切除脑深部肿瘤内窥镜的研制

研制一种切除脑深部肿瘤的内窥镜．该镜由内窥镜镜体、导向管，有关手术器械，光源及术中录像显示装置五部分组成。镜体里抢状．长200mm，外径10mm,工作道最大径9．6mm，导向管有筒状及伞状两种；有关手术器械保证镜下直视取肿瘤和确切止血；术中屏幕显示对手术操作起到放大作用。此外．有冲洗吸引装置通过内窥镜吸引道作持续吸引和间断冲洗，保证术野清晰：该镜与立体定向术相结合能准确而微侵袭地切除脑深部肿瘤，其适应证是丘脑基底节区肿瘤和脑室内肿瘤。     

内窥镜立体定向术切除脑深部肿瘤

内窥镜立体定向术切除脑深部肿瘤万经海江澄川脑深部肿瘤如丘脑基底节肿瘤、脑室内肿瘤部位深在，常规手术切除要损伤较多的正常皮质和施加较严重的脑牵拉才能到达肿瘤区，创伤大，术后并发症多；此外，深部脑实质内微小肿瘤手术时常有定位困难，手术探查时易伤及周围重要...     

立体定向标记经脑窥镜显微手术脑深部肿瘤切除

一、临床资料男 2 1例 ,女 11例 ,平均年龄 45(2 3～ 5 1)岁。病变部位 :脑深部 (包括脑室旁、丘脑、基底节区、颞叶内侧部 ) 2 2例 ,中央前回皮质下 6例 ,语言运动区皮质下 4例。病灶最大4 5ｃｍ× 5ｃｍ× 4ｃｍ ,最小 1 5ｃｍ×1 5ｃｍ× 1 5ｃｍ。临床表现 :头痛 18例 ,癫痫发作 15例 ,偏瘫 8例 ,语言障碍 3例 ,偏盲 2例。病理诊断 :脑胶质瘤 15例 ,脑转移癌 8例 ,脑脓肿3例 ,海绵状血管瘤 6例。二、手术方法局麻下安装ＬｅｋｓｅｌｌＧ型立体定向头环 ,行ＣＴ常规或增强扫描 ,层厚5ｍｍ ,有病灶的每张ＣＴ片均放大洗片 ,确定病灶中心和…     

立体定向标记经脑窥镜显微手术脑深部肿瘤切除

立体定向引导小骨窗开颅与显微手术相结合,称为立体定向显微外科手术近年来已较普遍地应用于脑功能区和脑深部小型囊性病灶的手术中。但是位于脑深部体积较大和边界不清的肿瘤,术中准确地确定病灶边界和有效的手术显露往往较为困难。我科自1997年2月至1999年10月,采用立体定     

经内窥镜激光切除第三脑室和丘脑肿瘤

目的探讨进行脑重要功能区肿瘤切除术的良好的方法。方法应用ＳＬＴ接触式Ｎｄ：Ｙａｇ激光及内窥镜进行脑室内肿瘤和丘脑肿瘤切除术。结果２例三室型颅咽管瘤和１例丘脑肿瘤术中出血少,止血方便,切除顺利,病人术后反应较轻,并发症较常规手术减少。结论ＳＬＴ接触式Ｎｄ：Ｙａｇ激光及内窥镜适合用于脑重要功能区肿瘤的切除术。     

锁孔手术切除颅内深部肿瘤

自1997年以来,我们共行锁孔(keyhole)手术治疗颅内深部肿瘤162例,效果满意,报告如下.     

SLT接触式激光治疗脑深部肿瘤

ＳＬＴ接触式激光治疗脑深部肿瘤范益民孙之洞闫青云薛乃照李守缄郝解贺赵学明我院１９９５年３月至１９９７年３月应用美国Ｍｅｄｉ－Ｔｈｅｒｍ公司生产的ＳＬＴ接触式激光治疗脑深部肿瘤１７例，取得满意疗效，现报告如下。一、临床资料与方法：１．一般资料：男７例，...     

立体显微手术切除脑深部病变

立体显微手术切除脑深部病变王如，张锡增，王守森，陈苏自１９９６年３月以来，我们利用Ｆｉｓｃｈｅｒ定向仪的ＺＤ系统同ｏｐｔｏｍⅣ型手术显微镜匹配进行的１０例立体显微手术，其中男９例，女１例，年龄１８～５６岁，８例肿瘤除１例肿瘤直径３．２ｃｍ以外。其余均...     

神经内窥镜下手术切除脑室内肿瘤

脑室肿瘤的手术对于神经外科医师是一具有挑战性的课题,由于肿瘤位置深,必然会带来一定的手术死亡率和致残率。采用神经内镜下手术可以切除某些脑室内肿瘤,治疗的效果和显微神经外科手术效果相当,而对正常脑组织损伤更轻。本文报道经内窥镜下连续手术治疗的30例全脑室内肿瘤,以确定内窥镜下治疗脑室内肿瘤的有效性。 临床资料和方法;1993.2～1996.10。30例入住神经外科的脑室内病变患者,男19例,女11例,年龄4～62岁,平均33.7岁。其中胶样囊肿7例,星形细胞瘤6例,松果体区肿瘤4例,室管膜瘤2例,室管膜下瘤3例,脉络丛乳头状瘤、髓母细胞瘤、垂体腺瘤、海绵状血     

Rigid endoscopic resection of deep-seated or intraventricular brain tumors

Abstract

Rigid endoscopic resection using a thick sheath (ViewSite) may be a viable method for the resection or biopsy of selected deep-seated brain tumors, such as thalamic gliomas and malignant lymphomas. Neuroendoscopic biopsy is one technique used for the histological verification of suspected brain tumors. There are a number of advantages to using this technique. For example, under direct vision, it is possible to carefully observe the tumor surface and avoid vessels during tumor resections. It is also possible to collect enough specimens for a pathological diagnosis. Eighteen consecutive patients safely underwent rigid endoscopic resection or biopsy using a thick sheath (ViewSite). The two-handed endoscopic technique that utilized a mounted rigid endoscope proved very useful and safe, since it enabled easy stanching of hemorrhages. The aim of this study was to demonstrate how to use a thick sheath for deep-seated or intraventricular tumors. The rigid endoscopic approach with a thick sheath provides an alternative medial approach with improved visualization and a wider working space.     

国产胶体硅酸钇近距离照射脑肿瘤

应用国产胶体硅酸钇（￣（９０）Ｙ）近距离照射脑肿瘤５６例，病例大多为开颅手术难以全切的深部及重要功能区的肿瘤、多发肿瘤。本组共注射￣（９０）Ｙ７２次。术后随访６～１５个月，临床症状改善者４１例（７３％），肿瘤显著缩小或消失者３８例（６８％），无严重副作用及并发症。作者讨论了￣（９０）Ｙ近距离照射脑肿瘤的治疗原则及手术体会。     

Granular cell brain tumors of the laboratory rat: an immunohistochemical approach

Summary We have studied paraffin-embedded specimens of 17 rat granular cell brain tumors (GCBT) from four long-term drug safety carcinogenicity studies by peroxidase-antiperoxidase (PAP) immunohistochemistry with either polyvalent or monoclonal antibodies against glial fibrillary acidic protein (GFAP), S-100 protein (S-100), Leu-7 epitopes, vimentin (VIM), keratin, desmin, and myelin basic protein. We have found that 9 of the 17 GCBT contained GFAP-positive, S-100-positive, and VIM-positive astrocytes, while GFAP-positive and VIM-positive granular cells were observed in 5 of these 9 tumors. Our findings indicate that astroglial cells are involved in rat GCBT and suggest that an astrocytic origin should be considered for these neoplasms.     

伽玛刀治疗脑转移瘤 (附72例报告)

目的 探讨伽玛刀对脑转移瘤的治疗作用。方法 从2001年9月～2003年9月．79例脑转移患者接受伽玛刀治疗。其中72例(162个病灶)获得完全随访。该72例患者以50％～70％等剂量曲线包绕肿瘤，边缘剂量为14-24Gy，60例患者同时接受全脑照射，外照射剂量为30～40Gv。结果 72例患者(162个病灶)，随访期1～22个月，平均随访期10个月。完全缓解(CR)87例．部分缓解(PR)52例，无变化(NR)23例，总有效率为93．8％。结论 伽玛刀是一种安全的治疗脑转移瘤的方法，它可以缓解神经症状．提高生存质量，局部控制率较高。     

Ultrastructure of capillary walls in human brain tumors

Summary Changes in capillary walls between human glial, non-glial and metastatic brain tumors were studied with conventional ultrathin section and freeze-fracture replica techniques. The following results were obtained. (1) In glial tumors, ultrathin section studies showed cell junctions of the capillaries were either short or elongate. Moreover, endothelial hyperplasia, surface infolding of endothelial cells, irregularity of the basal lamina and a large extravascular space were observed. Freeze-fracture replicas of capillary endothelium showed tight junctions as two to seven strands. In addition, pinocytotic vesicles had increased markedly and were an average of 25 per m². Both ultrathin and freeze fracture studies showed that, in contrast to malignant gliomas, there were only slight changes in benign astrocytomas. (2) In non-glial tumors, ultrathin sections showed surface infoldings, increased vesicles, many fenestrations of endothelial cells, irregularity of basal lamina and enlarged perivascular space. Freeze-fracture replicas of vascular endothelium, showed that the average number of pinocytotic vesicles and fenestrations were 25 and 22 per m², respectively. Moreover, the tight junction was composed of one or two strands which appeared to be a discontinuous array of particles. (3) In metastatic brain tumors, ultrathin studies showed capillary endothelia were proliferated, had marked infolding, and showed an increased number of pinocytotic vesicles and many fenestrations. Moreover, short and elongate intercellular junctions were presented but no open junction was detected. Finally the basal lamina lost its three-layered appearance and was irregular in width. Freeze-fracture replicas showed pinocytotic vesicles had increased and were 24 per m² on average in four cases, but fenestrations and tight junctions could not be detected. The most fundamental feature of vessels in these three different kinds of tumors was whether they were fenestrated or not. Glial tumors were non-fenestrated, whereas non-glial and metastatic tumors were fenestrated.     

脑肿瘤超选择性脑动脉灌注化疗的临床分析

目的:研究超选择性脑动脉插管灌注嘧啶亚硝脲(ACNU)或卡氮芥(BCNU)治疗恶性脑肿瘤的近期疗效及其并发症的防治。方法:对67例经组织学确诊的恶性脑肿瘤采用超选择性脑动脉插管灌注嘧啶亚硝脲或卡氮芥化疗,并对照化疗前后的影像学表现,评价该化疗对恶性脑肿瘤的疗效。结果:本组67例病人治疗后完全缓解10例(14.9％),部分缓解43例(64.2％),稳定11例(16.4％),恶化3例(4.5％)。对部分病例行免疫组化和神经病理研究,证实超选择性脑动脉灌注化疗可诱导肿瘤的凋亡。超选择性脑动脉插管灌注化疗可明显降低常规化疗的并发症和毒性反应,并发症和毒性反应的发生率明显低于文献报道。结论:超选择性脑动脉插管灌注化疗治疗恶性脑肿瘤可明显降低药物毒性,近期疗效良好。     

Gut microbiota in brain tumors: An emerging crucial player

In recent decades, various roles of the gut microbiota in physiological and pathological conditions have been uncovered. Among the many interacting pathways between the host and gut flora, the gut–brain axis has drawn increasing attention and is generally considered a promising way to understand and treat brain tumors, one of the most lethal neoplasms. In this narrative review, we aimed to unveil and dissect the sophisticated mechanisms by which the gut-brain axis exerts its influence on brain tumors. Furthermore, we summarized the latest research regarding the gastrointestinal microbial landscape and the effect of gut–brain axis malfunction on different brain tumors. Finally, we outlined the ongoing developing approaches of microbial manipulation and their corresponding research related to neuro-malignancies. Collectively, we recapitulated the advances in gut microbial alterations along with their potential interactive mechanisms in brain tumors and encouraged increased efforts in this area.     

Ommaya储液囊在脑肿瘤并发脑积水中的应用

目的探讨Ommaya储液囊在脑肿瘤并发脑积水中的临床应用效果。方法回顾分析江苏大学附属武进医院神经外科2012年6月至2014年6月收治的4例颅内肿瘤并发脑积水患者,应用Ommaya储液囊治疗。结果 1例患者的症状完全缓解,2例好转,1例自动出院。结论 Ommaya储液囊在脑肿瘤并发脑积水中的临床应用效果良好,临床安全性可靠。     

弥散张量成像在脑深部肿瘤术前评估中的应用

目的 探讨弥散张量成像(DTI)在脑深部肿瘤术前评估和手术设计中的作用.方法 回顾性分析20例脑深部肿瘤病人的临床资料,利用各向异性分数(FA)图和纤维示踪图(DTT),观察白质纤维束结构、走行及其与肿瘤的毗邻关系,测量病侧白质纤维束及其对应健侧白质纤维束的FA值、弥散系数(ADC)值.结果 白质纤维束单纯推移5例,单纯破坏7例,推移并破坏8例.单纯破坏、推移并破坏者.其病侧与健侧FA值、ADC值比较均有显著差异(P <0.05);而单纯推移者,其病侧与健侧队值、ADC值比较无显著差异(P >0.05).肿瘤全切除15例,次全切除3例,部分切除2例.12例随访6个月-2年,平均1年.正常工作、学习8例,生活自理但未参加工作3例,死亡1例.结论 DTI有助于准确判断肿瘤与周围白质纤维束的毗邻关系,对脑深部肿瘤术前评估和手术设计有重要指导意义.     

Galectin‐3: A useful biomarker for differential diagnosis of brain tumors

Galectin‐3 (gal‐3) is a 31 kDa β‐galactoside‐binding lectin that is immunohistochemically expressed in macrophages, lymphocytes, and endothelial cells, and also in some neoplastic cells. Gal‐3's expression in and significance to brain tumors has not been fully addressed. Here, we investigated its immunohistochemical expression in 409 cases of surgically resected primary brain tumors, including various glioneuronal tumors, pituitary adenomas, meningiomas and Schwannomas, among others. In normal brain tissues, gal‐3 was robustly expressed in normal astrocytes, endothelial cells and macrophages. It showed consistent and diffuse positivity in 100% of the pilocytic astrocytomas, pleomorphic xanthoastrocytomas (PXA), Schwannomas, meningiomas, capillary hemangioblastomas, as well as in ependymomas, but it was completely negative in the diffuse astrocytomas, anaplastic astrocytomas, both low‐ and high‐grades of the oligodendrogliomas, central neurocytomas, and medulloblastomas. Definitely positive but heterogeneous expression was found in various tumors including subependymal giant cell astrocytomas (SEGA), classic glioblastoma multiforme, anaplastic oligoastrocytomas, CNS primitive neuroectodermal tumors (CNS PNETs), and hemangiopericytomas. Eighty percent of small cell glioblstomas were completely negative, but 20% showed heterogeneous positivity for gal‐3. Focal positivity for gal‐3 was also found in dysembryoplastic neuroepithelial tumors (DNTs) and gangliogliomas, in which the positive cells were the astrocytic component. On the basis of our immunohistochemical data in conjunction with previous reports, we therefore conclude that gal‐3 is differentially expressed in various brain tumors, and thereby, is a helpful biomarker in making differential diagnoses, especially in cases where a morphological diagnosis is controversial.