海绵窦海绵状血管瘤的手术治疗

目的 探讨海绵窦海绵状血管瘤的治疗方法.方法 对我院2000年6月至2010年7月以来收治的13例海绵窦海绵状血管瘤的临床资料进行回顾性分析.结果 2例患者仅行开颅探查术,其余11例行手术切除,肿瘤均完全切除,无手术死亡病例,术后视力改善者3例,5例出现动眼神经麻痹,其中3例伴有外展神经麻痹,4例出现手术同侧面部麻木.结论 选择合适的手术方式可成功切除海绵窦海绵状血管瘤并减少神经损伤的并发症.

Abstract：

Objective To investigate the treatment of cavernous sinus hemangioma Method The clinical data of 13 cavernous sinus hemangioma patients from June 2000 to July 2010 were analyzed. Results Exploratory craniotomy was used for 2 patients,the tumor was totally removed in 11 patients. There was no postoperative death. There were 3 patients having improved eyesight. The postoperative complications included oculomotor nerve palsy in 5 patients including abducens nerve palsy in 3 patients, and facial paralysis of ipsilateral side in 4 patients. Conclusions Through reasonable approach,cavernous sinus hemangioma could be totally removed with low complication rate.     

经耳前颧弓硬膜外入路切除海绵窦肿瘤60例分析

目的 总结回顾2002年至2009年经治的海绵窦病变60例的临床特点、手术人路及手术效果.方法 神经鞘瘤18例,海绵状血管瘤23例,皮样囊肿9例,脑膜瘤4例,脊索瘤3例,垂体瘤3例.均经耳前颧弓硬膜外入路切除.结果 神经鞘瘤18均全切,海绵状血管瘤23例,全切18例,5例有残留.皮样囊肿9例全切,脑膜瘤4例,全切3例,次全切1例.脊索瘤3例,结合经鼻蝶窦入路手术,均达到了全切.垂体瘤3例全切.结论 经耳前颧弓硬膜外入路切除海绵窦病变是一个理想的手术入路,可以充分显露病变,减少对脑组织的牵拉,也可以明确Ⅲ～Ⅵ脑神经和颈内动脉的位置,减少神经和血管损伤的概率.对与动脉或神经粘连无法彻底切除的病变可以辅以立体定向放射治疗.

Abstract：

Objective To review our experience of microsurgery for 60 cavernous sinus tumors from 2002 to 2009.The clinical features,surgical techniques and outcome of cavernous sinus tumor in 60 cases were investigated retrospectively.Methods The patients included 23 hemangiomas,18 shwannomas,9 dermoid cysts,4 meningiomas,3 chordomas,3 pituitary adenomas.AIl the tumors were removed with subtomperal preauricular extradural approach.Results The tumors were removed satisfactorily.The shwannomas were totally removed. The hemangiomas were totally removed in 18,near-totally removed in 5 cases.Nine dermoid cysts were removed totally.For the 4 meningiomas,3 were removed completely,neartotallv removed in 1 cases.The 3 Chordomas were resected near-totally and achieved a completely removal with combined approach.Conclusion The subtomperal preauricular extradural approach is a rational choice.It can reveal the cranial nerve branches and artery at an early stage so that cranial nerves Ⅲ～Ⅵ and internal carotid artery can be preserved during operation.The tumor exposure is ideal and brain traction and contusion are slightly.The adjunctive radiotherapy is demanded for residual tumors adhering to nerves and arteries severely.     

虚拟现实技术在海绵窦手术入路定量分析中的作用

目的 探讨虚拟现实系统在海绵窦手术量化比较中的应用价值.方法 5例尸头行CT 和MRI扫描,影像数据输入Dextroscope虚拟现实系统构建海绵窦三维解剖模型.选取颅盖和颅底骨性标识点连线形成空间框架,模拟经外上、外下两个方向入路,测量解剖结构体积和手术窗口面积,进行比较分析.结果 在海绵窦三维解剖模型中成功模拟手术入路,操作空间中可清楚显示解剖结构,成功测量脑组织、脑神经、颈内动脉等体积和手术窗口面积数据并进行比较.结论 虚拟现实解剖模型模拟海绵窦手术入路清晰逼真,相关体积和面积数据测量有助于不同手术入路的比较研究.

Abstract：

Objective To evaluate the utility of virtual reality system in quantitative comparison for cavernous sinus surgical approach.Method Image data of CT and MRI scan performed in five adult cadaver heads was inputted into the Destroscope virtual reality system to build 3-D model of cavernous sinus.Surgical approaches for cavernous sinus from superolateral and inferolateral directions were simulated respectively in virtual reality system by lining landmark points selected on the calvaria and skull base to form special framework.Then,the two approaches were compared and analyzed according to the data measured for volume of anatomic structures and area of surgical entry.Results Images of anatomic structures related to cavernous sinus were displayed well in the operative space simulated successfully by the virtual reality system.The data measuring of volume for brain tissue, cranial nerves,intracavernous artery and area for operative entry was obtained and compared successfully.Conclusions Surgical approaches for cavernous sinus can be simulated in the virtual reality system with high fidelity.Data of correlative volume and area measuring is helpful for comparison between different surgical approaches.     

巨大海绵窦海绵状血管瘤的硬膜内入路显微外科治疗

目的探讨巨大海绵窦海绵状血管瘤(cavernous sinus cavernous hemangiomas,CSHs)的临床特征及显微外科治疗方法,为CSHs的治疗提供临床经验。方法回顾性分析2009年1月—2018年12月解放军东部战区总医院神经外科收治的15例CSHs患者的临床及随访资料;分析患者的临床表现、颅神经受累情况、手术方式、术后并发症及随访结果。结果15例CSHs患者占同期收治的颅内海绵状血管瘤(CHs)患者的5.6%。临床表现为头痛者11例、视神经损害者5例、动眼神经损害者6例、面部感觉异常者2例、肢体无力者1例。15例患者通过扩大翼点、翼点或颞前小切口入路经硬膜内切除血管瘤,均完整切除;无死亡病例。10例患者术后出现同侧Ⅲ、Ⅳ、Ⅴ及Ⅵ神经部分麻痹。术后获得随访的患者9例,随访时间5~117个月,平均48.9个月,均无肿瘤复发表现;其中4例患者遗留长期海绵窦颅神经功能障碍。结论CSHs多具备特征性影像学表现,术前多可明确诊断。经硬膜内入路手术切除是治疗巨大CSHs的有效方法,术中应尽量按界限整块切除,以减少出血。海绵窦内神经功能的保留仍是目前巨大CSHs手术治疗的难点。     

蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析

目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.

Abstract：

Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.     

Adipose-derived stem cells modified by BDNF gene rescue erectile dysfunction after cavernous nerve injury

Cavernous nerve injury is the main cause of erectile dysfunction following radical prostatectomy.The recovery of erectile function following radical prostatectomy remains challenging.Our previous studies found that injecting adipose-derived stem cells(ADSCs)into the cavernosa could repair the damaged cavernous nerves,but the erectile function of the treated rats could not be restored to a normal level.We evaluated the efficacy of ADSCs infected with a lentiviral vector encoding rat brain-derived neurotrophic factor(lenti-rBDNF)in a rat model of cavernous nerve injury.The rats were equally and randomly divided into four groups.In the control group,bilateral cavernous nerves were isolated but not injured.In the bilateral cavernous nerve injury group,bilateral cavernous nerves were isolated and injured with a hemostat clamp for 2 minutes.In the ADSCGFP and ADSCrBDNF groups,after injury with a hemostat clamp for 2 minutes,rats were injected with ADSCs infected with lenti-GFP(1×106 in 20μL)and lenti-rBDNF(1×106 in 20μL),respectively.Erectile function was assessed 4 weeks after injury by measuring intracavernosal pressures.Then,penile tissues were collected for histological detection and western blot assay.Results demonstrated that compared with the bilateral cavernous nerve injury group,erectile function was significantly recovered in the ADSCGFP and ADSCrBDNF groups,and to a greater degree in the ADSCrBDNF group.Neuronal nitric oxide synthase content in the dorsal nerves and the ratio of smooth muscle/collagen were significantly higher in the ADSCrBDNF and ADSCGFP groups than in the bilateral cavernous nerve injury group.Neuronal nitric oxide synthase expression was obviously higher in the ADSCrBDNF group than in the ADSCGFP group.These findings confirm that intracavernous injection with ADSCs infected with lenti-rBDNF can effectively improve erectile dysfunction caused by cavernous nerve injury.This study was approved by the Medical Animal Care and Welfare Committee of Wuhan University,China(approval No.2017-1638)on June 20,2017.     

海绵窦海绵状血管瘤MRI诊断

正海绵窦海绵状血管瘤(cavernous hemangiomas in cavernous sinus,CHCS)为较少见的脑外海绵状血管瘤,好发于颅中窝鞍旁,易误诊为脑膜瘤[1-2]。其解剖结构特殊且富含血管,术前正确诊断可有效切除肿瘤,避免术中发生大出血等意外。本文回顾性分析我院11例经病理证实的CHCS的MRI资料,总结其特征,提高对该病的诊断水平。1材料与方法     

Magnetic resonance imaging diagnosis of acute Guillain-Barré syndrome in children

The present study examined 24 children with acute Guillain-Barré syndrome using magnetic resonance imaging (MRI) plain scans and fat-suppressed enhanced T1-weighted imaging (T1WI) scans.Axial MRI plain scans centering on the medullary conus were positive in nine patients (38%).These displayed variable thickening involving the cauda equina with isointensity on T1WI and isointensity or slight hyperintensity on T2WI.False negatives were obtained in patients with cervical and cranial nerve symptoms.Contrast enhancement of T1WI with fat suppression was positive in all patients in the cauda equina with varied thickening and enhancement centering on the medullary conus.Five patients (36%) were positive in the cervical nerves and 3 patients (50%) were positive in the cranial nerves.These patients had corresponding cervical and cranial nerve symptoms,respectively.Patients with serious clinical symptoms in the lower limbs exhibited obvious involvement of the cauda equina by MRI.Statistical analysis revealed a positive correlation between the extent of enlargement of the cauda equina,centering on the medullary conus,and cerebrospinal fluid protein concentration.     

蝶窦内间隔与经单鼻孔-蝶窦-鞍区肿瘤切除术效果分析

目的 对蝶窦内间隔特点及经蝶窦-鞍区肿瘤手术的关系进行探讨.方法 分析北京军区总医院附属八一脑科医院自2008年1月至2010年12月收治的107例经单鼻孔-蝶窦-鞍区肿瘤切除术患者的术前蝶窦内间隔资料,并用以指导术中操作.结果 本组肿瘤全部切除67例(62.6%),大部切除21例(19.6%),部分切除19例(17.8%).其中47例根据蝶窦间隔的指示,迅速确定肿瘤所在鞍底位置,或保留无关间隔,并根据间隔确认颈内动脉位置,避免损伤;11例存在复杂蝶窦内间隔者,根据影像学提示得以快速判定鞍底与间隔的关系并确定蝶窦内骨质切除范围与方向,顺利完成手术.手术相关并发症:左侧颈内动脉破裂1例,海绵窦破损4例.结论 术前仔细判读蝶窦内间隔影像学资料,用以指导经蝶窦-鞍区肿瘤手术操作,可以预防和减少并发症.

Abstract：

Objective To study the relationship of sphenoidal intersinus septa with transsphenoidal resection of sellar area tumor. Methods The pre-operative MRI and CT images of the sphenoid intersinus septa and its importance in transsphenoidal resection of sellar area tumor were studied in 107 patients, admitted to our hospital from January 2008 to December 2010. The amounts, locations, anatomic specialties of the septa and its relationships with the floor of selle, the internal carotid artery canals and the tumors were analyzed to guide the operative procedures during the operation. Results Total removal of the tumors in seller region was obtained in 67 patients, subtotal removal in 21 and partial removal in 19. According to the MRI and CT images of the sphenoid intersinus septa, the location of the tumor and the carotid artery in 47 patients were quickly determined; complex sphenoid intersinus septa was noted in 11 patients, and the relation of sellar floor with the septa was quickly determined and the scope and direction of removal were determined too. Rupture of the internal carotid artery occurred in 1 patient, and damages of the cavernous sinuses occurred in 4. Conclusion Careful study of the pre-operative MRI or CT images of the sphenoidal intersinus septa and its relationship with the floor of seller, the internal carotid artery and the tumor will assure the transspenoidal surgery more precisely and safely, and the complication can be efficiently prevented and decreased.     

Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries

The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.     

Meningiomas of the cavernous sinus: the surgical resectability and complications

The optimal management for patients with cavernous sinus meningiomas is to evacuate tumor without causing mortality or morbidity. The records of 16 patients, including 11 women and 5 men ranging in age from 31 to 63 years, underwent surgical treatment for this condition were reviewed. Completeness of tumor resection, cranial nerve morbidity, complications, mortality, the internal carotid artery encasement and outcome were studied. Total removal was achieved in six patients. Of ten patients who underwent subtotal resection there was one death and four were sent to radiotherapy. Morbidity was 24% for cranial nerves controlling extraocular motor function; trigeminal nerve function did not improve after surgical treatment. Symptomatic recurrence occurred in two patients who underwent subtotal tumor resection and in one who underwent complete tumor resection. The average follow-up period was of 26 months. According to our findings, we conclude: 1) the resectability of meningiomas of cavernous sinus depends on the degree of internal carotid artery involvement; 2) total resection of meningiomas confined in cavernous sinus is rare; 3) morbidity of the cranial nerves is significant; 4) subtotal resection is an effective mean to obtain control of the disease.     

手术切除从颅底侵犯海绵窦的肿瘤

目的探讨手术切除侵犯海绵窦的颅底肿瘤的指征及手术要点。方法自1998年11月至2002年5月，中日友好医院神经外科与中国医学科学院肿瘤医院头颈外科合作，连续切除侵犯海绵窦的颅底肿瘤32例，其中鼻咽纤维血管瘤7例，脊索瘤5例，鼻咽癌和鼻咽囊腺癌5例，副鼻窦癌5例，神经鞘瘤3例，嗅神经母细胞瘤1例，颞下翼腭窝低分化癌2例，颞下翼腭窝肉瘤3例，恶性纤维组织细胞瘤1例。23例曾经1次或多次手术切除后复发。对临床资料进行回顾性总结。结果根据肿瘤主体的部位分别选用经上颌骨入路、颞下耳前入路、或额眶入路。全部病例术中显露满意，肿瘤均得到肉眼切除，受累的颅神经一并切除，无手术死亡，术后无偏瘫等严重并发症。、术后辅以放射治疗。随访3—50个月，平均19个月，失访3例，4例术后3—6个月死亡，4例带瘤生仔，21例健在。结论由下向上侵犯海绵窦的颅底肿瘤可以手术切除，近期效果满意。对颅底正常和病理性解剖结构的熟练掌握以及多学科医生的密切协作是手术取得成功的关键。     

两种不同入路手术治疗海绵窦区肿瘤

目的探讨海绵窦区肿瘤切除的手术入路,以提高手术全切率,降低残障率.方法对14例海绵窦内肿瘤行硬膜下入路切除5例,行硬膜外入路切除9例,比较两种入路的方法及疗效.结果行硬膜下入路者中全切除2例,大部切除3例;术后出现新的神经功能障碍4例.行硬膜外入路者中全切除5例,次全切除3例,大部切除1例;术后出现新的脑神经功能障碍3例,其中1例完全恢复.结论针对不同类型的肿瘤及生长特性,选择适当的手术入路和显微神经外科技术,可有效提高全切率,降低残障率.     

Relationship between the number of involved cranial nerves and the percentage of lesions located in the cavernous sinus

The main objective of this study is to investigate the relationship between the number of cranial nerves passing through the cavernous sinus affected by a lesion and the percentage of lesions located in the cavernous sinus itself. We collected cases retrospectively and classified them into groups according to the number of involved cranial nerves. The diagnoses were confirmed either with MRI, angiography or pathological examination. Sixty-eight cases in total were collected. In the increasing order of cranial nerve involvement (from 1 to 4 nerves), 17.7, 44.4, 56.3 and 77.8% of cases were found to have lesions in the cavernous sinus. A linear regression model with a least square estimator showed an approximately linear correlation. We concluded that there was an approximately linear correlation between the number of cranial nerves affected by a lesion and the percentage of lesions located in the cavernous sinus.     

经额颞硬膜外入路显微手术切除海绵窦区肿瘤

目的 报告经额颞硬膜外入路显微手术切除海绵窦区肿瘤的经验。方法 回顾性分析8例海绵窦区肿瘤的临床及影像学特征、手术方式、疗效和术后并发症。结果 肿瘤全切5例，次全切3例；术后原有颅神经症状的63．6％获得改善，27．3％同术前，9．1％较术前加重，无新的神经症状出现，无疾病及死亡病例，随访7例，时间20－23个月，无肿瘤复发。结论 采用经额颞硬膜外手术入路可较好地暴露和切除海绵窦区肿瘤，明显降低术后并发症和死亡率。     

海绵窦内侧壁的显微解剖与扩大经蝶窦入路治疗侵袭海绵窦的垂体腺瘤（附103例分析）

目的研究海绵窦内侧壁结构的解剖特点，并探讨采用扩大经蝶窦入路治疗侵袭海绵窦垂体腺瘤的方法。方法在10具成人新鲜尸头上模拟扩大经蝶窦手术入路，观察海绵窦内侧壁结构的解剖特点。根据解剖学研究结果，指导临床采用扩大经蝶窦手术入路治疗侵袭海绵窦的垂体腺瘤103例。结果垂体侧方的海绵窦内侧壁薄弱，仅有一层疏松的纤维组织结构。颈内动脉是扩大经蝶窦入路海绵窦内所见的主要结构，可分为5段，有3个主要分支。颈内动脉海绵窦段主要的分支有脑膜垂体干、海绵窦下动脉和被囊动脉。向内侧走行的脑膜垂体干和被囊动脉是经蝶窦入路中较易损伤的血管。手术显微镜下全切除肿瘤62例（60．2％），次全切除38例（36．9％），大部切除3例（2．9％）；无手术死亡；手术并发症包括短暂性脑脊液鼻漏5例，暂时性脑神经功能损伤4例，垂体功能低下3例，颈内动脉损伤2例，永久性尿崩症1例。术后行放射治疗17例，γ刀治疗15例，药物治疗13例。随访3个月～8年，2例出现肿瘤复发而予以γ刀治疗。无再手术病例。结论扩大经蝶窦入路是切除侵袭海绵窦垂体腺瘤理想的入路；了解颈内动脉海绵窦段及其分支在解剖形态上的变化，对于减少术中出血，确保术中安全，具有重要意义。     

显微手术治疗术前放射治疗的海绵窦巨大海绵状血管瘤二例

目的 探讨一种新的治疗方法处理中颅窝底巨大海绵窦海绵状血管瘤,以提高手术治疗效果.方法 回顾性分析2例中颅窝底巨大海绵窦海绵状血管瘤的临床资料,术前均行放疗,放疗后1-2个月行手术治疗.结果 放疗后病灶体积明显缩小,术中输血量显著减少,术后随访动眼神经和视神经功能恢复良好,MRI检查证实病灶完全切除.结论 对中颅窝底巨大海绵窦海绵状血管瘤行先放疗后手术的治疗策略,对减少术中出血、避免脑神经损伤、提高手术切除率具有重要意义.