大型听神经瘤的显微手术治疗及术中面神经保护

目的 探讨显微手术切除大型（肿瘤最大径>3 cm）听神经瘤的疗效及术中面神经保护的方法。方法 回顾性分析2014年1月至2018年2月手术治疗的86例大型听神经瘤的临床资料,均在电生理监测下采用枕下乙状窦后入路显微手术。结果 肿瘤全切除83例,近全切除3例。面神经保留78例（91%）;术后1周面神经功能House-Backmann分级:1级11例,2级37例,3级22例,4级16例。术后门诊随访3~30个月,术区皮下积液4例,口唇疱疹9例,无死亡病例。结论 术前多模态肿瘤-神经评估,术中实时电生理监测,精细显微手术对大型听神经瘤全切和保留面神经功能可提供保障。     

大型听神经瘤的显微外科治疗

目的探讨听神经瘤显微手术方法,提高肿瘤全切除率及面神经解剖和功能保留率。方法回顾我科2003-08～2009—08经枕下乙状窦后入路显微手术切除的41例大型听神经瘤患者的临床资料,结合文献进行总结探讨。2005—04—29后,对27例行术中面神经电生理监测。结果41例病例中镜下肿瘤全切除37例（92％）,次全切除4例（9．8％）。面神经解剖保留36例（87．8％）,5例（13．2％）未能解剖保留面神经。无手术死亡病例,随诊3个月～6年,术后病人均能恢复正常生活,遗留永久性面瘫5例。结论经枕下乙状窦后人路采用显微技术切除大型听神经瘤,能明显提高手术全切率及面神经保存率。     

大中型听神经瘤的显微手术治疗及面神经的保护

目的 探讨显微手术治疗大中型听神经瘤的疗效及保护面神经的方法。方法 23例大中型听神经瘤（直径>2 cm）患者均在电生理监测下采用枕下乙状窦后入路显微手术切除,术后对其面神经功能进行随防。结果 肿瘤全切除15例,近全切除8例;面神经保留22例,保留率为95.7%;术后面神经功能House-Brackmann分级:1级3例,2级10例,3级6例,4级2例,5级1例,6级1例。术后所有病人随访3~24月,发生脑脊液漏者1例,长期昏迷1例,无死亡病例。结论 显微手术与面神经的电生理监测为全切除大中型听神经瘤并保留面神经提供了保障。     

大型听神经瘤的显微手术治疗

目的探讨经枕下乙状窦后入路显微手术切除大型听神经瘤的效果。方法回顾性分析我院2008年1月至2011年12月手术切除的大型听神经瘤182例患者的临床资料。手术采用侧卧位单侧枕下乙状窦后入路。结果肿瘤全切除162例（89.0%）,次全切除12例,大部切除8例。术中面神经解剖保留率为92.3%（168/182）,术后1周面神经功能保留率为69.8%（127/182）。术后死亡4例。术中行神经电生理监测48例中面神经功能保留率为89.5%（43/48）,较同期未监测患者面神经保留率（70.0%,14/20）明显提高（P〈0.05）。146例术后随访3个月至1年,面神经功能保留121例（82.9%）。结论采用枕下乙状窦后入路显微手术切除大型听神经瘤手效果确切,术中神经电生理监测可有效提高面神经的功能保留率。     

显微手术切除听神经鞘瘤临床疗效分析(附98例报告)

目的评价经枕下乙状窦后经内听道入路,术中神经电生理监测下显微手术切除听神经鞘瘤的疗效。方法本组回顾性分析了98例听神经鞘瘤病例的临床及随访资料。所有患者均采用枕下乙状窦后经内听道入路行显微手术切除肿瘤。术中均行神经电生理监测。结果本组肿瘤全切除96例(97.9%);次全切除2例;面神经解剖保留98例(100%);岩静脉解剖保留95例(96.9%);听力保留14例(14.3%);无死亡病例。结论经枕下乙状窦后内听道入路,术中神经电生理监测下显微手术切除听神经鞘瘤可以获得满意的临床疗效。     

大型听神经瘤的显微手术治疗

目的总结大型听神经瘤显微手术治疗的临床经验。方法对52例大型听神经瘤病人的临床资料进行回顾性分析。均在面神经电生理监测下,采用枕下乙状窦后经内听道入路行肿瘤显微切除。结果肿瘤全切除45例,次全切除7例。面神经解剖保留46例,断端吻合4例,无手术死亡。结论显微手术是治疗大型听神经瘤安全有效的方法,术中熟识解剖和熟练的显微手术技巧能有效提高手术效果。     

大型听神经瘤的显微手术治疗

目的 探讨显微手术切除大型听神经瘤的入路和方法。方法 经枕下入路显微手术切除大型听神经瘤226例,其中锁孔手术93例。结果 肿瘤全切除193例,次全切除33例。术后死亡1例。术后出现肿瘤部位血肿4例。术中面神经解剖保留205例。177例出院后随访2月~13年,面神经House-Brachmann分级Ⅰ~Ⅲ级143例,Ⅲ级以上34例。结论 枕下入路是显微手术切除大型听神经瘤的有效入路,并能较好地保留面神经功能;强调术中监测,仔细、耐心操作以便保留面神经的功能;当肿瘤与面神经或脑干粘连紧时勿强求肿瘤全切;锁孔手术完全可以达到切除大型听神经瘤要求,损伤小。     

枕下乙状窦后入路锁孔手术切除听神经瘤

目的 探讨枕下乙状窦后入路锁孔手术切除听神经瘤的方法及效果。方法 回顾性分析2016年1月至2018年6月经枕下乙状窦后入路锁孔手术治疗的116例听神经瘤的临床资料,根据术前增强MRI分为中小型听神经瘤组（最大径≤3 cm;83例）和大型听神经瘤组（最大径>3 cm;33例）。结果 中小型听神经瘤组肿瘤全切除率为97.6%（81/83）,面神经解剖保留80例（96.4%）。术后1周面神经功能良好（H-B分级Ⅰ~Ⅱ级）59例（71.1%）。大型听神经瘤组肿瘤全切除率87.9%（29/33）,面神经解剖保留28例（84.8%）,术后1周面神经功能良好18例（54.5%）。结论 对于中小型听神经瘤,采用枕下乙状窦后入路锁孔手术可实现肿瘤完全切除和良好的面神经功能保护。对于大型听神经瘤,在良好体位、充分释放脑脊液、电生理监测等辅助下,采用乙状窦后入路锁孔手术也可实现肿瘤安全满意切除和面神经功能保护。     

面神经监测显微手术切除听神经瘤(附16例报告)

目的总结面神经监测下神经内镜辅助锁孔入路切除听神经瘤的临床经验.方法采用神经内镜辅助经枕下乙状窦后锁孔入路切除听神经瘤16例,术中行面神经自发和诱发电位监测,指导手术切除.结果肿瘤全切除14例(87.5%),面神经解剖保留15例(93.8%),术后2周面神经功能保留13例(81.3%).结论面神经自发和诱发电位监测下行神经内镜辅助枕下乙状窦后锁孔入路显微手术,可以有效提高听神经瘤全切率,减少并发症.     

大型听神经瘤的手术治疗方法

目的探讨在术中神经电生理监测下经枕下-乙状窦后入路显微手术切除大型听神经瘤的方法及效果。方法回顾性分析2013年1月至2015年10月收治的85例大型听神经瘤的临床资料,均在术中神经电生理监测下,采取直切口乙状窦后入路小骨窗显微手术切除肿瘤。结果肿瘤全切除76例(89.4%),次全切除9例(10.6%);术中面神经解剖保留80例(94.1%)。术后即刻、7 d、3个月、6个月、9个月、1年面神经功能分级优良率(H-B分级Ⅰ~Ⅱ级)分别为88.2%、56.0%、41.9%、50.9%、68.6%、86.7%。结论在术中神经电生理监测下显微手术治疗大型听神经瘤,可更好保护面神经功能,提高术后生活质量。     

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.     

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。     

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.     

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.