椎基底动脉瘤的血管内治疗

目的探讨椎-基底动脉系统动脉瘤血管内治疗方法和疗效。方法回顾分析28例椎-基底动脉系统动脉瘤行血管内治疗病例,其中,基底动脉顶端动脉瘤12例;基底动脉主干动脉瘤7例;椎动脉瘤6例;小脑后下动脉瘤3例。行电解可脱性弹簧圈(GDC)动脉瘤囊内栓塞25例,对其中的宽颈、梭形动脉瘤等复杂动脉瘤辅以血管支架、球囊辅助的瘤颈成形技术完成治疗;另对3例大、巨型椎动脉瘤行载瘤动脉闭塞术。结果25例行GDC动脉瘤囊内栓塞病例,达完全致密栓塞11例,90%以上填塞14例,其中1例置入支架的基底动脉梭形动脉瘤病例,术后半年复查,发现支架发生移位。1例巨型椎动脉瘤于载瘤动脉闭塞术后2 d出现脑干缺血症状,给予气管切开、呼吸机维持呼吸,术后4 w死于肺部感染。术后半年,GOS预后评分良好27例。结论血管内治疗是治疗椎-基底动脉瘤,尤其是后循环各种宽颈动脉瘤、梭形动脉瘤的有效方法,采用恰当的操作策略是提高治疗质量的关键。     

单支架及重叠支架植入术治疗椎-基底动脉夹层动脉瘤的疗效分析

目的 观察与评价单支架植入术与重叠支架植入术治疗椎-基底动脉夹层动脉瘤(VBDA)的疗效.方法 回顾性分析24例VBDA病人临床资料,共28个夹层动脉瘤.其中破裂动脉瘤3个,未破裂动脉瘤25个;椎动脉夹层动脉瘤25个,基底动脉夹层动脉瘤3个.采用单支架技术治疗夹层动脉瘤(单支架组)13个,重叠支架技术治疗(重叠支架组)15个.结果 术后6个月随访DSA显示:单支架组夹层动脉瘤完全闭塞2个,部分闭塞5个,无变化6个;重叠支架组夹层动脉瘤完全闭塞7个,部分闭塞8个.两组动脉瘤闭塞率经统计学分析,有显著性差异(P=0.000).单支架组发生支架内狭窄1例;重叠支架组发生支架移位2例,短暂性脑缺血2例,蛛网膜下腔出血1例.所有病人临床随访8～75个月,均在随访结束时行改良Rankin量表(mRS)评分,其中mRS评分0分20例,1分4例.结论 单纯支架植入术治疗椎-基底动脉夹层动脉瘤安全、有效,且重叠支架技术有助于更好地闭塞夹层动脉瘤,得到更满意的影像学结果.     

自膨式支架治疗椎-基底动脉巨大夹层动脉瘤

目的探讨自膨式支架治疗椎-基底动脉巨大夹层动脉瘤的方法及效果。方法10例椎-基底动脉巨大夹层动脉瘤均行血管内治疗并随访。结果术后即刻造影显示6例支架植入处血流发生明显改变,夹层扩张处缩小,4例无明显改变。术中无血栓事件及动脉瘤破裂出血,1例出现严重血管痉挛,应用罂粟碱后迅速缓解。临床随访3～30个月,8例头晕病例中有7例症状消失或减轻;7例术前饮水呛咳病例症状消失4例,减轻2例,1例无变化。造影随访10例,其中1例单支架治疗的患者五个月后夹层动脉瘤复发,球囊闭塞椎动脉,8个月后死于脑干衰竭。结论对于椎-基底动脉巨大夹层动脉瘤,采用单支架治疗效果不佳,多支架技术可以缓解症状并可能修复夹层,但其长期疗效有待进一步随访。     

经皮血管内支架成形术治疗椎-基底动脉狭窄疗效观察

目的 评价经皮血管内支架成形术治疗椎-基底动脉狭窄的安全性、有效性和中短期疗效.方法 23例椎-基底动脉狭窄患者施行经皮血管内支架成形术,共检出25个狭窄病变,其中22个位于椎动脉起始段(左侧13个,右侧9个),1个位于椎动脉颅内段,2个位于基底动脉.共成功植入26枚球囊支架,金属裸支架15枚,药物洗脱支架11枚;基底动脉植入2枚,椎动脉植入24枚.其中1例基底动脉急性闭塞患者采用尿激酶动脉溶栓辅助药物洗脱支架治疗.结果 23例患者施行经皮血管内支架成形术后血管平均狭窄率从治疗前的81.40%(50%～95%)降至6.30%(0～15%).20例患者平均持续随访21个月,17例(85%)症状明显缓解或消失,3例(15%)部分缓解;2例复发患者中1例再次血管内植入药物洗脱支架后血管开通良好,1例拒绝接受再次治疗.结论 经皮血管内支架成形术治疗椎-基底动脉狭窄安全、有效,中短期疗效满意.药物洗脱支架对手术后支架内再狭窄具有一定的预防作用且优于金属裸支架,若手术后积极辅以抗血小板治疗可进一步提高药物洗脱支架治疗椎-基底动脉狭窄的有效性.     

椎基底动脉瘤的手术治疗

目的 探讨手术治疗椎基底动脉瘤的方法.方法 26例28个椎基底动脉瘤患者.动脉瘤破裂出血9例;16例基底动脉瘤,10例椎动脉瘤.5例基底动脉顶部动脉瘤经翼点入路,5例基底动脉顶部和2例基底动脉上段动脉瘤用额颞颧(切断颧弓、扩大中颅窝底)入路,4例基底动脉中段动脉瘤采用乙状窦前(岩骨)和远外侧联合入路.10例椎动脉瘤中,4例椎动脉瘤采用乙状窦前(岩骨)和岩骨联合入路,6例取用远外侧-枕骨髁联合入路.11例术中临时阻断血管时间延长或可能影响开通血管患者行血管搭桥术,其中颈内动脉大脑后动脉P2段移植搭桥2例,颈外动脉与大脑后动脉P2段移植搭桥4例,椎动脉移植搭桥2例,枕动脉与小脑后下动脉搭桥3例.结果 术后恢复正常工作,无神经功能障碍者:基底动脉顶端动脉瘤9例,基底动脉干动脉瘤5例,椎动脉瘤10例,良好率为92%.1例基底动脉顶端动脉瘤患者术后有严重神经功能缺失,生活不能自理;1例基底动脉主干动脉瘤术后穿通动脉闭塞引起中脑缺血,术后20 d死亡.结论 选择适合的颅底手术入路有利于术中获得充分的手术操作空间.对于单纯手术夹闭困难的动脉瘤,用血管移植搭桥的方法,可以避免因夹闭动脉瘤和临时阻断载瘤动脉出现术后脑缺血.     

椎动脉血管内闭塞治疗后循环巨大动脉瘤

目的 对椎动脉血管内闭塞治疗后循环不可夹闭动脉瘤疗效进行评价。方法用血管内球囊或弹簧圈闭塞椎动脉治疗9例颅内后循环不可夹闭动脉瘤。结果血管内闭塞近端椎动脉可使动脉瘤完全闭塞，神经受压和占位症状逐步改善、消失。3例经MRI追踪检查的病例显示动脉瘤明显缩小或完全消失。结论血管内椎动脉闭塞治疗后循环不可夹闭动脉瘤是一种有效、安全的治疗方法。     

椎动脉V4段闭塞单纯球囊扩张成形术4例报告

<正>后循环缺血性卒中病情严重程度及复发率均高于前循环脑卒中,尤其是伴椎-基底动脉狭窄的患者,其复发率增加3倍[1,2]。若出现椎-基底动脉急性闭塞,预后极差。研究证实,椎动脉球囊扩张成形术或支架植入术具有较好中远期疗效及较低手术并发症[3~7]。对于一侧椎动脉闭塞并伴有对侧椎动脉严重狭窄的后循环卒中患者,一般介入治疗主要针对狭窄侧椎动脉。当狭窄侧椎动脉先天发育不良或手术入路很差时,手术风险极高,如术中出现急性闭塞,很可能危及     

儿童颅内动脉瘤血管内治疗

目的 报道儿童颅内动脉瘤血管内治疗的特征和血管内治疗的结果.方法 2002-2006年收治29例儿童动脉瘤患者(年龄<19岁);其中14例蛛网膜下腔出血,10例意外发现,2例脑神经麻痹,3例神经功能障碍.动脉瘤的位置:10个椎动脉动脉瘤,5个大脑中动脉瘤,4个大脑后动脉瘤,3个基底动脉动脉瘤,3个前交通动脉瘤,1个小脑后下动脉瘤,2个大脑前动脉瘤,1个颈内动脉动脉瘤.结果 7例动脉瘤行动脉瘤囊内弹簧圈栓塞,17例载瘤动脉闭塞(9例使用球囊闭塞载瘤动脉,8例使用弹簧圈载瘤动脉闭塞).1例椎动脉瘤病人全脑血管造影后4 d动脉瘤白发血栓形成.4例行支架或者支架辅助弹簧圈栓塞动脉瘤(其中2例基底动脉瘤患者死亡,2例动脉瘤栓塞后复发并再次给予栓塞治疗).平均随访20.7个月,93.1%的病人GOS评分4分或5分.结论 儿童颅内动脉瘤在发病特点上,男性比女性多见,好发部位是椎动脉、大脑后动脉和人脑中动脉.对于梭形动脉瘤行载瘤动脉闭寒是一种安全有效的治疗方法.基底动脉主十的梭形动脉瘤治疗困难而且死亡率高.     

双支架重叠技术治疗未破裂椎基底动脉夹层动脉瘤的近期疗效分析

目的 探讨双支架重叠技术治疗未破裂椎基底动脉夹层动脉瘤的可行性及治疗效果。方法分析衡水市第四人民医院神经外科采用双支架重叠技术治疗的12例未破裂椎基底动脉夹层动脉瘤患者的临床资料。结果 所有支架成功释放,位置满意。术后即刻数字减影血管造影(DSA)复查未见支架部位血栓形成及急性闭塞。所有患者DSA随访6～12个月,夹层动脉瘤完全闭塞治愈9例、夹层动脉瘤缩小2例、无明显变化1例。所有患者无围手术期出血或缺血并发症,随访期间未见载瘤动脉内膜过度增生及狭窄并发症。结论 双支架重叠技术是治疗未破裂椎基底动脉夹层动脉瘤的有效方法。     

血管内治疗椎基底动脉夹层动脉瘤(附45例分析)

目的总结椎基底动脉夹层动脉瘤的诊断和血管内治疗经验。方法采用血管内介入治疗椎基底动脉夹层动脉瘤45例,其中支架辅助弹簧圈栓塞31例,单纯支架置入8例,夹层责任动脉单纯弹簧圈闭塞6例。结果44例病人于治疗后1～46个月获造影随访,平均16.3个月。临床症状均不同程度改善,无再出血。26例支架辅助弹簧圈即刻致密栓塞的病人,动脉瘤未再显影;5例即刻大部栓塞者中,瘤体扩大、复发1例。7例单纯支架置入病人中,可见进行性血栓形成3例,无明显变化3例,另1例双BX支架重叠置入者支架狭窄变形,椎动脉闭塞。6例责任动脉闭塞病人,闭塞效果均切实。结论血管内治疗是椎基底动脉夹层动脉瘤理想的选择。     

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.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

A projection to the striatum from the medial subdivision of the posterior group of the thalamus in the cat

Injections of wheat germ agglutinin-conjugated horseradish peroxidase in the lateral part of the caudate nucleus or the putamen of the cat result in retrograde thalamic cell-labeling in the rostral extension of the medial subdivision of the posterior group (POM). Autoradiography after [³H]amino acid injection of POM reveals a dense and discontinuous distribution of axons in the lateral half of the caudate and putamen concentrated at their middle rostrocaudal levels. This newly discovered thalamostriatal projection of POM may account for somatosensory activity observed in striatal cells.     

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.     

Evidence for the collateral innervation of the esophagus and the heart from neurons in the compact formation of the nucleus ambiguus of the rat

We investigated whether the heart receives collateral projections from the neurons which innervate the esophagus with a retrograde double-labeling method using two fluorescent tracers. Following injections of True Blue (TB) into the esophagus and Diamidino Yellow (DY) into the heart, about 21.9% of the labeled esophageal motoneurons in the compact formation of the nucleus ambiguus (AmC) were retrogradely double labeled. No single-labeled cardiac motoneurons were found in the AmC. The present results provide anatomical substrates for the esophagocardiac reflex.     

Role of the paraventricular nucleus in the projection from the nucleus of the solitary tract to the olfactory bulb

Electrophysiological experiments were performed on anesthetized rats to determine the effects of lesions of the paraventricular nucleus on the amplitude of evoked potentials recorded in the periglomerular layer of the olfactory bulb after nucleus of the solitary tract electrical stimulation. Lesions of the paraventricular nucleus enhance the amplitude of both the positive and negative components of the evoked potential in the olfactory bulb. The pathway from the paraventricular nucleus to the olfactory bulb seems to exert a suppressive influence over the projection from the nucleus of the solitary tract to the olfactory bulb under these conditions.     

On the origin of the serotonergic input to the intermediate lobe of the rat pituitary

Single stimulations of the vagina and cervix were performed between proestrus and the first day of diestrus with a stimulator designed to grade the intravaginal penetration of a rod. The percent incidence of pseudopregnancy after this stimulation was exponentially related to the extent of intravaginal penetration and was also affected by the stage of the cycle at which the stimulation was performed. At 10.00 h on proestrus, an exponential increase in the incidence of pseudopregnancy was observed with shallow penetrations, while an exponential decrease was found when deeper penetrations were applied. Such negative exponential correlation had disappeared at 22.00 h on proestrus. At that time, also, some responses were elicited by very shallow penetrations (17 mm) and all the animals responded to penetrations of 20 mm or more. Sensitivity to cervicovaginal stimulation at 10.00 h on estrus was lower than that at 22.00 h on proestrus and it was even lower at 10.00 h on the first day of diestrus. The response to 18 mm of penetration was studied every 3 h between 10.00 h on proestrus and 10.00 h on estrus, and then every 12 h until 10.00 h on the first day of diestrus. This stimulation was usually ineffective to induce pseudopregnancy, except for a brief period encompassing the night between proestrus and estrus, when a peak in the incidence of responses was reached. This peak sensitivity could be advanced following the s.c. administration of 250 and 500 ng of LH-RH at 11.00 h on proestrus. Other doses were ineffective. The peptide (500 ng) was unable to induce pseudopregnancy in rats that received no cervicovaginal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the development of the stratification of the inner plexiform layer in the chick retina

This study investigated the development of the subdivision of the chick inner plexiform layer (IPL). The approach included an immunohistological analysis of the temporal and spatial expressions of choline acetyltransferase, of the neural-glial-related and neural-glial cell adhesion molecules (NrCAM and NgCAM, respectively) and axonin-1, and of inwardly rectifying potassium (Kir) channels in 5- to 19-day-old (E5-E19) embryos. Ultrastructural investigations evaluated whether synaptogenesis accompanies the onset of differentiation of the IPL. We found that the differentiation of the IPL started at E9. Distinct cholinergic strata appeared, NrCAM immunoreactivity showed a poorly defined stratification, and Kir3.2 was expressed in the IPL and in the inner nuclear layer. From E10 until late E14, NgCAM- and axonin-1-immunoreactive strata emerged in an alternating sequence from the outer to the inner IPL. During this period, the NrCAM pattern sharpened, and eventually five bands of weaker and stronger immunoreactivity were found. Conventional synapses formed at the beginning of E9, and stratification of the IPL also began on the same day at the same location. Synaptogenesis and stratification followed a gradient from the central to the peripheral retina. The topographic course of differentiation of the IPL generally corresponded to the course of maturation of ganglion and amacrine cells. Synaptogenesis and the expression of G-protein-gated Kir3.2 channels accompanied the onset of stratification. These events coincide with the occurrence of robust and rhythmic spontaneous neuronal activity. The subsequent differentiation of the IPL seemed to be orchestrated by several mechanisms.