导航系统三维重建软件,对2例病人的颈内动脉和垂体、垂体腺瘤进行三维重建。结果①动态增强扫描中期对海绵窦的结构显示最佳。②海绵窦外侧壁脑神经在冠状位上有良好的显示。③采用eFilm软件的测量结果:海绵窦段颈内动脉间距离为(16.6±4.3)mm,床突上段颈内动脉间距离为(13.8±3.3)mm,颈内动脉与垂体的距离为(2.9±0.9)mm,垂体上下径、左右径、前后径分别为(4.8±1.9)mm、(15.8±5.7)mm、(9.6±2.8)mm。④利用三维重建软件,可成功实施对颈内动脉和垂体、垂体腺瘤的三维重建。结论海绵窦MRI解剖学研究与三维重建对指导海绵窦区影像学诊断和海绵窦区手术具有重要意义。     

颈内动脉海绵窦段显微解剖

本文介绍在手术显微镜下对100个(50例成人)海绵窦标本进行颈内动脉海绵窦段分支的研究,观察了分支的起点、分布、数目和吻合。主要结果如下:(1)颈内动脉海绵窦段分为五段:后升部、凸弯、水平部、凹弯、前升部;(2)脑膜垂体动脉是一支短干,它通常发出三个分支:小脑幕动脉、脑膜背侧动脉和垂体下动脉。依分支起始位置脑膜垂体动脉分为干型(64%)和非干型(36%)。(3)在凸弯上动脉分支的数目和起点变化颇大,脑膜背侧动脉起自海绵窦内颈内动脉者24%,天幕动脉为6%,垂体下动脉10%。(4)海绵窦下动脉在标本中出现95%,它们是起于颈内动脉海绵窦段的水平部;另外,起自脑膜垂体动脉者5%。幕缘动脉和眼动脉出现率14%和11%。垂体被膜动膜16%。文中对一些特殊变异提出了报告,供临床参考。     

垂体上动脉显微外科解剖学研究

目的 了解垂体上动脉的起始、行程、分布和变异,为鞍区肿瘤手术时保护垂体上动脉以有变垂体上动脉瘤与床突旁其他类型动脉瘤区别提供依据。方法 ５０具成人尸体头颅垂体上动脉标本,在解剖显微镜下解剖和分析。结果 垂体上动脉为一组血管丛,分１～４支,起始于颈内动脉则,平均直径０．２２ｍｍ。起始部距眼动脉起始部小于５ｍｍ者占８２％,二种分支类型：粗大支型占４５％,呈烟台式供应垂体柄、视神经和视交叉,平均直径为０     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

Origins of the sympathetic innervation of the cervical end of the uterus in the rat

A retrograde neuronal tracer (Fast Blue) was injected in the cervical end of the uterine horn of virgin rats. The majority of the retrogradely labeled post-ganglionic sympathetic neurons were found in the sympathetic chain (74%). The superior mesenteric ganglia, inferior mesenteric ganglia and suprarenal ganglia accounted for 22, 3 and <1%, respectively. The distribution of neurons in the sympathetic chain labeled from the uterus resembles that described for other pelvic organs.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Topographical organization of the motoneuron pools that innervate the muscles of the pinna of the cat

The topographical organization of the 22 motoneuron pools that innervate the pinna muscles of the cat was examined by injecting the B-subunit of cholera toxin conjugated to horseradish peroxidase into individual muscles. All 22 pools are found in the facial nucleus, organized as rostro-caudally oriented columns, and arranged according to the action of the muscles they innervate. Pools innervating muscles that pull the pinna dorsally are located in the dorsal two thirds of the medio-dorsal subdivision, and those innervating muscles that pull the pinna ventrally are located in the ventral one half of the nucleus. Motoneurons innervating muscles that pull the pinna cranially are located laterally, those that pull the pinna caudally are located medio-ventrally, and those that change the shape of the pinna are located along the entire dorso-ventral extent in the center of the medio-dorsal subdivision. This topographical layout is consistent with the somatotopic organization of the entire facial nucleus as demonstrated in a variety of species. © 1995 Wiley-Liss, Inc.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Histochemical methods for the further characterisation of the tumourettes of the posterior lobe of the pituitary

Summary The granular cell tumourettes of the posterior lobe of the pituitary possess neuraminic acid containing carbohydrate. After removal of neuraminic acid with neuraminidase and exposure to FITC (Fluorescein isothiocyanate) labelled peanut agglutinin (Arachis hypogaea) (PNA), intracellular receptor structures could be demonstrated. The significance of the findings is discussed.