神经内镜在囊性颅咽管瘤治疗中的作用

目的 探讨神经内镜在巨大囊性颅咽管瘤治疗中的作用。方法 对巨大囊性颅咽管瘤伴有梗阻性脑积水的15例患者,应用神经内镜先缩小肿瘤体积、解除梗阻性脑积水并穿通囊内分隔,之后再辅以放射治疗或显微手术切除。结果 15例患者术后颅内压增高症状均消失、术前症状改善。影像学复查(CT或MR)见肿瘤均缩小至鞍区、脑积水消失。除1例有暂时多尿及低钠外,余无其他严重并发症。内镜治疗后再手术全切除肿瘤的3例患者术后反应明显减轻。结论 对有囊性变并伴有脑积水的巨大颅咽管瘤,先采用神经内镜手术,是进一步提高治疗效果、降低致残率和死亡率的有效方法。     

神经内窥镜在囊性颅咽管瘤治疗的作用

目的探讨神经内窥镜在巨大囊性颅咽管瘤治疗中的作用.方法对巨大囊性颅咽管瘤伴有梗阻性脑积水的9例患者,应用神经内窥镜先缩小肿瘤体积、解除梗阻性脑积水并穿通囊内分隔,然后再辅以放射或显微手术切除.结果9例患者术后颅内压增高症状均消失,术前症状改善.影像学复查(CT或MR)见肿瘤均缩小至鞍区、脑积水消失.除1例有暂时多尿及低钠外,无其他严重并发症.再手术全切除肿瘤的3例,患者术后反应明显减轻.结论对有囊性变并伴有脑积水的巨大颅咽管瘤,先采用神经内窥镜手术,是提高进一步治疗疗效、降低致残率和死亡率的有效方法.     

神经导航辅助内镜在神经外科手术中的应用

目的：探讨神经导航辅助内镜在神经外科手术中的应用价值。方法：术前对7例颅内囊性病变(4例透明隔囊肿．3例颅咽管瘤)，4例梗阻性脑积水，1例侧脑室内囊虫病患者进行磁共振扫描，图像资料传人ASA-610V导航计算机工作站．制定手术计划，术中导航实时引导，内镜准确穿刺脑室及病灶，按照手术计划进行造瘘或活检术。结果：导航引导下1例脑室内囊虫病病灶顺利找寻并摘除，7例颅内囊性病变及4例梗阻性脑积水顺利穿刺造瘘(2例多房性颅咽管进行多房造瘘)，术后复查囊腔或脑室明显缩小，未出现并发症。结论：神经导航可以实时引导内镜正确辨认方向，尤其在解剖结构显示不清时，帮助安全、准确地找寻病灶，减少了并发症，缩短了手术时间。     

内窥镜应用于神经外科手术（附73例报告）

目的：探讨内窥镜在神经外科手术中的应用。方法：应用内窥镜铺助的显微神经外科对36例垂体瘤经蝶入路手术。结合立体定向技术对27例位于脑深部或脑室内病变（梗阻性脑积水22例,其中合并松果体区肿瘤3例;透明隔囊肿4例;囊性颅咽管瘤1例）进行单纯内窥镜手术;对10例桥小脑角病变应用内窥镜控制的显微神经外科行微血管减压。结果：36例垂体瘤中24例全切除,12例次全切除;22例梗阻性脑积水中21例经随访脑室缩小,症状改善,1例术后复发,行脑室-腹腔分流,22例中3例合并松果体区肿瘤经活检明确肿瘤性质;5例颅内囊性病变经随访囊腔缩小;10例桥小脑角微血管减压术应用内窥镜创伤小,手术效果满意。结论：内窥镜可以充分显露鞍区肿瘤,更完全切除肿瘤;可以将立体定向活检与三脑室底部造瘘结合为同期可视的方法;可直视下对囊肿及囊性颅咽管瘤穿刺冲洗、房腔贯通;可从不同角度观察了解桥小脑角显微解剖结构。微创直观。     

神经内镜手术治疗脑室内肿瘤

目的探讨神经内镜手术治疗脑室内肿瘤的临床疗效及经验.方法回顾性分析16例经神经内镜手术治疗的脑室内肿瘤的临床资料,其中肿瘤单纯位于侧脑室8例,第三脑室6例,同时位于侧脑室和第三脑室2例.结果肿瘤全切除4例,部分切除8例,囊性颅咽管瘤经囊腔内置Ommaya管术后囊腔明显缩小4例.术后根据病理检查对部分病例进行放射治疗.均无明显手术并发症.随访2～36个月,平均15.7个月,无死亡病例,第三脑室内生殖细胞瘤复发1例,第三脑室内囊性颅咽管瘤囊腔扩大1例.结论神经内镜手术治疗脑室内肿瘤具有微创、手术视野好、并发症少等优点,是一种有效的诊疗手段.     

多模态神经导航系统联合神经内镜在颅咽管瘤手术中的临床应用

目的 探讨多模态神经导航系统联合神经内镜手术治疗颅咽管瘤的临床效果及安全性,寻找颅咽管瘤手术治疗的最佳策略。方法 回顾性分析中国医科大学附属第一医院神经外科2017年1月—2019年1月在多模态神经导航系统辅助下经鼻神经内镜切除颅咽管瘤的18例患者的临床资料。分析患者的肿瘤切除程度及术后并发症。结果 16例患者(88. 9%)的肿瘤完全切除,2例患者(11. 1%)的肿瘤次全切除。6例患者(33. 3%)术后出现并发症,其中脑脊液鼻漏1例、尿崩症2例、发热1例、低血钠1例、甲状腺功能下降1例。结论 多模态神经导航系统通过多图像融合和三维重建原理,联合术中多普勒超声和神经电生理监测实时显示病变与邻近血管、神经的空间关系,提高了颅咽管瘤的全切率,减少了术后并发症的发生率。多模态神经导航系统联合神经内镜在颅咽管瘤手术中的应用显著改善了手术效果,并为颅咽管瘤的手术治疗提供了更好的保障。     

鞍下鼻咽部颅咽管瘤1例报告

目的 探讨原发于鞍下鼻咽部颅咽管瘤的治疗方法。方法 对1例CT和MRI显示鞍下鼻咽部巨大囊性肿瘤的病儿，行经蝶入路手术大部分切除肿瘤。结果 病理诊断为颅咽管瘤，术后辅以放疗，随访2年，病儿症状消失。结论 鞍下鼻咽部颅咽管瘤可采用经蝶入路，术后辅以放疗有助于消除残留肿瘤及防止复发。     

颅咽管瘤的微侵袭外科治疗

目的探讨颅咽管瘤的微侵袭治疗方法的选择及并发症。方法46例颅咽管瘤患者,30例行显微手术切除,其中25例行全切除,5例行大部分切除后予r刀治疗;6例行单纯r刀治疗;10例行MRI立体定向囊内放射治疗。结果手术组25例全切除患者,术后21例恢复正常工作,2例需生活照顾,2例死于下丘脑损害;随访2年以上16例,CT或MRI检查未见肿瘤复发。r刀治疗组11例患者临床症状明显改善,随访6～30个月,MRI检查显示4例肿瘤完全消失,5例缩小,2例无变化,无术后并发症。囊腔放疗组10例经手术排除囊液后临床症状明显改善,随访3～30个月,MRI显示3例肿瘤完全消失,7例瘤腔明显缩小,无手术死亡率及严重并发症。结论显微手术全切除颅咽管瘤仍是目前理想的治疗方法,r刀治疗适用实质性和部分实质性,体积较小(<3～4cm)的肿瘤。对囊性体积较大的颅咽管瘤行立体定向囊腔内放疗是一种十分安全有效的方法。     

翼点入路显微手术切除颅咽管瘤

目的探讨经翼点入路切除颅咽管瘤的手术方法及效果。方法13例颅咽管瘤患者均采用经右侧翼点入路手术,合理利用四个手术间隙切除肿瘤。结果11例肿瘤达到全切,1例囊实性和1例实性肿瘤次全切除(术后分别行γ-刀治疗);1例术后9d死亡。随访6月～2.4年,12例均未见肿瘤复发。结论应用显微外科技术经翼点入路可满意地切除颅咽管瘤,术后辅以放疗或γ-刀治疗能有效地延长患者生存时间,减少复发。     

扩大经鼻蝶入路神经内镜手术切除鞍上颅咽管瘤

目的 探讨扩大经鼻蝶入路神经内镜手术切除鞍上颅咽管瘤的疗效。方法 回顾性分析2018年3月至2022年7扩大经鼻蝶入路神经内镜手术治疗的20例鞍上颅咽管瘤的临床资料。结果 肿瘤全切除17例，次全切除2例，部分切除1例。术后8例新发甲状腺功能减退，10例新发肾上腺素功能减退，5例新发尿崩症。无新发高泌乳素血症。术后1例发生脑膜炎，无脑脊液漏。术后随访6～22个月，平均（12.16±3.40）个月，无肿瘤复发或病人死亡。结论 扩大经鼻蝶入路神经内镜手术是一种治疗鞍上颅咽管瘤的有效方法。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -