内镜经眉弓上锁孔入路的解剖学研究

目的 探索内镜经眉弓上锁孔入路暴露颅底中线区域的解剖结构,为临床该术式切除颅底中线区域肿瘤提供解剖学基础。 方法 内镜经眉弓上锁孔入路解剖5具成人尸头标本,观察该入路暴露的颅底中线区域脑组织、血管及神经。 结果 内镜经眉弓上锁孔入路可充分暴露前床突及其内侧前颅底硬脑膜、嗅沟及嗅神经;蝶鞍区可显露视神经、视交叉、视交叉前间隙、垂体上动脉、眼动脉、颈内动脉及其周围间隙;上斜坡区域可显露鞍背硬脑膜、乳头体、基底动脉末端、小脑上动脉、大脑后动脉、后交通动脉、动眼神经、滑车神经、三叉神经、面神经、前庭蜗神经及脑桥腹侧。 结论 内镜经眉弓上锁孔入路切除颅底中线区域肿瘤在解剖学上可行,临床上可作为常规显微镜手术及经鼻内镜入路手术的有效补充。     

经穹窿间中间帆锁孔入路的显微解剖

目的:为经穹窿间中间帆锁孔入路提供显微外科解剖基础.方法:导航辅助下在16尸头标本上模拟左、右经穹窿间中间帆锁孔入路手术,显微镜下观察第三脑室、松果体区的手术显露范围,并比较左、右锁骨孔入路对手术显露的影响.结果:导航辅助下经穹窿间中间帆锁孔入路手术能在尸头上顺利完成,可清晰显露乳头体之后的第三脑室后大部.松果体区,显露的最深处为小脑中央小叶与小舌,上界达胼胝体压部下表面.对侧锁孔入路对第三脑室侧壁、松果体区外侧部的手术显露好于同侧锁孔入路.结论:经穹窿间中间帆锁孔入路技术上可行,适用于侵犯第三脑室后部的松果体区中间部肿瘤的手术治疗.     

神经内镜与显微镜经远外侧锁孔入路在颅颈交界区手术中应用的解剖学对比研究

目的 探讨神经内镜与显微镜经远外侧锁孔入路行颅颈交界区手术中,枕髁磨除前后的解剖观察范围,并分析枕髁磨除的意义。方法 纳入10%甲醛固定的5例（10侧）成年国人尸头标本,动静脉分别以红、蓝乳胶灌注,其中男3具、女2具,年龄58~70岁、平均61岁。模拟远外侧手术入路：取乳突后“S”形切口、枕髁后微骨窗开颅,分别在显微镜和神经内镜下操作,观察磨除枕髁前后镜下术野显露的解剖结构,测量并计算延髓腹外侧的显露面积,对比2种手术入路的观察范围。结果 显微镜经远外侧锁孔入路可显露成人尸头标本后组颅神经、椎动脉、基底动脉、小脑前下动脉和小脑后下动脉,枕髁磨除后扩大了对椎动脉、舌下神经、延髓侧方及腹侧的显露。神经内镜经远外侧锁孔入路通过面听-舌咽神经间隙、舌咽-迷走神经间隙、迷走-副神经颅根间隙和副神经脊髓根腹侧间隙,可观察后组颅神经、椎动脉、基底动脉、小脑前下动脉、小脑后下动脉、脑干侧面及腹侧面;磨除枕髁前、后内镜下延髓腹外侧显露面积分别为（331.0±6.6）mm²和（464.7±10.6）mm²,差异有统计学意义（t=52.99, P<0.001）;磨除枕髁前、后显微镜下延髓腹外侧显露面积分别为（205.8±9.6）mm²和（329.1±6.7）mm²,差异有统计学意义（t=75.07, P<0.001）;磨除枕髁前、后内镜下延髓腹外侧显露面积均大于显微镜下,差异均有统计学意义（t=62.18、64.62, P值均<0.001）;内镜磨除枕髁前与显微镜磨除枕髁后的显露面积差异无统计学意义（t=1.63, P=0.137）。结论 远外侧锁孔入路磨除枕髁后神经内镜与显微镜2种手术方式均能增加延髓腹外侧的显露面积;神经内镜远外侧锁孔入路不磨除枕髁即可获得良好的、与显微镜远外侧锁孔入路磨除枕髁后相似的显露范围,对脑干腹侧面、椎动脉、基底动脉等深部结构的显露更具优势,临床手术中可免于磨除枕髁。     

蝶骨嵴锁孔入路的显微外科解剖

目的:掌握经蝶骨嵴锁孔入路显露鞍周结构的显微外科解剖,探讨该入路治疗颅内病变的可行性.方法:14例(28侧)10%甲醛溶液固定尸体头颅标本模拟蝶骨嵴锁孔入路,借助手术显微镜通过鞍区手术间隙对鞍区重要结构进行显微解剖.结果:对颈内动脉床突上段及其分支、基底动脉顶部、垂体柄等鞍周重要结构进行良好的显露和观测,并获得重要参数.结论:蝶骨嵴锁孔入路适用于显露大部分前循环动脉瘤及前颅底后方、鞍旁、蝶骨嵴、颞极、中颅窝底前部病变.     

眶上锁孔入路内镜辅助显微镜应用解剖研究

目的:研究神经内镜下眶上锁孔入路的解剖特点,探讨其在手术中的应用价值.方法:8例成人尸头,取眶上锁孔入路,在手术显微镜和内镜下观察鞍区和鞍旁区,观察和测量其内容及比邻关系.结果:测量颧突至同侧及对侧视神经管颅口、同侧及对侧前床突尖、同侧及对侧后床突尖的距离.额骨颧突内板到同侧前床突的距离最短,为(5.96±0.22)cm;到对侧后床突尖距离最长,为(8.11±0.28)cm.额骨颧突内板与同侧后床突尖的轴位水平夹角最小,为(32.58±3.44)°,与对侧前床突尖的轴位水平夹角最大,为 (50.33±3.44)°.通过不同角度内镜及解剖间隙,能够观察到鞍区结构,前循环血管各部.结论:该入路可作为鞍区和鞍旁区肿瘤切除、动脉瘤夹闭、经终板第三脑室造瘘、视神经管减压等手术的常用手术入路,熟悉入路中各结构间的相互位置关系距离对术中定位有很大帮助.     

内镜辅助下远外侧髁后锁孔手术入路的解剖学研究

目的：探讨内镜辅助下枕下远外侧锁孔手术的可行性及入路的显微外科解剖学基础。方法：10具尸体头标本于乳突后作纵向“S”型、约7cm长头皮切口，上缘起自乳突中点向后2cm处，下界至C2水平。分层翻转枕下肌群，显露枕骨远外侧，做直径约3cm的骨窗，牵开小脑半球，神经内镜及显微镜下观察所显露的解剖结构。结果：通过调整神经内镜及显微镜角度，经枕下远外侧髁后锁孔入路可显露同侧椎动脉、小脑下后动脉、小脑下前动脉、面神经、前庭蜗神经神经、后组脑神经、舌下神经和延髓腹外侧等结构。结论：枕下远外侧髁后锁孔入路可很好地显露上述结构，应用神经内镜技术，可在不磨除枕髁和颈静脉结节的情况下进行颅颈交界区手术。     

眶上"锁孔"入路的内窥镜解剖学研究

目的 :研究眶上“锁孔”入路的内窥镜局部解剖学并测量有关解剖数据 ,为临床外科手术提供形态学参考信息。方法 :测量 10 0例成人颅骨标本额骨颧突距同侧和对侧前后床突的距离和角度 ;用手术显微镜和硬质内窥镜交替使用通过 2 5具成人尸头 ,探讨眶上“锁孔”手术入路 ,并测量颧突与颅内血管的距离和角度。结果 :通过使用不同角度窥镜和在不同解剖间隙内操作可达到Willis环双侧及鞍区、岩斜区。结论 :锁孔技术是一种微侵袭神经外科技术。解剖数据结果对于选择手术器械的长度有参考价值 ;窥镜辅助手术可达Wills环及鞍区、岩斜区 ,配合特殊手术器械可完成上述区域病变的治疗。     

经眶额颞入路鞍区手术间隙的应用解剖

目的研究眶额颞入路中鞍区4个手术间隙的显微解剖特征,探讨这些间隙在鞍区显微外科手术中的应用。方法在10例(20侧)成人尸头标本上,模拟眶额颞入路开颅,在显微镜下对鞍区手术常用的4个手术间隙及其内部结构进行解剖观察和测量。结果对视交叉前间隙、视神经-颈内动脉间隙、颈内动脉-小脑幕三角间隙及终板间隙的结构构成及其邻近血管神经进行描述测量。结论选择合适的手术入路、熟悉鞍区解剖间隙的显微解剖、保护穿通支是鞍区手术成功的关键。眶额颞入路兼有额下和翼点入路的优点,适合大型鞍区肿瘤的切除。     

经眉弓切口锁孔手术切除鞍区病变的解剖及临床应用研究

报道经眉弓切口锁孔入路切除鞍区肿瘤的应用解剖及临床手术经验。方法：取成入干性颅骨标本30侧，福尔马林固定的成人尸体头部标本5例，测量与经眉弓锁孔入路相关的数值，模拟手术过程，临床32例鞍区肿瘤经该入路行手术切除。结果：颅骨相关部位测量结果表明，眶上孔及额窦位置的变异与手术相关，在尸体标本上显微镜和内窥镜下模拟手术入路，可暴露鞍区四个间隙及相关结构。临床32例鞍区肿瘤经此入路手术，效果满意，肿瘤全切17例(53．12％)，无重大并发症。结论：经眉弓切口锁孔入路切除鞍区病变是完全可行的，可取得与经额下入路和翼点入路相似的暴露效果，且能克服其他入路存在的某些缺陷。     

内镜辅助显微镜经鼻蝶入路垂体腺瘤切除术应用解剖及临床研究

目的：探讨内镜辅助显微镜经鼻蝶入路的解剖与临床应用价值。方法：在6例成人尸头标本上模拟经鼻蝶入路手术。采用内镜辅助显微镜经鼻蝶入路手术治疗垂体瘤患者32例。结果：（1）采用经鼻蝶入路,内镜下在蝶窦内可观察到更多的周围结构,利于确定鞍底、海绵窦与鞍结节位置,在显露硬膜下结构时,内镜下侧方可显露海绵窦外侧壁,前方可显露双侧嗅神经和直回。（2）32例患者中,肿瘤全切29例,次全切除2例,大部切除1例;无手术死亡病例,无严重并发症发生。结论：内镜辅助显微镜经鼻蝶入路对鞍区显露良好、肿瘤全切率高、手术创伤小、术后并发症少,是切除垂体瘤的理想术式。     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

Adequate function of the cell: Interactions between the needs of the cell and the needs of the organism

The continuous maintenance of cell adequate function (cellular stress) is considered to be the main feature which characterizes the activity of a live cell. In accordance with the concept of cellular stress, the transition of the cell to the state of adequate funcitoning represents a dual commitment. The cell must function adequately to respond to the demands of the organism and to provide for its own needs. Thus, it is proposed that two systems exist for the regulation of the adequate function of the cell: one enabling the cell to respond to the demands of the organism, and the other providing for the needs of the cell itself. The hormonal system of the organism represents the first of these mechanisms, and I believe that another system exists for regulation of intracellular needs. Adequate function of the cell is determined by the regulative, controlling and defense mechanisms. The balance between the needs of the cell and of the organism should be a concern of physician, since it provides for the optimal function and health of the organism as a whole.     

The Beauty of the Network in the Brain and the Origin of the Mind in the Control of Behavior

Behavior is not adequately described as a stimulus-response process. It is initiated by the animal and is generated because of its expected outcome in the future. The outcome can be good or bad for the animal. The brain is in charge of the selection process. This is the basic function of the brain. Taking Drosophila as a study case, this paper discusses initiating activity, several examples of outcome expectations, trying out (the internal search for a suitable behavior), chaining of actions, and the functional roles of chance in action selection. It takes mental processes and states such as goals, intentions, feelings, memories, cognition, and attention as higher levels of behavioral control that have their origin in biological evolution.     

On the development of the sympathetic chain and the adrenal medulla in the mouse

Summary The first visible primordia of the sympathetic chain appear in the anterior thoracic region and run caudally through 8 segments in an embryo of 11 gestation days. At 12 gestation days the trunk reaches from the base of the skull into the sacral region. During the following days the trunk develops into ganglia with interganglionic fibers.At 16 gestation days there is a well developed trunk with a cranial ganglion cervicale superior and a ganglion stellatum in the anterior part of the thoracic region. In the remaining sympathetic chain there are segmentally arranged ganglia but in this common pattern large differences are noticed.At the 13th gestation day the first signs of the adrenal medulla and the splanchnic plexus appear in the form of sympathoblasts ventral to the sympathetic chain. The migration of sympathoblasts into the primordia of the adrenal cortex goes on for 3 days while the migration to the splancnic plexus in the mesenchym ventral and lateral to the aorta goes on at least 2 more days.     

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

On the origin of the corticotectal projections in the cat

Summary Stereotaxic injection of horseradish peroxidase into the superior colliculus produced retrograde labelling of layer V pyramides in the Clare Bishop area and the lateral bank of the suprasylvian sulcus, in area 17,18 and 19. Single labelled cells were also found scattered in the splenial, the suprasplenial, the lateral and the suprasylvian gyri. In the cruciate sulcus no labelled cells were observed. Autoradiographically, the lateral bank of the suprasylvian sulcus was also shown to give rise to fibres to the superior colliculus.     

PEComas: the past,the present and the future

The perivascular epithelioid cell (PEC) is a cell type constantly present in a group of tumors called PEComas. PEC expresses myogenic and melanocytic markers, such as HMB45 and actin. Recently, recurrent chromosomal alterations have been demonstrated in PEC. At present, PEComa is a widely accepted entity. In the past 10 years, the use of this term has allowed to report and describe numerous cases permitting to start highlighting the biology of this group of lesions. PEComas are related to the genetic alterations of tuberous sclerosis complex (TSC), an autosomal dominant genetic disease due to losses of TSC1 (9q34) or TSC2 (16p13.3) genes which seem to have a role in the regulation of the Rheb/mTOR/p70S6K pathway. There are some open questions about PEComas regarding its histogenesis, the definition of epithelioid angiomyolipoma and the identification of the histological criteria of malignancy. An innovative therapeutic trial using rapamycin is under way for tumors occurring in TSC such as renal angiomyolipoma and lymphangioleiomyomatosis. Its success could provide the rationale for the use of the same drug in other lesions composed of PECs, especially in the malignant ones.