颅底肿瘤的显微外科治疗

目的提高对颅底肿瘤治疗的认识。方法回顾分析显微外科手术治疗颅底肿瘤56例的临床特点和总结手术体会。结果56例颅底肿瘤中,手术全切除46例,次全切除4例,大部切除6例。术前颅神经功能损伤35例46条,术后恢复23条（50%）,好转8例（17.4%）,症状无改善9条（19.6%）,加重6条（13.0%）,出现新的颅神经症状者5例。结论术前精确的诊断对手术及预后非常重要。手术入路主要取决于肿瘤的位置、延伸及大小。显微外科手术是减少术后并发症、获得良好预后的关键。     

Pain and dysphagia in patients with squamous carcinomas of the head and neck: the role of perineural spread

Clinical and pathological features of perineural spread have been investigated in patients with squamous carcinomas at several sites in the head and neck. In 100 surgical cases, the clinical and pathological findings were congruent in 76%. Combined clinical and histological evidence of perineural invasion was recorded in 33% and the overall incidence of nerve involvement detected morphologically was 44%. Perineural infiltration was demonstrated histologically in 51% of major excisions from the buccal cavity and in 34% of resections from the oropharynx, hypopharynx and cervical oesophagus. The neurological findings were dominated by hypoaesthesia, dysaesthesia and referred pain – mainly in the territories of cranial nerves V and IX. Multiple and/or sequential nerve involvement was occasionally seen. No correlation was established between nerve invasion and metastasis to regional lymph nodes. Long-distance infiltration of nerve trunks, and multiple involvement, are grave prognostic features.

In 17 terminal patients submitted to autopsy, 65% had combined clinical and pathological evidence of perineural spread and the overall incidence of nerve involvement detected morphologically was 88%. Sensory changes again predominated. Multiple nerve involvement was observed in 35%. An apparently new `dysphagia syndrome' is described in 4 patients with oropharyngeal carcinomas in whom gross mechanical obstruction was simulated by a combination of perineural spread of tumour into the ipsilateral vagal trunk, sometimes accompanied by segmental infarction, variable invasion of the sympathetic chain, and `splinting' of the pharynx by local fibrosis and tumour in the soft tissues of the neck. Short-term palliation was achieved in these patients with high-dose steroids.

     

神经补片在大骨瓣开颅硬脑膜减张修补中的应用

目的探讨颅脑损伤大骨瓣开颅人工硬脑膜减张修补的优缺点。方法对137例重型颅脑损伤病人分为神经补片硬脑膜修补组和自体组织硬脑膜修补组进行了临床观察。结果经对92例神经补片、45例自体组织硬脑膜修补患者临床疗效比较,神经补片硬脑膜修补组与自体组织硬脑膜修补组临床预后无差异,并发症发生率低于自体组织硬脑膜修补组（P〈0.05）。14例患者分别于硬脑膜修补术3-6个月后行颅骨修补时发现神经补片与正常硬脑膜已完全愈合,无不良反应。结论大骨瓣开颅人工硬脑膜减张修补可减少术后并发症。德国贝朗神经补片可安全、有效地用作大骨瓣开颅硬脑膜减张修补材料。     

内窥镜辅助下侧颅底手术

目的 观察内窥镜辅助下侧颅底手术的疗效及并发症.方法 在内窥镜辅助下采用迷路进路及乙状窦后进路行听神经瘤手术11例,颅中窝进路及颅中窝、乳突联合进路行岩尖胆脂瘤手术5例.结果 听神经瘤全切除9例,2例残留部分包膜;术中内窥镜下探查面神经均完整,其中9例术后无面瘫表现,2例术后出现轻度周围性面瘫;术中内窥镜下探查蜗神经均完整,2例术后听力与术前比较保持不变,9例出现不同程度听力下降.其中,中度感音神经性耳聋1例,中重度2例,重度3例,极重度3例.岩尖胆脂瘤患者均行病变全切除,3例术前面瘫患者经术中减压,术后9个月内均恢复.2例术后出现中重度传导性耳聋,其余患者术后听力无明显改变.结论 侧颅底手术中使用内窥镜可提高血管、神经保全率及病变全切率,但也有其不足,仅能作为显微镜手术的辅助使用.     

内窥镜辅助下侧颅底手术

目的观察内窥镜辅助下侧颅底手术的疗效及并发症。方法在内窥镜辅助下采用迷路进路及乙状窦后进路行听神经瘤手术11例，颅中窝进路及颅中窝、乳突联合进路行岩尖胆脂瘤手术5例。结果听神经瘤全切除9例，2例残留部分包膜；术中内窥镜下探查面神经均完整，其中9例术后无面瘫表现，2例术后出现轻度周围性面瘫；术中内窥镜下探查蜗神经均完整，2例术后听力与术前比较保持不变，9例出现不同程度听力下降。其中，中度感音神经性耳聋1例，中重度2例，重度3例，极重度3例。岩尖胆脂瘤患者均行病变全切除，3例术前面瘫患者经术中减压，术后9个月内均恢复。2例术后出现中重度传导性耳聋，其余患者术后听力无明显改变。结论侧颅底手术中使用内窥镜可提高血管、神经保全率及病变全切率，但也有其不足，仅能作为显微镜手术的辅助使用。     

Malignant otitis externa: a review

Malignant otitis externa is a rare but potentially fatal disease of the external auditory canal seen mostly among elderly, diabetic or immunocompramised patients. The causative organism is mainly Pseudomonas aeruginosa. The disease spreads rapidly, invading surrounding soft tissues, cartilage and bones causing their necrosis and even spreading to the cranial nerves. The disease can be fatal if treatment is not aggressive and timely, especially if it spreads outside the auditory canal with involvement of the cranial nerves. Treatment is mainly medical with antipseudomonal drugs like the third generation cephalosporin and the fluoroquinolones and local debridement. With aggressive treatment the mortality rate from this disease, which used to be 50% in the past has now been reduced to 10-20%. The pathophysiology of the disease, clinical presentation, diagnosis, treatment and the outcome has been discussed and reviewed.     

经乙状窦后锁孔入路的显微解剖学研究

目的对经乙状窦后锁孔入路至岩斜区进行显微解剖学研究，为临床应用提供解剖学依据。方法采用6具（共12侧）经10％甲醛溶液固定的尸体头颅标本，模拟经乙状窦后锁孔入路，显微镜下观察所显露的解剖结构。结果通过凋整头位和显微镜角度，经乙状窦后锁孔入路可显露同侧三叉神经、面神经、听神经、后组颅神经、脑桥腹外侧面、小脑半球外侧面、小脑前下动脉、椎动脉、小脑后下动脉等。结论经乙状窦后锁孔入路符合微创原则，可良好显露岩斜区重要解剖结构。     

459例神经鞘瘤多发部位临床分析

目的研究神经鞘瘤的流行病学和不同部位分布情况,为防治这一临床常见软组织肿瘤提供参考资料。方法统计本院2002年1月-2012年6月住院手术并经过病理学证实的459例神经鞘瘤患者的流行病学和治疗学资料,按照流行病学、各部位发病率等进行分别统计。结果神经鞘瘤男女比例为1：1．20,颅神经鞘瘤发病率占全身发病率的53．59％,颅神经发病中桥小脑角占86．99％。椎管内神经鞘瘤排第2位。占神经鞘瘤全身发病率的40．52％,颈椎、胸椎和腰椎为56：49：58,即发病顺序为颈椎〉腰椎〉胸椎〉其他。病理上可见多种改变。如坏死、囊变、液化和细胞丰富等。结论神经鞘瘤是一种常见的住院治疗疾病．通过流行病学的统计可对神经鞘瘤的发病率和分布情况进行了解,同时认为颅神经鞘瘤最为常见,其次为颈椎神经并以颈椎为主。     

经乙状窦后锁孔入路的显微解剖学研究

目的 对经乙状窦后锁孔入路至岩斜区进行显微解剖学研究,为临床应用提供解剖学依据.方法 采用6具(共12侧)经10%甲醛溶液固定的尸体头颅标本,模拟经乙状窦后锁孔入路,显微镜下观察所显露的解剖结构.结果 通过调整头位和显微镜角度,经乙状窦后锁孔入路可显露同侧三叉神经、面神经、听神经、后组颅神经、脑桥腹外侧面、小脑半球外侧面、小脑前下动脉、椎动脉、小脑后下动脉等.结论 经乙状窦后锁孔入路符合微创原则,可良好显露岩斜区重要解剖结构.     

Blink reflex latency after exposure to trichloroethylene in well water

The electrophysiological measurement of the blink reflex (BR) can quantify the conduction latency in the reflex arc involving the Vth (trigeminal) and VIIth (facial) cranial nerves. We measured the electrophysiological BR in a population (N = 21), which had alleged chronic exposure to trichloroethylene (TCE) through the public drinking water at levels 30-80 times higher than the Environmental Protection Agency (EPA) Maximum Contamination Level (MCL). A highly significant difference was observed in the conduction latency means of the BR components (p less than .0001), when the study population was compared with laboratory controls (N = 27). This difference suggests a subclinical alteration of the Vth cranial nerve function due to chronic, environmental exposure to TCE.     

Trauma to the nervous system and its sequelae in a one-year birth cohort followed up to the age of 14 years.

The one-year birth cohort of 12 058 children, 96% of all children born in the two northernmost provinces of Finland, Oulu and Lapland, in 1966 was studied prospectively up to the age of 14 years. During this period 14 children, 1.2 per thousand, were lost from the follow-up. Data on development, mortality, and morbidity were collected prospectively by means of questionnaires and from various registers, the most important of which was the National Hospital Discharge Register. A total of 299 cases of trauma to the nervous system (skull fracture, cerebral contusion, concussion, fracture of the vertebral column with spinal lesion, injury to the cranial or peripheral nerves) occurred in 286 children, 116 girls and 170 boys, which yields a cumulative incidence of nervous system trauma of 24.1 per thousand. The trauma was fatal in 11 boys and 7 girls, 63 per thousand of all children with neurotrauma, and 136 per thousand of all cases of death occurring in the age group 29 days to 14 years. Spinal injury occurred in 12 children, cerebral contusion in 28, skull fracture in 19, and concussion in 216. Such trauma resulted in chronic disease, cerebral palsy, mental retardation, and epilepsy in 16 children, 5.6% of all children with neurotrauma and 3.2% of the 495 children in the cohort with cerebral palsy, epilepsy or mental retardation only.     

Familial schwannomatosis, a new entity distinct from neurofibromatosis type 1 and 2

A Dutch family was diagnosed with familial schwannomatosis, a disorder that is distinct from neurofibromatosis (NF) type 1 and 2. The proband and 4 relatives had schwannomas on spinal roots, cranial nerves, plexuses, and peripheral nerves; no vestibular schwannomas were found. One of the affected relatives was later diagnosed with intracerebral glioma; schwannomas were not found. None of the living affected relatives had genomic defects affecting the NF2 gene. Large deletions in the proximal region of chromosome 22 were found in all resected schwannomas. Schwannomatosis can occur sporadically or be inherited. Pain is often the clinical manifestation of schwannomas. Resection should be reserved for tumours that are symptomatic or threaten to cause spinal cord compression.     

Follow-Up Studies in Tokyo-Yokohama Respiratory Disease

The electrophysiological measurement of the blink reflex (BR) can quantify the conduction latency in the reflex arc involving the Vth (trigeminal) and VIIth (facial) cranial nerves. We measured the electrophysiological BR in a population (N = 21), which had alleged chronic exposure to trichloroethylene (TCE) through the public drinking water at levels 30–80 times higher than the Environmental Protection Agency (EPA) Maximum Contamination Level (MCL). A highly significant difference was observed in the conduction latency means of the BR components (p < .0001), when the study population was compared with laboratory controls (N = 27). This difference suggests a subclinical alteration of the Vth cranial nerve function due to chronic, environmental exposure to TCE.     

Preoperative radiological evaluation and surgical strategy for the preservation of visual acuity in patients with skull base meningiomas--two case reports

Two women aged 48 and 73 years, respectively, presented with unilateral visual disturbance. On admission, magnetic resonance imaging (MRI) showed an extraaxial mass in the parasellar region. Contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) showed that the optic nerves were compressed and encased by the tumors. At an early stage of surgery, we performed decompression of the optic nerves to avoid optic nerve injury. Both the patients were relieved of visual disturbances without any postoperative neurological deficit. In conclusion, CE-FIESTA is a useful diagnostic tool for preoperative evaluation of the optic nerves in patients with skull base meningiomas. Decompression of the optic nerves should be performed at an early stage of surgery in meningioma patients presenting with visual disturbance.     

Asymmetric type F botulism with cranial nerve demyelination

We report a case of type F botulism in a patient with bilateral but asymmetric neurologic deficits. Cranial nerve demyelination was found during autopsy. Bilateral, asymmetric clinical signs, although rare, do not rule out botulism. Demyelination of cranial nerves might be underrecognized during autopsy of botulism patients.     

非艾滋病相关隐球菌性脑膜炎合并脑神经损伤的危险因素及预后分析

目的 探讨非艾滋病（AIDS）相关隐球菌性脑膜炎合并脑神经损伤患者的危险因素及预后因素.方法 回顾性分析非AIDS相关隐球菌性脑膜炎115例患者的临床资料,记录其临床特征、治疗及预后情况,采用Logistic逐步回归法对危险因素和预后因素进行分析.结果 115例患者脑神经损伤发生率为35.7％（41/115）,其中视神经、动眼神经、听神经、外展神经、嗅神经和面神经受累比例分别为48.8％ （20/41）、39.0％（16/41）、24.4％（10/41）、12.2％ （5/41）、7.3％ （3/41）、4.9％（2/41）.预测脑神经损伤的危险因素是确诊时间延长（OR=1.057,95％ CI 1.003～ 1.112）,同时脑脊液有核细胞数降低及颅内压增高也是发生脑神经损伤的独立预测因素（P＜0.05）.72.2％ （26/36）发生脑神经损伤患者可以完全恢复,恢复时间为0.5～24.0（3.8±1.7）个月.脑神经损伤恢复的独立预测因素是脑神经受累数量（OR=0.241,95％ CI0.067～0.801,P=0.023）及采用联合治疗方案（OR=10.328,95％CI 2.087～51.026,P=0.006）.结论 脑神经损伤在非AIDS相关隐球菌性脑膜炎中比较常见,确诊时间延长、颅内压增高以及脑脊液有核细胞数降低与其发生率相关,而脑神经受累数量和采用联合治疗方案是脑神经恢复的独立预测因素;早期诊断加积极有效抗真菌治疗对防治脑神经损伤至关更要.     

Gut-brain axis

PURPOSE OF REVIEW: To summarize recent studies on the regulation and the functions of the gut-brain axis. RECENT FINDINGS: Visual cues of food and food intake interact with the gut-brain axis at the level of the hypothalamus. However, the hypothalamic response to glucose intake is considerably altered in patients with type 2 diabetes mellitus, indicating involvement of the hypothalamus in the pathophysiology of this disease in humans. A large number of studies have documented the functions of gut peptides with respect to the regulation of satiety. Gut peptides are involved in the regulation of insulin secretion and sensitivity. Recent data indicate that peptide YY is a gut hormone that also modulates bone metabolism. Increasing evidence is obtained on the role of afferent gastrointestinal nerves, especially the vagal nerve, in the modulation of the functions of the gut-brain axis. SUMMARY: The gut-brain axis is involved in a multitude of physiological processes including satiety, food intake, regulation of glucose and fat metabolism, insulin secretion and sensitivity and bone metabolism. It is likely, that more aspects of this system will be found the near future.     

矩形压电双晶片骨传导听觉装置的研究

目的:根据骨传导原理,采用矩形压电双晶片作为声振动元件,将音讯信号转变为振动信号,经由脑颅骨刺激听神经使人产生听觉,设计压电骨传导听觉装置。方法:利用有限元对矩形压电振子进行仿真分析,提出矩形压电振子支撑方式及结构参数的优化方案,提高装置在听觉低频信号区域发声效果。对矩形压电骨传导听觉装置进行实验测试,得此结构装置的测试曲线和性能参数。结果:实验研究表明,矩形压电骨传导装置能很好实现骨传导听觉装置的功能。结论:应用仿真分析矩形压电振子的振动位移及基频、阻抗等特性结果,作为骨传导听觉装置结构尺寸的参数,所制作的样机与电磁式骨传导听觉装置对比测试表明,矩形压电双晶片的骨传导听觉装置具有效率高、结构简单的优点。     

Skull base fractures in childhood. The role of CT in the accuracy of diagnosis]

The authors treated 51 patients suffering from basilar skull fractures between January 1995 and June 1997 following a newly initiated protocol. The effectiveness of recognizing these fractures increased to twice and a half after applying a complex (neurologic, otolaryngologic, ophthalmologic, X-ray and cranial CT) diagnostic examination. CT scans were performed at the slightest suspicion of basilar skull fracture since they provide far more information than the native skull X-ray. A close coherence was observed concerning clinical symptoms, potential complications and the manifested fractures, which helped to draw an exact therapeutical strategy and to prevent potential complications. The authors found X-ray gave satisfactory information only about fractures starting on the vault. In the studied period CT proved the basilar skull fracture in 40 (78%) cases out of the total 51. X-ray did it in only 4 (8%) cases and raised the suspicion of the vault fracture spreading to the cranial floor in 20 (39%) cases. CT did not prove the clinically supposed basilar skull fractures in only 11 (22%) cases compared to 27 (53%) by X-ray. After having consultation with radiologists examination methods were always determined by the clinical picture and the available technical conditions (helical technique, multiplan or 3D-reconstruction).