脑干肿瘤的手术治疗

手术治疗6例脑干肿瘤病人，次全切除2例，大部切除1例，部分切除3例。术后临床表现明显改善1例，改善3例，无变化2例，无一例术后死亡。作认为脑干肿瘤手术治疗成功的关键在于手术适应证的选择。弥漫性脑干肿瘤不适合手术治疗，局限性脑干肿瘤，囊性脑干肿瘤，颈髓延髓交界处脑干肿瘤及背侧外生性脑干肿瘤适合手术治疗。其中囊性脑干肿瘤，颈髓延髓交界处脑干肿瘤，背侧外生性脑干肿瘤常能做到肿瘤的全切除或次全切除。     

脑干肿瘤的显微外科治疗(附21例报告)

目的 报告应用显微神经外科技术切除脑干肿瘤的手术适应证及手术经验。方法 总结我院1998年2月～2001年2月间应用显微神经外科技术治疗的21例脑干肿瘤病例。结果15例肿瘤全切，6例大部或部分切除。1例术后死于呼吸衰竭。结论 应用显微神经外科技术切除脑干肿瘤，只要方法得当，可以取得较好的治疗效果。     

第二届（天坛）颅底及脑干肿瘤国际学术研讨会暨第五届全国颅底外科会议

第二届颅底脑干肿瘤学术研讨会暨第五届全国颅底外科会议定于2008年10月10～14日召开。本次研讨会还特意邀请了包括Al-Mefty、Beterlanffy、Nanda等在内的知名神经外科专家，全面、系统介绍国内外颅底和脑干肿瘤方面最新学术动态，普及和提高我国颅底和脑干肿瘤的治疗水平的神经外科最新诊治技术在我国全面、有序的发展。进一步提高我国颅底外科的整体水平，规范颅底外科相关手术入路，规范脑干肿瘤的手术指征，树立正确的微创理念，推动我国颅底脑干肿瘤外科的发展。     

脑干肿瘤的诊断与治疗

探讨脑干肿瘤的诊断和治疗方法。总结我院自1988年以来采用显微外科手术治疗19例、放射治疗2例脑干肿瘤的经验。6例痊愈或症状明显改善，3例术后无明显变化。5例术后死于呼吸循环衰竭，3例术后死于继发呼吸道感染，2例放疗症状加重。     

显微手术治疗脑干占位性病变(附13例分析)

目的探讨脑干占位性病变的手术适应证、手术入路及显微手术技巧。方法回顾性分析我院2003～2006年手术治疗的13例脑干肿瘤病人的临床表现、肿瘤影像学特点及生长模式和手术治疗效果。结果脑干不同位置、不同类型肿瘤生长模式不尽相同。本组镜下判断肿瘤全切除7例,次全切除3例,部分切除3例。术后死亡1例。结论应用显微神经外科技术切除脑干肿瘤,只要适应证选择正确,方法得当,可以取得较好的治疗效果。     

脑干肿瘤的诊断及手术干预策略

目的探讨脑干肿瘤的诊断和显微手术适应证、方法、技巧和疗效。方法回顾性分析2002年1月至2007年12月收治的32例脑于肿瘤诊断和显微手术治疗的资料。结果32例脑干肿瘤患者均行显微手术,术后患者颅神经症状明显好转22例．变化不明显7例,加重2例,死于呼吸循环衰竭1例。结论MRI为脑干肿瘤诊断的首选检查方法。手术适应证和手术入路的正确选择,精细的术中操作,积极预防和处理术后并发症是提高脑干肿瘤治疗效果的关键。     

脑干肿瘤的手术治疗

手术治疗6例脑干肿瘤病人,次全切除2例,大部切除1例,部分切除3例.术后临床表现明显改善1例,改善3例.无变化2例,无一例术后死亡.作者认为脑干肿瘤手术治疗成功的关键在于手术适应证的选择.弥漫性脑于肿瘤不适合手术治疗,局限性脑于肿瘤、囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤及背侧外生性脑干肿瘤适合手术治疗.其中囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤、背侧外生性脑干肿瘤常能做到肿瘤的全切除或次全切除.     

脑干肿瘤的显微外科治疗

本报告了19例经显散外科手术治疗的脑干肿瘤，其中肿瘤全切4例，大部分切除9例，部分切除6例。除1例术后第8d死于消化道出血。2例症状加重外。其余均获得良好疗效。初步分析了脑干肿瘤的性质，好发部位．临床症状和体征。讨论了脑干肿瘤的手术指征，手术入路，手术要点，术后并发症的防治和综合治疗。     

脑干肿瘤的手术治疗:回眸与展望

<正>作者有幸跟随王忠诚院士开展脑干肿瘤的手术治疗18载,从第1例脑干肿瘤手术到现在,首都医科大学附属北京天坛医院神经外科中心颅底与脑干病房每年收治近百例脑干肿瘤病例,脑干肿瘤的治疗已经形成一定规模。近年来,国内脑干手术较前也有较大发展,脑干手术的成功病例报道经常能见诸媒体。由于脑干位置的特殊性,脑干肿瘤的手术风险性较大,有必要对脑干肿瘤的手术治疗进行再次梳理。     

世界神经外科发展简史(Ⅳ)

现代神经外科治疗技术在继承古老方法的基础上亦得到了长足的发展。1968年，以瑞士学者Yasargil为代表的神经外科学家首先开展在显微镜下进行手术操作，由于手术视野放大及良好的照明，使得手术精确性大为提高，临近组织的损害机会明显减少。许多原来不能做的手术如今成为现实，原来的手术禁区正逐步被打破。脑深部病变、脑干肿瘤、脊髓髓内肿瘤等许多疑难病症，前人束手无策，如今在显微神经外科时代许多问题得到了解决，这是神经外科治疗史上的一项重大技术革命。     

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 -