经颅底扩大翼点入路切除颅底肿瘤

目的:经颅底扩大翼点入路开颅术是将翼点开颅术向颅底方向的进一步扩大,包括眶上翼点入路、颧弓翼点入路和眶翼弓入路。本文探讨该入路的手术方法和适应证。方法:经扩大翼点入路切除颅底肿瘤30例。观察术中显露情况及手术效果,并就该入路的手术方法和适应证进行探讨。结果:所有病例术中病灶显露良好,无1例出现脑牵拉损伤。肿瘤全切除25例,次全及大部分切除5例。术后死亡1例,其余病例均无严重并发症。结论:经扩大翼点入路切除颅底肿瘤具有显露好、脑牵拉轻的优点,适用于中颅底、鞍旁肿瘤、颅眶沟通瘤及部分自中颅底向后颅底或颅外生长的肿瘤。     

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。     

口腭咽入路的解剖基础及手术中应用

目的　探讨口腭咽入路相应的解剖学结构和临床应用效果。 方法　在15具动脉灌注乳胶的成人尸头上模拟口腭咽入路,在显微镜下观察腭大孔、切牙孔的位置,骨嵴的比例,腭大动脉的走行,硬腭部软组织的结构特点并测量颅底重要解剖结构间的距离;对2006年3月至2010年6月经口腭咽入路行显微手术治疗的18例颅底中线区肿瘤患者的资料进行回顾性分析。 结果　切牙孔距牙槽嵴前端的距离为(5.18±2.44)mm,骨嵴的比例为93.3%,54支腭大动脉走行于硬腭半宽的中内2/3侧,术式的暴露范围主要受限于双侧的视神经、颈内动脉、舌下神经管内口等结构;本组18例中12例全切除,6例次全切除,并发症包括1例脑脊液鼻漏,1例构音不良,无死亡、偏瘫等严重并发症。 结论　口腭咽入路切除颅底中线区肿瘤具有暴露充分、手术创伤小、并发症少的优点。该入路是切除颅底中线区肿瘤的较佳入路。     

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。     

双鼻孔入路神经内镜手术在颅底脊索瘤切除中的应用

目的 探讨经双鼻孔鼻蝶入路神经内镜手术在颅底脊索瘤切除中的应用价值。方法 回顾性分析2015年1月—2016年4月华中科技大学同济医学院附属协和医院神经外科5例颅底脊索患者的临床资料。其中男1例、女4例,年龄44～63岁,均采用经双鼻孔鼻蝶入路神经内镜手术治疗。术前根据影像学图像判断肿瘤位置及其侵润范围,术中用吸引器探查肿瘤的质地,根据术中观察及术后影像学检查判断肿瘤切除程度。结果 5例患者肿瘤均位于颅底中线区域,侵润范围:向左为13.07～32.34 mm,向右为10.60～37.23 mm,上下为28.15～55.15 mm。术中见肿瘤质地韧,与周围组织粘连紧密,需要内镜显示及2个器械同时操作才能完成切除。本组患者肿瘤全切除3例、次全切除2例;术后病理诊断均为脊索瘤。术后5例患者随访6～20个月,患者症状较术前均有改善,无脑脊液鼻漏、尿崩症、电解质紊乱和死亡的发生,未见肿瘤复发。结论 采用双鼻孔神经内镜技术,可以利用多器械的协同操作切除较大范围的颅底病变,对于切除颅底脊索瘤是一种较好的手术入路选择。     

改良翼点入路显微手术治疗鞍区肿瘤

目的探讨经改良翼点入路显微手术治疗鞍区肿瘤的方法。方法回顾性总结近4年来我院神经外科采用改良翼点入路显微手术治疗的326例鞍区肿瘤病例，其中，垂体腺瘤158例，颅咽管瘤89例，鞍区脑膜瘤79例。术前准备主要是进行糖激素的替代疗法和癫痫的预防。手术采用改良翼点入路，显微镜下解剖脑底诸池，经鞍区的5个手术间隙切除肿瘤。术后处理主要包括严密观察病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素的替代疗法。结果采用改良翼点入路开颅，面神经额支的保留率达到92％，眶上神经的保留率达到96％，颞肌萎缩发生率为0％；全部肿瘤的全／次全切除率达到95％，垂体柄的保留率达到62％；术后并发症主要为尿崩症和电介质紊乱，发生率虽然高达61％，但是经过术后的严密观察和处理，97％的病人在术后1个月内得到恢复。结论改良翼点入路对面神经额支、眶上神经和颞肌的损伤机会减少。采用改良翼点入路，应用显微解剖技术，结合积极有效的防治并发症的措施，可以提高鞍区肿瘤的全切除率，减少术后并发症的发生，值得在临床中推广应用。     

经纵裂胼胝体入路显微手术切除三脑室肿瘤及囊虫

目的：介绍一种切除三脑室肿瘤的手术入路。方法：显微镜下经纵裂胼胝体入路切除三脑室肿瘤及猪囊虫8例。结果：肿瘤全切除5例、大部切除2例，1例猪囊虫完整摘除。术后死亡1例。5例随访6个月未复发，2例失访。结论：该手术入路可以切除三脑室前、中、后部的肿瘤及猪囊虫，术野暴露清楚，不易造成穹窿、匠脯、大脑内静脉、丘纹静脉的损伤，减少了术后并发症的发生。     

扩大额下硬膜外入路切除全组鼻窦霉菌性肉芽肿

目的:探讨经扩大额下硬膜外入路切除侵及眶内、颅底的全组副鼻窦霉菌性肉芽肿的手术方法,以及术后并发症的防治。方法:采用扩大额下硬膜外入路,经前颅底直接开放全组副鼻窦及眼眶,直视下切除全组鼻窦内、额底、鞍旁的病灶。结果:术野显露充分、切除彻底。术中严密修补硬膜,重建颅底,术后未出现颅内及鼻腔内感染。结论:本术式是切除侵及眶内、额底、鞍旁的全组副鼻窦霉菌性肉芽肿理想的手术入路,其优点是显露充分、病灶切除彻底、脑损伤小、术后并发症少。     

内窥镜辅助眶上锁孔入路的应用解剖

目的：为眶上锁孔入路提供临床解剖学基础。方法：在21例福尔马林固定尸头上测量各有关解剖结构距离及夹角，在9例新鲜尸头上进行模拟手术，进一步验证其观察及操作范围。结果：提供了角突及眶上孔至盲孔、视神经管颅口、前床突尖、后床突尖距离，两点与上述结构连线与中线的成角，视交叉前缘至鞍结节距离，视神经颅内段长度，颅口处视神经内侧缘之间距离，第一间隙面积，颈内动脉床突上段长度等数据及入路的观察、操作范围。结论：眶上锁孔入路有广泛的视野及充足的操作空间，熟悉入路到各结构的距离对术中定位有重要意义。     

35例显微外科治疗前颅底区沟通性肿瘤的临床分析

目的:探讨显微外科治疗前颅底区沟通性肿瘤的临床方法及影响因素的分析。方法:总结2009年1月至2016年7月我科35例显微外科治疗前颅底区沟通性肿瘤的临床资料,对疾病的病理特点及诊治进行临床分析。结果:全部患者均顺利完成手术,无严重并发症发生及手术死亡患者。肿瘤全切21例,次全切除10例,部分切除4例。结论:前颅底区沟通性肿瘤采用颅面联合入路手术并进行颅底修复是一种有效的治疗手段。     

Clinical evidence of decreased olfaction in Bardet-Biedl syndrome caused by a deletion in the BBS4 gene

Recent discoveries have lead to the hypothesis that ciliary dysfunction is a mechanism underlying the pathogenesis of Bardet-Biedl syndrome (BBS). Here, we describe two individuals with decreased olfaction who are members of an extended family affected with BBS caused by a homozygous deletion (c.77-220del) in the BBS4 gene. These findings correlate with the evidence that several BBS proteins, including BBS4, are expressed in the olfactory epithelium (OE). Although the prevalence and the spectrum of impaired olfaction in BBS are not known, the causal relationship of the BBS4 deletion in this family and the decreased olfaction is corroborated by evidence that Bbs2 and Bbs4 knockout mice have severe olfaction deficits and that also patients with BBS caused by mutations in other BBS genes can have impaired olfaction. This finding broadens the spectrum of clinical manifestations associated with BBS, confirms the role of BBS4 in olfaction, and lends support to the hypothesis that ciliary dysfunction is an important aspect of BBS pathogenesis.     

Can olfactory training change the psychosocial aspects of chronic pain?

Pain and smell are the oldest senses for apperceive our environment. It is known that chronic pain and olfaction share common limbic cortical regions which are the main parts of the pain neuromatrix such as the anterior cingulate cortex, amygdala, and orbitofrontal cortex. Also, these regions point out the psychosocial aspects of chronic pain. And currently, the most challenging part of chronic pain management is the psychosocial aspect such as kinesiophobia, catastrophizing, or depression. Thus, the connection between olfaction and pain has promising clues to determining new combined therapies with odor training. According to intriguing brain imaging and genetic studies, we hypothesized that patients with chronic pain may have differentiated olfactory thresholds. Further, the additional odor training to the traditional therapeutic approach could be beneficial regarding the patients’ pain perspective and psychosocial domains.     

Olfaction evaluation and correlation with brain atrophy in Bardet‐Biedl syndrome

Bardet‐Biedl syndrome (BBS) is a well‐recognized ciliopathy characterized by cardinal features namely: early onset retinitis pigmentosa, polydactyly, obesity, hypogonadism, renal and cognitive impairment. Recently, disorders of olfaction (anosmia, hyposmia) have been also described in BBS patients. Moreover, morphological brain anomalies have been reported and prompt for further investigations to determine whether they are primary or secondary to peripheral organ involvement (i.e. visual or olfactory neuronal tissue). The objective of this article is to evaluate olfactory disorders in BBS patients and to investigate putative correlation with morphological cerebral anomalies. To this end, 20 BBS patients were recruited and evaluated for olfaction using the University of Pennsylvania Smell Identification Test (UPSIT). All of them underwent a structural magnetic resonance imaging (MRI) scan. We first investigated brain morphological differences between BBS subjects and 14 healthy volunteers. Then, we showed objective olfaction disorders in BBS patients and highlight correlation between gray matter volume reduction and olfaction dysfunction in several brain areas.     

Genetic Architecture of Olfactory Behavior in Drosophila melanogaster: Differences and Similarities Across Development

In the holometabolous insect Drosophila melanogaster, genetic, physiological and anatomical aspects of olfaction are well known in the adult stage, while larval stages olfactory behavior has received some attention it has been less studied than its adult counterpart. Most of these studies focus on olfactory receptor (Or) genes that produce peripheral odor recognition. In this paper, through a loss-of-function screen using P-element inserted lines and also by means of expression analyses of larval olfaction candidate genes, we extended the uncovering of the genetic underpinnings of D. melanogaster larval olfactory behavior by demonstrating that larval olfactory behavior is, in addition to Or genes, orchestrated by numerous genes with diverse functions. Also, our results point out that the genetic architecture of olfactory behavior in D. melanogaster presents a dynamic and changing organization across environments and ontogeny.     

Quantitative Analysis of the Maturation of the Main and Accessory Olfactory Systems in Monotremes and Metatherians in Comparison to Rodents and Humans

We have used an unbiased statistical approach to compare the pace of development in the main and accessory olfactory systems in monotremes and metatherians with that in rodents and humans. We hypothesized that if metatherians and monotremes, which are born at small body size, use olfaction to locate the pouch and/or teat/milk field, then olfactory structures should reach structural maturity in metatherians and monotremes at a smaller size than eutherians like humans and rodents. The achievement of key structural milestones in the development of the main and accessory olfactory systems (11 and 7 milestones, respectively) was scored for 354 specimens and compared against a measure of general somatic growth (body length). We used a statistical approach adapted from Kaplan‐Meier analysis to determine median body length at which structural milestones were achieved, and to test the differences for statistical significance (Braslow statistic). The laboratory mouse achieved most main olfactory milestones at a smaller body size than all the metatherians and the monotremes, although the dasyurids (which are born at only 5.0 mm) and mouse achieved accessory olfactory milestones at similar body length. All other metatherians and monotremes reached olfactory milestones at body lengths similar to or larger than the laboratory rat. We therefore reject the hypothesis that metatherians and monotremes as a group exhibit advanced development of the olfactory pathways relative to body size. The findings suggest that, if olfaction is used by metatherians and monotremes at birth, it is achieved with only a rudimentary system without structurally mature central components. Anat Rec, 301:1258–1275, 2018. © 2018 Wiley Periodicals, Inc.     

Acute anosmia in the mouse: behavioral discrimination among the four basic taste substances

The importance of taste and smell in discrimination of tastes was examined in normal and anosmic mice. We studied the influence of olfaction on taste sensation using behavioral and electrophysiological methods in both normal animals and animals made anosmic mice by destroying their olfactory receptor cells with zinc sulfate (ZnSO(4)) solution. Electrophysiological responses from chorda tympani nerves showed that peripheral taste receptor cells transmitted taste signals normally to the central nervous system, even when the olfactory senses were abnormal. Behavioral observations showed that mice with abnormal olfaction could not differentiate tastes.     

Artificial Circulation of the Liver: Machine Perfusion as a Preservation Method in Liver Transplantation

Due to the sharp increase in liver transplant candidates and the subsequent shortage of suitable donor livers, an extension of the current donor criteria is necessary. Simple cold storage, the current standard in organ preservation has proven to be insufficient to preserve extended criteria donor livers. Therefore a renewed interest grew toward alternative methods for liver preservation, such as hypothermic machine perfusion and normothermic machine perfusion. These “new” preservation methods were primarily assessed in rat models, and only a few clinically relevant large animal models have been described so far. This review will elaborate on these alternative preservation methods. Anat Rec, 291:735–740, 2008. © 2008 Wiley‐Liss, Inc.     

Prediction of olfactory response based on age, gender and smoking habits.

The measurement of olfaction has been neglected compared with the other senses. Recently, some progress has been made in the search for an instrument to objectively measure olfaction. This article outlines the early test results of a low cost, computer-based olfactometer which uses the frequency content of evoked potentials to quantify a subject's response to an olfactory stimulus. Clinical trials have been undertaken to establish the validity of the olfactometer and several thousand tests have been carried out using patients with olfactory dysfunctions as well as normals for norm referencing. The paper discusses a theoretical model for olfaction based on the age, gender and smoking habits of a subject. The validity of the model is then compared with the experimental data. The correlation between the model and the experimental results is strong.     

Immunolocalization of Parathyroid Hormone in Human Parathyroid Glands with Special References to Microwave Antigen Retrieval

The subcellular localization of parathyroid hormone (PTH) in the normal human parathyroid glands with particular reference to microwave antigen retrieval was investigated using peroxidase-labeled PTH antibody, immunohistochemical, and immunoelectron microscopic methods. The results revealed that PTH granules existed mainly as pro-PTH on the trans side of Golgi and in the regions adjacent to Golgi apparatus. Only a small proportion of secretory granules were stored near the plasma membrane. Microwave irradiation was essential for the immunodetection of PTH. As the irradiative time extended from 1 to 30 min, the staining intensity increased, and the subcellular preservation decreased. Microwave irradiation for 15 min (with the sections in citrate buffer) with a power output of 500 W is the most ideal for PTH antigen retrieval, as well as for subcellular preservation.