神经导航引导下直视手术治疗脑内小病灶

目的 探讨在神经导航辅助下微创手术治疗脑内小病灶的经验。方法 在神经导航系统辅助下显微外科手术治疗24例脑内小病灶。其中脑脓肿2例，脑囊虫5例，炎性肉芽肿2例，转移癌7例，海绵状血管瘤2例，星形细胞瘤2例，胶质细胞增生2例，中枢神经细胞瘤1例，生殖细胞瘤1例。结果 导航平均注册误差（2．3±0．45）mm。病灶全切16例，次全切3例，大部分切除2例，取病检3例。术后无死亡、无神经导航误差引起的并发症。全部病例恢复良好。结论 神经导航引导直视手术治疗脑内小病灶手术准确、安全，减少了术中的盲目性和并发症的发生。     

神经导航辅助显微外科手术(附389例报告)

目的 探讨神经导航系统辅助显微手术切除颅内病变的应用.方法 总结了2004年9月～2006年6月我科神经导航辅助显微外科手术切除颅内病变389例的导航定位准确性和临床疗效.结果 389例手术机显定位误差0.8～3.1mm,寻找病灶成功率100%;299例脑肿瘤全切除279例,占93.3%,46例动脉瘤全部夹闭成功,脑AVM40例全切除,4例次全切除,术后均未出现严重并发症.结论 神经导航系统在显微手术中定位准确,可以实时准确的指示术区的有关解剖结构,并引导手术操作,有效地减少了创伤,提高了手术疗郊.     

神经导航在神经外科中的应用

目的:探讨和研究神经影像导航技术在神经外科领域的应用前景,尤其是位于重要功能区的颅内小病灶应用无框架立体定向影象导航技术,结合显微神经外科手术切除的经验和体会.方法:采用Stealth Station神经影象导航系统进行影象导航和显微手术切除的颅内病灶18例,男性11例,女性7例,年龄17～58岁.额叶6例(其中6例为于运动区),顶叶4例,枕叶2例,颞叶1例,桥小脑角2例,小脑半球3例.所有病例均常规应用影象导航下显微切除肿瘤或炎性肉芽肿.结果:影象导航总体误差1.8～3.7mm,平均2.68mm.手术病灶全切除14例,次全切4例,尤其位于运动区3例小病灶,手术全切除后无任何并发症.结论:影象导航系统定位准确,对病灶手术全切除、减少术后并发症具有重要价值,应用前景广阔.     

神经导航系统在颅内病变手术治疗中的应用

目的 探讨神经导航系统在颅内病变显微手术中的应用效果。方法 回顾性分析2017年6月至2018年8月在神经导航系统辅助下手术切除的72例颅内病变的临床资料。结果 72例均在导航下顺利完 成手术,病灶定位准确率为100%。术后复查MRI发现,病灶全切除63 例,次全切除8例,大部分切除1例。术后症状显著好转或改善54例,无明显变化16例,加重2例。术后均没有严重的并发症,无新发神 经功能障碍,无死亡病例。72例术后随访3~12个月;复查MRI未见复发。结论 神经导航系统有助于精确定位颅内病灶,提高全切率,是显微手术切除颅内病变的有效辅助手段。     

神经导航辅助锁孔手术治疗功能区小病灶

目的探讨神经导航辅助锁孔显微手术切除脑功能区小病灶的应用价值。方法采用神经导航辅助锁孔显微手术切除18例脑功能区小病灶。术前将影像学资料输入神经导航系统进行三维重建,制定手术计划。术中实时导航指导手术切除范围,分析治疗结果。结果导航平均注册误差（2．05---0．62）mm,平均骨窗直径3．0cm。所有病例术中均准确定位病灶,其病灶全切17例,次全切除1例。术后16例病人恢复良好,原有症状均获得不同程度改善,1例原有神经症状加重,1例出现新的神经功能损害。结论神经导航辅助锁孔显微手术能准确切除脑功能区病灶,减少手术创伤,提高手术效果,降低死亡率、病残率,在显微神经外科手术中具有重要的临床应用价值。     

神经导航在脑内小病灶手术中的应用(附25例报道)

目的 探讨神经导航辅助显微手术治疗脑内小病灶的应用价值.方法 用神经导航系统辅助显微外科手术切除25例脑内小病灶.术前将头颅CT或MRI连续薄层扫描所获取的影像资料输入神经导航系统进行三维重建并注册,制定手术计划.术中实时导航指导手术切除范围,分析治疗结果.结果 导航平均注册误差2.12±0.73mm,术中准确定位病灶.病灶全切23例,次全切2例.术后22例病人症状改善或无变化,3例原有神经症状加重或出现新的神经功能损害.结论 神经导航能准确引导切除脑内小病灶,减少手术创伤,提高手术效果,降低死亡率、病残率,在显微神经外科手术中具有重要的临床应用价值.     

神经导航在颅脑微创手术中的临床应用

目的研究在神经导航指引下微创手术切除颅内病变的临床效果。方法对33例患者进行术中实时导航，小皮瓣锁孔微创手术，显微镜下切除病变。结果33例颅内病变显微镜下全切26例，次全切6例，大部切除1例。28例术后功能有所好转或无变化，5例出现功能障碍。本组未出现术中、术后死亡。结论神经导航能精确的定位、动态跟踪、实时导航，在神经导航指引的锁孔微创手术，可以提高手术治疗效果，减少手术副损伤。     

神经导航下引导切除颅内海绵状血管瘤

目的 探讨神经导航技术在颅内海绵状血管瘤手术中的应用价值。方法术前对9例脑深部（肼胝体2例，海马4例，额叶2例，顶叶1例）海绵状血管瘤的病 人进行磁共振扫描，数据输入神经导航系统，手术时进行导航注册配准，术中在导航棒引导下找寻病灶并完整切除。结果术中导航注册误差在2mm左右，9例病人均达到全切除，术后未出现并发症。结论神经导航手术有助于脑深部海绵状血管瘤的准确找寻与切除，是一种安全，有效，并发症少的微侵袭手术方法。     

神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤 (附26例临床报告)

目的探讨神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤的初步体会、注意事项及该手术入路优缺点。方法对26例垂体腺瘤患者采用神经导航辅助下经单鼻孔蝶窦入路显微手术治疗。结果术后经MRI检查证实全切除20例,4例次全切除,2例巨大腺瘤大部切除,术后均未出现严重并发症。结论神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤,手术快捷、安全、创伤小,符合微创治疗趋势。     

神经外科导航系统辅助切除颅内微小占位病变

目的 探讨神经外科显微镜导航系统对切除颅内微小病变，提高手术疗效及降低并发症的作用。方法 1996年10月－2000年10月应用神经导航系统手术治疗62例颅内微小病变患，其中病变位于感觉、运动、语言重要功能区23例，额叶11例，顶叶10例，颞叶9例，枕叶3例，后颅窝、丘脑各2例，鞍上和多发性占位占1例。病变直径0．5－1.8cm，＜1cm55例；＞1cm7例，病变均位于皮导下。施行神经外科显微镜导航手术。结果 62例（包括功能区23例）患均在神经导航系统引导下施行病灶切除手术，导航误差＜2mm。术后患恢复良好，无一例发生偏瘫，失语等并发症。结论 应用导航系统可促进神经外科手术的微创化，准确指示颅内微小病变的位置和切除范围，降低手术并发症和保护神经系统功能。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.