Perioperative olfactory dysfunction in patients with meningiomas of the anteromedial skull base

Olfactory dysfunction represents a main symptom in olfactory groove meningiomas (OGM). Besides this, olfactory function has been sparsely investigated in patients suffering from supratentorial meningiomas. Here, the authors explore pre‐ and postoperative variables associated with olfactory dysfunction in supratentorial meningioma patients. This is a retrospective study on supratentorial meningioma patients who underwent meningioma resection between January 2015 and January 2016. Preoperative and postoperative olfactory performance was quantified using a lateralized sniffin' stick odor identification test. Meningiomas affecting the olfactory system (n = 23) were compared to meningiomas in other locations among the control group (n = 40). Meningiomas that affected the olfactory system had odds of 3.6 and 3.7 in being associated with ipsilateral (lesional) and bilateral anosmia, respectively. Subgroup analysis revealed that meningiomas causing a midline shift across the frontal base and older age represented risk factors for preoperative anosmia. The odds of experiencing acquired postoperative ipsilateral anosmia were significantly increased in olfactory system affecting meningiomas (OR 11.1). Subgroup analysis highlighted OGMs to represent the predominant location associated with deterioration. General surgical complications predisposed patients to loss of contralateral (OR 12.3) and bilateral olfactory function (OR 27.8). Older age and meningiomas causing a midline shift across the frontal base predispose patients to preoperative olfactory dysfunction. Resection of OGMs and surgical complications are risk factors for postoperative olfactory deterioration to anosmia. Likely, olfactory dysfunction is underrecognized even in OGMs. In OGM surgery, however, preoperative lateralized testing might be critical to selecting an appropriate surgical route to preserve olfactory function. Clin. Anat. 32:524–533, 2019. © 2019 Wiley Periodicals, Inc.     

开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良因素分析

目的探讨开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良的影响因素。方法回顾性分析92例行开颅动脉瘤夹闭术治疗颅内破裂动脉瘤老年患者的临床资料。根据改良Rankin量表(mRS)评分,将患者分为预后良好组(0~2级)和预后不良组(3~6级)。评价开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤预后不良的影响因素,采用单因素、多因素Logistic回归分析影响患者开颅动脉瘤夹闭术预后不良的危险因素。结果根据mRS评分结果,92例患者中,预后不良46例,预后不良率为50%。单因素分析结果显示2组患者在性别、年龄、合并脑动脉粥样硬化、高血压、冠心病、术前Hunt-Hess分级、术前CT改良Fisher分级、术后低蛋白血症、术后脑梗死、术后脑积水方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示合并脑动脉粥样硬化、术前Hunt-Hess分级Ⅲ~Ⅳ级、术后脑梗死是开颅动脉瘤夹闭术治疗老年颅内破裂动脉瘤患者预后不良的独立危险因素。结论合并脑动脉粥样硬化、术前Hunt-Hess分级高、术后脑梗死是影响老年患者开颅动脉瘤夹闭术后近期预后不良的独立危险因素,为改善患者预后,术中应操作轻柔,以减少血管刺激;术后给予足够血容量,预防血管痉挛、改善循环等,以减少术后脑梗死发生;提倡健康生活方式,控制血压、血糖稳定,减少脑动脉粥样硬化的发生。     

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。     

颅内动脉瘤的介入治疗进展

颅内动脉瘤是最常见的脑血管病之一,其发病率仅次于脑梗塞和高血压脑出血居第3位,是临床上引起蛛网膜下腔出血的主要原因,其致残率、死亡率都很高。传统的治疗方法是开颅行动脉瘤夹闭手术,近年来随着各种技术的发展,自从用可脱乳胶球囊经血管内介入治疗外伤性颈内动脉海绵窦瘘病例成功报道以来,颅内动脉瘤的介入治疗以其手术损伤小、疗效好、恢复快的特点在动脉瘤的治疗手段中占领了重要地位,同时由于消费高、复杂动脉瘤的介入治疗难度大等缺点也使患者只能行开颅夹闭术。本文就动脉瘤介入治疗的发展历程,治疗方法,治疗材料以及新手段新技术展开阐述。     

改良眶翼点入路开颅治疗前交通动脉瘤破裂的疗效优势

目的分析改良眶翼点入路进行开颅手术治疗前交通动脉瘤破裂的疗效。方法回顾性分析湖北医药学院附属襄阳市第一人民医院收治的134例前交通动脉瘤破裂患者的临床资料,根据手术路径的不同分为对照组(左侧翼点入路进行开颅手术)和观察组(改良眶翼点入路进行开颅手术),每组67例。比较2组患者出院后6个月的神经恢复情况,比较2组患者手术前后(术前、术后1 d、出院后1个月、出院后6个月)髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100β)含量及Barthel指数差异,比较2组患者术后6个月内不良事件发生情况。结果观察组患者出院后6个月神经恢复情况显著优于对照组,中残和重残患者人数显著少于对照组,2组比较差异具有统计学意义(P<0.05)。随着时间迁移,2组患者MBP、NSE、S100β指标含量及Barthel指数均显著上升,组内不同时点比较差异有统计学意义(P<0.05);出院后1、6个月,观察组患者MBP、NSE、S100β指标含量显著低于对照组,Barthel指数显著高于对照组,差异具有统计学意义(P<0.05)。观察组患者术后6个月病死率显著低于对照组,2组比较差异具有统计学意义(P<0.05)。结论采用改良眶翼点入路开颅治疗前交通动脉瘤破裂的临床效果优异,可广泛应用于临床。     

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。     

TCD对行开颅去骨瓣减压术患者的诊疗指导价值

目的：采用经颅多普勒超声(trans-cranial Doppler,TCD)探究行开颅去骨瓣减压术的重度颅脑损伤患者围手术期血流动力学改变与其预后相关性。方法：选取100例于2012年9月至2015年9月入我院神经外科诊治的重度颅脑损伤[格拉斯哥昏迷评分(Glasgow coma scale,GCS)<8分]患者,采用TCD监测患者术前、术后双侧大脑中动脉(middle cerebral artery,MCA)和颈内动脉颅外段(extracranial internal carotid artery,ICAex)血流动力学参数,并比较差异是否具有统计学意义。结果：相比于术前,患者术后双侧MCA和ICAex平均流速(Vm)显著提高(P<0.01),其中手术侧Vm上升更明显。相比于术前,患者术后搏动指数(pulse index,PI)显著下降,且手术侧下降更为明显。患者术后频谱形态改变为高血流低阻力型。结论：应用TCD能很好地检测行开颅去骨瓣减压术重度颅脑损伤患者围手术期血流动力学改变,且患者颅内血流动力学改变对预后判断具有重要意义。     

Bilateral Wilms' tumor: a clinicopathologic review

Bilateral Wilms' tumor occurs at a younger age than unilateral disease. While it generally has a good prognosis, it presents a therapeutic dilemma to balance curative surgical resection with preservation of renal tissue. A 15 year review of bilateral Wilms' tumors diagnosed at Princess Margaret Hospital was undertaken. Of 46 Wilms' tumor cases, eight were designated bilateral by diagnostic imaging (median age 1.1 years compared with 3.5 years for unilateral tumors). The surgical management entailed primary nephrectomy with contralateral biopsy in two patients, and bilateral biopsy and delayed resection in all remaining surviving patients (one patient died of perioperative complications). Seven patients had localized disease (stage I/II) and the six surviving patients received chemotherapy with vincristine and actinomycin; no patient received radiotherapy. All are alive and well (median follow-up 5.1 years). The remaining patient presented with pulmonary metastases and died of disease progression. Pathologic review revealed that four patients had truly bilateral disease demonstrable by histology, three had unilateral Wilms' tumor with contralateral nephrogenic rests, and in one patient the biopsies of the contralateral kidney showed neither tumor nor nephrogenic rests. In most cases pathological material was subject to external review. Follow-up demonstrates excellent renal function with compensatory hypertrophy in the remaining renal tissue. Conservative surgery and simple out-patient based, low toxicity chemotherapy is curative in most patients.     

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。     

Heterosynaptic long-term depression of craniofacial nociception: divergent effects on pain perception and blink reflex in man

Noxious low-frequency stimulation (LFS) of presynaptic nerve fibers induces long-term depression (LTD) of synaptic transmission. In vitro studies suggest a sole homosynaptic effect. Consequently, the present study addressed the hypothesis that LTD of craniofacial nociception in man is mediated by a homosynaptic mechanism. Nociceptive supraorbital afferents were excited by electric pulses via a concentric electrode in ten healthy volunteers. The electrically evoked bilateral blink reflex (BR) was recorded from both orbicularis oculi muscles by surface electrodes. The BR was evoked in blocks of ten electric stimuli each (0.1 Hz) with an interblock interval of 8 min. Conditioning noxious LFS (1 Hz, 20 min) was applied via concentric electrode either to the same site as BR test stimuli (ipsilateral) or to the corresponding contralateral forehead area (contralateral). LFS and test stimulus intensities corresponded to about threefold the pain threshold. After three baseline stimulus blocks, either conditioning ipsilateral or contralateral LFS were applied or stimulation was interrupted for 20 min as a control task. Afterwards, test stimulation blocks were continued for 40 min. Each volunteer participated in all three sessions on different days. Noxious LFS induced LTD of the BR independently from the side of conditioning stimulation. Pain perception decreased after ipsilateral LFS but not after contralateral LFS. The bilateral effect of noxious LFS on the BR provides evidence for heterosynaptic LTD based on bilateral projections of supraorbital nerve afferents onto spinal trigeminal nuclei. The divergent effect on pain perception may be due to a preferential contralateral projection of nociceptive afferents onto reflex interneurons but not onto trigeminothalamic projection neurons.     

Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy

Collateral circulation plays a major role in maintaining cerebral blood flow (CBF) in patients with internal carotid artery (ICA) stenosis. CBF can remain normal despite severe ICA stenosis, making the benefit of carotid endarterectomy (CEA) or stenting difficult to assess. Before and after surgery, we assessed CBF supplied through the ipsilateral (stenotic) or contralateral ICA individually with a novel hemisphere-selective arterial spin-labeling (ASL) perfusion MR technique. We further explored the relationship between CBF and ICA obstruction ratio (OR) acquired with a multislice black-blood imaging sequence. For patients with unilateral ICA stenosis (n = 19), conventional bilateral labeling did not reveal interhemispheric differences. With unilateral labeling, CBF in the middle cerebral artery (MCA) territory on the surgical side from the ipsilateral supply (53.7 +/- 3.3 ml/100 g/min) was lower than CBF in the contralateral MCA territory from the contralateral supply (58.5 +/- 2.7 ml/100 g/min), although not statistically significant (p = 0.09). The ipsilateral MCA territory received significant (p = 0.02) contralateral supply (7.0 +/- 2.7 ml/100 g/min), while ipsilateral supply to the contralateral side was not reciprocated. After surgery (n = 11), ipsilateral supply to the MCA territory increased from 57.3 +/- 5.7 to 67.3 +/- 5.4 ml/100 g/min (p = 0.03), and contralateral supply to the ipsilateral MCA territory decreased. The best predictor of increased CBF on the side of surgery was normalized presurgical ipsilateral supply (r(2) = 0.62, p = 0.004). OR was less predictive of change, although the change in normalized contralateral supply was negatively correlated with OR(excess) (=OR(ipsilateral) - OR(contralateral)) (r(2) = 0.58, p = 0.006). The results demonstrate the effect of carotid artery stenosis on blood supply to the cerebral hemispheres, as well as the relative role of collateral pathways before surgery and redistribution of blood flow through these pathways after surgery. Unilateral ASL may better predict hemodynamic surgical outcome (measured by improved perfusion) than ICA OR.     

The bilateral bulbar projections of the primary olfactory neurons in the frog

Summary Whether or not the frog olfactory neuroreceptor cells project bilaterally to the olfactory bulb is still a debated question. We therefore decided to ascertain whether bilateral projections of the primary olfactory input exist and if so to investigate their extent. Reproducible extracellular bilateral bulbar potentials were recorded in the frog following electrical stimulation of dorsal or ventral olfactory nerve bundles. The general features of the contralateral evoked responses were very similar to those of the ipsilateral response. The contralateral response disappeared after transection of the rostral part of the olfactory interbulbar adhesion but not following transection of the habenular or anterior commissures. Horseradish peroxidase labelling showed that the fiber terminations of the olfactory nerve bundle was not restricted to the ipsilateral olfactory bulb but included the medial aspects of the contralateral bulb. The intertelencephalic sections increased the magnitude of the ipsilateral evoked responses. Olfactory bulb isopotential maps revealed a rough topographical correspondence between the olfactory neuroepithelium and bulb along the medio-lateral axis as well as along the dorso-ventral axis. In addition, a projection of the medial and central part of the olfactory sac to the medial part of the contralateral olfactory bulb through the interbulbar adhesion was confirmed. These findings suggest first, that the fibers from the neuro-receptors located in either the ventral or the dorsal olfactory mucosae project to both olfactory bulbs, and second, that the left and right bulbs exert a constant inhibition on each other via the habenular commissure.Abbreviations AON anterior olfactory nucleus - ax olfactory neuroreceptor axon - BA bulbar adhesion - D_I latero-dorsal olfactory nerve bundle - D_II centro-dorsal olfactory nerve bundle - D_III mediodorsal olfactory nerve bundle - EPL external plexiform layer - GL glomerular layer - gl glomerulus - GRL granular cell layer - MOB main olfactory bulb - m mitral cell - MBL mitral cell body layer - ON olfactory nerve - V lateral ventricule - V_I latero-ventral ol-factory nerve bundle - V_II centro-ventral olfactory nerve bundle - V_III medio-ventral olfactory nerve bundle - VN vomero-nasal nerve     

Loss of interhemispheric inhibition in patients with multiple sclerosis is related to corpus callosum atrophy

Axonal injury and loss in the corpus callosum (CC) is characteristic of the pathology of multiple sclerosis (MS). Functional magnetic resonance imaging (fMRI) potentially allows neurophysiological consequences of this interhemispheric axonal loss to be defined quantitatively. Here we have used 3T fMRI to study the activation in the contralateral primary sensorimotor cortex and deactivation (mediated by transcallosal tracts) in the homologous ipsilateral region in 14 patients with MS and in 14 matched healthy controls during a simple hand-tapping task. Both healthy controls and MS patients showed similar activation in the motor cortex contralateral to the hand moved, but the patients showed a significantly smaller relative deactivation in the ipsilateral motor cortex (P = 0.002). The difference was accounted for by the sub-group of MS patients who previously had impairment of motor function of the hand tested (MS-phd). The CC of the whole patient group was significantly thinner than for the controls (P = 0.001). Atrophy of the CC was correlated with loss of deactivation for the whole patient group (r = −0.50, P = 0.035), but particularly for MS-phd (r = −0.914, P = 0.004). Interhemispheric physiological inhibition thus is impaired in patients with MS, potentially contributing to impairment of motor control. This work suggests one way in which FMRI monitoring of the transcallosal interactions in motor cortex could become a tool for evaluation of therapies that may enhance function in reversibly impaired pathways.     

双膝骨性关节炎患者未行二期膝关节置换的影响因素

背景：双膝骨性关节炎患者,做单侧置换后,很大一部分患者未作二次对侧置换,有很多影响因素。 目的：双膝骨性关节炎患者一期选择性单侧全膝关节置换后未行二期对侧膝关节置换的影响因素分析。 方法：纳入初次一期单侧全膝关节置换的双膝骨性关节炎患者28例28膝,假体均采用施乐辉公司普通型,所有患者一期单侧全膝关节置换后1年内未行二期对侧膝关节置换。记录置换前后HSS评分、膝关节活动范围;同时对28例患者未行二期膝关节置换影响因素进行问卷调查。 结果与结论：2例失访,2例在外院行对侧膝关节置换,最终随访24例24膝,平均随访12.6个月(12-19个月)。膝关节活动范围与HSS评分置换后与置换前比较均显著增加,差异有显著性意义(P =0.007,P =0.409)。问卷调查分析影响患者选择二期手术因素,单因素随访结果围手术期疼痛是主因占到95%以上;多因素随访结果：围手术期的疼痛占95.8%,心理因素占87.5%,医院的软件条件占70.8%,3项原因平均占总因素的84.7%。说明24例24膝未行二期膝关节置换影响因素中置换后围手术期的疼痛、患者的心理因素及医院的软件条件占据主导地位。     

颅内前循环动脉瘤夹闭术的显微外科技术

目的 总结我院自2004年以采采用显微神经外科手术治疗的104例颅内前循环动脉瘤的经验，探讨颅内前循环动脉瘤夹闭术的显微手术技巧，以期进一步提高该病的临床治疗效果。方法 104例颅内前循环动脉瘤病人中，1例胼周动脉瘤采用前纵裂入路，1例后交通合并胼周动脉瘤采用翼点和前纵裂的联合入路，其余部位的动脉瘤均采用改盘翼点入路。手术采用显微外科技术解剖脑池，锐性分离瘤颈并夹闭之。术中采用控制性降压、栽瘤动脉临时阻断和动脉瘤体翻转等技术以防止破裂出血和误夹正常血管。结果 104例手术病人中，102例成功夹闭瘤颈，2例采用了动脉瘤包裹术。术后病人恢复盘好78例，轻残17倒，重残6例，植物生存2例。死亡1例。结论 采用显微外科技术夹闭动脉瘤颈是治疗颅内前循环动脉瘤的根本方法；术中采用控制性降压、载瘤动脉临时阻断和动脉瘤体翻转等技术以防止破裂出血和误夹正常血管。可以提高颅内前循环动脉瘤的手术治疗效果。     

The effects of iloprost, a prostacyclin analogue, in experimental ischaemia/reperfusion injury in rat ovaries

Ovarian torsion is a surgical emergency affecting not only the ipsilateral ovary but also contralateral ovary. Although the conventional treatment is salpingo-oophorectomy, recent studies advocate detorsion. We hypothesized that iloprost, an analogue of prostacyclin with cytoprotective properties, may prevent the harmful effects of ischaemia–reperfusion injury in bilateral ovaries after unilateral ovarian torsion–detorsion in rat. In this study, 24 female Wistar-albino female rats were divided into four groups. Ovarian torsion was produced by applying vascular clamps to right ovaries. In Group I, bilateral oophorectomy was performed. In group II, bilateral oophorectomy was performed after a unilateral torsion period of 4 h. In group III, bilateral ovaries were removed, following unilateral torsion–detorsion periods each lasted for 4 h. Saline was injected i.p. 30 min before detorsion. In group IV, same experimental protocol, which was conducted in group III, was repeated. Iloprost was injected i.p. 30 min before detorsion instead of saline in group IV. Tissue levels of malondialdehyde (MDA) and nitric oxide (NO), which are the indicators for oxidative stress were determined and histopathological evaluation was performed in bilateral ovaries in all groups. The MDA and NO levels for ipsilateral ovaries of four groups were compared and no significant difference was found (p>0.05). The same comparison were done for the contralateral sides and no difference was seen either (p>0.05). In histological examination, iloprost produced improvement in I/R-induced alterations in ipsilateral and contralateral ovaries. In conclusion, these results showed that iloprost has beneficial effect on the histological appearences in both the ipsilateral and contralateral rat ovaries after unilateral torsion–detorsion.     

经穹隆间第三脑室底锁孔入路的显微解剖

目的 探索经穹隆间第三脑室底锁孔入路的可行性和手术方法。 方法 设计经穹隆间第三脑室底锁孔入路(第三脑室底切口起自灰结节向后,经乳头体间,止于后穿质)。运用解剖学方法在导航辅助下在16例尸头标本上模拟经穹隆间第三脑室底锁孔入路手术,在手术显微镜下对手术显露进行观察,利用导航作解剖学测量。 结果 导航辅助下能顺利完成16例尸头标本的经穹隆间第三脑室底锁孔入路手术。冠状缝与矢状缝交点到室间孔上缘、丘脑间黏合、乳头体和中脑导水管上缘的距离分别为（68.4±4.6）mm、(66.3±6.0)mm、(86.3±5.3)mm、(82.0±7.6)mm,冠状缝与矢状缝交点到基底动脉末端分叉的操作距离为(91.8±5.0)mm。灰结节向后经乳头体间止于后穿质切开第三脑室底可获得长（9.5±2.6）mm的手术通道。术中经第三脑室底切口能清晰显露脚间池内的基底动脉末段、大脑后动脉P1段、P2段、小脑上动脉、后交通动脉以及它们的穿通支血管。向前解剖Liliequist膜可显露斜坡和鞍背,侧方可显露出动眼神经,向后显露出脚间窝。基底动脉末端分叉多偏于左侧（68.8%）,两侧大脑后动脉多向前外侧斜行（68.8%）。大部分大脑后动脉夹角上有1～4支小穿支血管自基底动脉末端分出。 结论 经穹隆间第三脑室底锁孔入路在技术上可行,深入研究可望应用于基底动脉末端动脉瘤的直接手术。     

神经内镜额部锁孔手术与显微手术治疗基底节区出血的临床疗效

目的探讨神经内镜额部锁孔手术与显微手术治疗基底节区出血的治疗效果。方法回顾性分析徐州医科大学附属医院神经外科2017年8月至2019年6月收治的34例经手术治疗基底节区出血患者的临床资料。根据手术方式分为内镜额部锁孔手术组(观察组)14例和显微手术组(对照组)20例,比较2组患者术前、术中和术后的病情变化及手术并发症发生情况,总结两种手术方式的临床应用效果。结果观察组平均血肿清除率、手术时间均少于对照组,差异均有统计学意义(P<0.05);2组患者术后并发症发生率比较,差异无统计学意义(P>0.05);观察组术后不同时间GCS评分及术后3个月ADL评分均优于对照组,差异有统计学意义(P<0.05)。结论与显微手术相比,神经内镜额部锁孔手术具有手术时间短、血肿清除率高、术后并发症少、患者预后较好等优点。     

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。     

眶上外侧-纵裂入路处理前交通动脉瘤的临床应用解剖

目的　研究经眶上外侧-纵裂入路至前交通动脉复合体区的显微解剖,为临床应用该入路夹闭前交通动脉瘤提供解剖学依据。 方法　选取20具（40侧）成人尸头模拟经眶上外侧-纵裂入路,显微镜下观察前交通动脉复合体区的暴露情况,测量并记录相关数据。 结果　经眶上外侧-纵裂入路可较好地暴露前交通动脉复合体,尤其是前交通动脉的上区和后上区,且在暴露时对同侧额叶及直回的牵拉明显减轻。前交通动脉长度为（2.80±1.12）mm,中间外径为（1.79±0.82）mm,其距视交叉前缘中点距离为（4.59±2.22）mm。 结论　眶上外侧-纵裂入路具有手术视野好、脑组织损伤小等特点,对于上突型和后上突型前交通动脉瘤的暴露十分有益。