周围神经鞘瘤的显微外科治疗

目的：探讨周围神经鞘瘤显微手术治疗的效果。方法回顾性分析54例经显微手术切除神经鞘瘤的疗效。结果本组54例均取得良好效果。经过1～2年的随访,5例恶性神经鞘瘤无复发;良性神经鞘瘤,1例术后出现皮肤感觉麻木,3例出现运动功能障碍,6个月后基本恢复。结论周围神经鞘瘤经显微手术治疗可最大限度地降低神经的损伤,可最大程度地完整切除肿瘤,对于恶性神经鞘瘤,扩大切除可降低复发。     

应用显微外科技术治疗周围神经鞘瘤

目的评价应用显微外科技术治疗周围神经鞘瘤的临床效果。方法2006--2010年，应用显微外科技术切除周围神经鞘瘤16例。结果本组16例均取得良好疗效，其中1例术后2周内部分手指感觉麻木，短时间内恢复。随访1～4年，无1例复发。结论周围神经鞘瘤应用显微外科技术可完整切除肿瘤，保护神经的连续性，最大程度降低复发率。     

四肢神经鞘膜瘤的显微外科手术治疗

目的介绍应用显微外科技术治疗神经鞘膜瘤的特点及疗效。方法对11例神经鞘膜瘤在放大6倍的手术显微镜下行肿瘤包膜内切除术。结果11例经6～24月随访,切除部位无1例复发,其中1例多发性神经鞘膜瘤因肿瘤数量众多,切除部分神经后行端一端神经外膜吻合术后6月,有局部麻木症状。其余神经功能均正常。结论采用显微外科技术,根据肿瘤大小、部位,选择合适入路治疗神经鞘膜瘤可获得瘤体切除彻底、神经干保护好、损伤少等优点。     

神经鞘瘤

神经鞘瘤是周围神经中常见的良性肿瘤,一般很少恶变。本文综述了神经鞘瘤的病理、分型、临床表现、诊断和治疗。     

显微外科技术切除小腿胫后神经鞘瘤1例

神经鞘瘤是由周围神经的Schwann鞘(即神经鞘)所形成的肿瘤,又称雪旺细胞瘤[1],较少出现恶变,多为良性肿瘤,临床多表现为无痛性肿块,症状以沿神经干区域走行的麻木及放射痛为主,术后易出现肿块复发及医源性神经损伤等并发症。本文回顾性分析胫后神经鞘瘤1例的临床特征、手术方案及辅助新技术等,并结合文献复习,报道如下。     

应用显微外科技术治疗腰骶椎管内神经鞘瘤

目的 探讨腰骶椎管内神经鞘瘤的诊断和手术方法。方法 应用显微外科技术进行手术治疗17例。术后随访6～42个月，进行疗效观察。结果 手术中均完整切除瘤体，术后未出现并发症和复发，手术效果满意。结论 应用显微外科技术进行手术具有术野清晰、对神经分离解剖十分精确，切除彻底损伤小，不易误伤神经，术后不易复发等优点。     

上肢神经鞘瘤的显微手术治疗

神经鞘瘤可以发生在上肢的任何神经上，常需要手术摘除。临床上常见到手术摘除神经鞘瘤时伤及神经而引起功能障碍。1997年3月至2003年12月，我院在手术显微镜下摘除上肢神经鞘瘤37例，无1例发生严重并发症，效果良好。     

臂丛恶性神经鞘瘤的诊断和治疗

臂丛恶性神经鞘瘤在周围神经中较少见。1996—2000年。我院共收治6例，对其中4例行手术治疗，2例未手术。臂丛恶性神经鞘瘤死亡率高，预后差。     

颈椎管哑铃形神经鞘瘤显微外科手术29例临床分析

目的 报道颈椎管哑铃形神经鞘瘤显微外科手术治疗的临床疗效. 方法 回顾性分析29例颈椎管哑铃形神经鞘瘤临床和随访资料.对其手术入路和显微外科手术技巧进行探讨. 结果 颈椎管哑铃形神经鞘瘤显微手术29例,其中经颈后入路手术23例,经颈前和颈后联合入路手术6例.手术全切除肿瘤28例,次全切除肿瘤1例.手术后神经功能改善21例,神经功能与术前相同8例.术后随访36.5个月,肿瘤全切除病例无肿瘤复发,全部病例颈椎稳定性良好. 结论 采用显微外科手术技术,选择合适的手术入路,在全切除颈椎管哑铃形神经鞘瘤的同时尽可能保留神经功能和颈椎自身的稳定性,能够取得较好的临床疗效.     

26例臂丛神经鞘瘤的显微手术治疗

目的探讨臂丛神经鞘瘤显微手术的治疗要点。方法回顾性总结2000年1月～2009年10月我院收治的26例臂丛神经鞘瘤患者的临床资料,其中臂丛上干11例,中干10例,内侧束2例,外侧束1例,C5-71例,C6-71例,均实行显微镜下手术切除。结果 26例患者臂丛神经鞘瘤均完整切除,术后无臂丛神经受损表现。病理提示Antoni A型18例,Antoni B型8例。随访6个月到10年,无一例复发。结论臂丛神经鞘瘤的显微外科手术治疗应尽量避开神经纤维,保护好神经干,逐层剥离包膜,将瘤体完整切除,多能获得较满意的疗效。     

Tracing Axons of Peripheral Nerves in Rats: A Potential Technique to Study the Equine Recurrent Laryngeal Nerve

To study the fascicular anatomy of peripheral nerves, three different groups of retrograde axonal tracers were evaluated: fluorophores, horseradish peroxidase conjugated to subunit B of cholera toxin (CT-HRP), and adeno-associated virus (AAV). The hindlimb nerves in rats served as a model to identify the most efficient tracer in regard to labeling axons within peripheral nerves. The rat's tibial and common peroneal nerves were injected with the different tracers and the sciatic nerve was subsequently examined for evidence of labeled axons. The CT-HRP clearly provided the best results in this rat model. Subsequently, CT-HRP was injected into the recurrent laryngeal nerve (RLN) of two horses in order to identify the location and distribution pattern of the RLN axons within the course of the cervical vagus nerve trunk. No labeling could be observed in either of the two horses.     

Nonselective Nerve Fibre Damage in Peripheral Nerves after Experimental Thermocoagulation

Summary  In this study the morphological effects of local heat application by controlled thermocoagulation to the sciatic nerve of rabbits are investigated. It concentrates on the question of a possible selective elimination of nerve fibres depending on their calibers.  Temperatures of 50°C, 55°C, 60°C, 70°C and 90°C were applied for 45 seconds. The nerves were examined histolgically after 2–3 minutes, 7 and 12 days and 5 weeks.  The light and electronmicrographs show no differential vulnerability of small myelinated or unmyelinated fibres as proposed by Sweet and Wepsic [20]. At a temperature of 50°C no fibre is damaged whereas at 60°C the fibre damage extends over nearly the total cut surface of the nerve. Even at the critical temperature of 55°C affecting only part of the cross-section no predilection of any fibre caliber was observed.  In summary thermocoagulation seems not to be able to cause selective fibre damage.     

显微手术治疗外伤性视神经损伤

目的总结经额入路行显微视神经减压术辅助药物治疗对外伤性视神经损伤的疗效,探讨其治疗原则。方法16例患者经额或额颞入路开颅,显微镜下清除骨折或出血,磨开视神经管,剪开视神经鞘行视神经减压;辅以大剂量皮质类固醇激素、能量合剂和神经营养药物。结果15例患者随访6个月至1年,10例有效,视力不同程度恢复,1例失访。结论经额或额颞入路开颅行显微视神经减压是治疗外伤性视神经损伤有效方法,辅以药物的显微外科治疗是治疗外伤性视神经损伤的一种较理想的治疗方案。     

Peripheral Nerve Repairs by the Funicular Suture Technique

Sixty-one peripheral nerve repairs in 48 patients sutured by the funicular suture technique were followed up for a minimum of 2 years after operation, the average follow-up period being 48 months. Useful recovery was obtained in 100 per cent of cases with radial and musculocutaneous nerve repairs. Seventy-five per cent of cases with median, 82 per cent with ulnar and 88 per cent with digital nerve lesions attained the 'useful' grade of recovery. in the lower extremity,-the motor recovery was excellent, whereas the sensory recovery was poor. in two out of three cases where cable grafting was performed between important funiculi the result obtained was excellent. to obtain satisfactory neurological recovery, the funicular suture technique using the surgical microscope is the method of choice for primary and secondary nerve suture and cable grafting.     

大型听神经瘤的显微手术治疗及面神经保护探讨

目的：总结经枕下乙状窦后入路显微外科手术切除听神经瘤及面神经保护的经验和技巧,以提高肿瘤的全切率和面神经的保留率。方法31例听神经瘤患者采用经枕下乙状窦后入路显微手术治疗,术中均行面神经电生理监测及面神经保护。结果肿瘤全切29例（93．6％）,大部分切除2例（6．4％）。术中面神经解剖保留28例（90．3％）,面神经功能状态 H-B 分级：Ⅰ～Ⅱ级22例（70．9％）,Ⅲ～Ⅳ级7例（22．6％）,Ⅴ～Ⅵ级2例（6．5％）。无长期昏迷及死亡病例。结论娴熟的显微操作技巧和术中面神经电生理监测有助于提高肿瘤切除率及保护面神经。     

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3–3% of cases, with transient palsies in 5–8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high‐risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re‐operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high‐risk cases including cancer surgery and re‐operative surgery.