冻干人硬脑膜微粒及微丝血管内栓塞的研究和应用

应用自制的冻干人硬脑膜微粒及微丝作为血管内栓塞材料，经实验研究及临床应用证实．栓塞材料很容易注入导管内，能有效栓塞不同脏器的靶血管，使组织缺血坏死．对周围组织无反应．可起到长期栓塞的作用。     

血管内栓塞材料研究的进展

近20年来，介入神经放射技术发展迅速，成为脑、脊髓血管病等诊断及治疗的一种重要手段。血管内栓塞材料相继产主并应用于临床，在应用中不断出现的新问题，对栓塞剂也不断提出新要求。目前我国血管内栓塞材料主要依赖进口，价格昂贵，因此，血管内栓塞材料的研究、开发与应用是介入神经放射学发展中的主要工作之一。现结合文献，对血管内栓塞材料研究的现状及其前景加以综述。     

颗粒栓塞剂及其临床应用研究进展

颗粒栓塞剂是最常用的一种血管内栓塞材料。本文对颗粒栓塞剂的优缺点、临床应用及其不足之处等作一综述。     

神经外科血管内治疗颗粒性栓塞材料的研究现状及展望

神经外科血管内治疗栓塞材料种类繁多,可分为固体栓塞材料和液体栓塞材料两大类,其中固体栓塞材料包括可吸收性栓塞材料及不可吸收的永久性颗粒栓塞材料两类。可吸收性颗粒栓塞材料包括:胶原蛋白微球、SAP-MS、壳聚糖微球、聚丙烯腈水凝胶微球、微胶原纤维止血剂等,而永久性颗粒栓塞材料包括聚乙烯醇泡沫微粒、EM微球、微晶纤维素、葡萄糖凝胶微球、水凝胶类微球等。理想的颗粒栓塞材料应符合以下要求:无毒,无抗原性,具有较好的生物相容性,能迅速闭塞血管,能按需要闭塞不同口径、不同流量的血管,易经导管运送,易消毒,能控制闭塞血管的时间长短,一旦需要可经皮回收或使血管再通,X线下显影等。目前临床应用的颗粒性栓塞材料X线下多不显影,操作时需要与造影剂混合以便于术中操作,且多是毛细血管前栓塞,单独应用于治疗脑血管疾病的较少,一般多和液体材料联合使用,或是血供丰富脑肿瘤的术前栓塞。但因颗粒栓塞材料具有生物相容性好、操作安全、适合粒径的颗粒到达靶血管的终末支可彻底治愈病变的优势,故开发对温度及PH值敏感、具有磁性可控及膨胀时间和胀系数可控的颗粒栓塞材料,将是对颗粒材料的又一次革命。     

栓塞材料甲基丙烯酸共聚物和丁氰酯胶的对比研究

目的　评价两种血管内液体栓塞材料甲基丙烯酸共聚物 (eudragit)和α 氰基丙烯酸正丁酯 (NBCA)的栓塞效果和病理学变化。方法　采用eudragit混合液和NBCA栓塞 2 4只家兔右侧颈外动脉分支血管 ,观察栓塞术后家兔全身一般状态、血管造影影像学变化及光镜和电镜下的组织形态学改变。结果　Eudragit混合液栓塞动物血管时易通过微导管 ,不产生堵塞、粘连微导管现象 ,可诱发血栓形成 ,能产生有效的血管栓塞作用 ,无毒、副作用 ,无血管再通现象。栓塞后急性期无炎症反应 ,亚急性期和慢性期发生轻、中度管腔内和血管周围的炎症反应。Eudragit和NBCA的对比研究可见NBCA栓塞的血管异物反应明显 ,血管内膜广泛受损 ,管壁坏死严重 ,这可能表明NBCA的毒性重于eudragit。结论　甲基丙烯酸共聚物混合液作为一种非粘性液体栓塞材料具有良好的血管栓塞作用 ,是一种较理想的新型液体栓塞材料。     

脑动静脉畸形部分栓塞后的再渗透：临床、放射学及组织学研究

本文描述了用α-氰基丙烯酸正丁酯(NBCA)行血管内栓塞脑动静脉畸形(AVM)后与栓塞相关的组织病变及血管巢铸型(intranidal cast)的再渗透。方法:作者对26例脑AVM先以NBCA行血管内栓塞治疗,随之行手术摘除,观察与栓塞相关的组织病变及血管巢铸型。每一例病人术前均经血管造影证实有残余血流经过血管巢。结果:与栓塞相关的组织病变的类型与演变是典型的。栓塞后3个月被栓塞的组织未出现再渗透。相反,在第一次栓塞后2个月每一个行外科手术的病人均出现再渗透。对这些病例的被切除血管巢的组织学检查示毛细血管内     

血管内栓塞治疗脑动静脉畸形35例临床分析

目的 分析脑动静脉畸形(cAVM)以血管内栓塞的治疗方法、栓塞材料的选择、适应证及并发症的防治措施。方法从1998-02～2001-12,共进行血管内栓塞治疗cAVM 35例。按Spetzler分级标准,Ⅰ级5例,Ⅱ级7例,Ⅲ级12例,Ⅳ级8例,Ⅴ级3例。栓塞材料以α-氰基丙烯酸正丁酯(NBCA)为主,部分联合应用真丝线段和液态弹簧圈。结果 cAVM完全被栓塞18例,栓塞75％以上9例,栓塞50％～75％者5例,栓塞<50％者3例,1例在治疗过程中表现为大脑中动脉痉挛,1例栓塞后表现为一过性神经功能障碍。结论 血管内栓塞治疗是cAVM的重要治疗手段,只要掌握好适应证及操作方法,就能完全栓塞或部分栓塞cAVM,减轻症状.且创伤小.并发症少.并能为手术切除或立体定向放射治疗创造机会。     

介入神经放射学栓塞材料的研究概况及其应用

介入神经放射学的发展,在很大程度上取决于导管及栓塞材料的更新应用。研究及发展血管内栓塞材料是介入神经放射学发展的重要课题。由于进口材料价格昂贵,所以,实行临床与科研、医务人员与工程技术人员、科研单位与相关企业结合,研制适合我国国情的栓塞材料,并实现产业化是目前栓塞材料研究中的当务之急。     

脑动静脉畸形栓塞治疗后的组织病理及免疫组化研究

目的研究脑动静脉畸形(CAVM)栓塞治疗后的组织病理变化。方法分析11例栓塞治疗后再行手术切除CAVM的病例资料,应用增殖细胞核抗原(PCNA)、α-平滑肌肌动蛋白(α-SMA)、骨桥蛋白(OPN)、血管内皮生长因子(VEGF)等抗体进行免疫组化研究。结果栓塞后,CAVM血管腔内出现不同程度的血管炎性反应,部分被栓塞的血管腔内可见再通。栓塞治疗后的新生内膜中OPN及α-SMA呈阳性染色;畸形血管团周围组织中发现异常微血管,其内皮细胞PCNA阳性染色率高,且VEGF呈阳性染色。畸形血管周围组织中的血管内皮细胞增殖指数(19.6%±8.4%)高于对照组(10.1%±6.2%),差异有统计学意义(P<0.05)。结论栓塞材料引起血管呈不同程度的炎性反应,适度的血管反应有助于管腔闭塞;栓塞治疗后畸形血管周边有微血管增生现象。     

非黏附性液体栓塞材料ONYX与脑动静脉畸形的治疗

摘要 目的：探讨非黏附性液体栓塞材料ONYX的优势与不足及其在脑动静脉畸形中的应用效果和栓塞技巧。 方法：应用中国知网（CNKI）、万方医学网数据库,由第一作者以“脑动静脉畸形;栓塞;非黏附性液体栓塞材料;ONYX;氰基丙烯酸正丁酯;栓塞技巧”检索1998/2010时限内,与非黏附性液体栓塞材料ONYX优势和不足、在脑动静脉畸形中的临床应用效果及其栓塞技巧相关文献。排除重复研究或较陈旧文献。 结果：依据纳入排除标准共保留相关文献20篇。非黏附性液体栓塞材料ONYX不黏管,在畸形血管团内弥散好,可以缓慢注射,栓塞率高,栓塞效果永久,无再通现象,栓塞后易于手术切除,是治疗脑动静脉畸形较为理想的栓塞材料。但有一定并发症,需注意掌握栓塞技巧。 结论：ONYX是治疗脑动静脉畸形较为理想的栓塞材料,需要掌握栓塞的技巧,减少并发症的发生。 关键词：脑动静脉畸形;栓塞;非黏附性液体栓塞材料;ONYX;氰基丙烯酸正丁酯;栓塞技巧 doi:10.3969/j.issn.1673-8225.2010.21.021     

Homologous amniotic membrane as a dural substitute in decompressive craniectomies

IntroductionA dura mater substitute in decompressive craniectomies must protect the brain while providing a dissection plane between the cortex and myocutaneous layer. The human amniotic membrane (AM) has anti-inflammatory, wound healing, and differentiation properties. We tested AM properties as a dural substitute by comparing the outcomes to biological ones.MethodsWe prospectively collected data on 25 patients who randomly underwent decompressive craniectomy with lyophilized AM patches and 25 in which biological substitutes were utilized between 2015 and 2019. The AM was laid with the epithelial side facing the brain because of the anti-adhesive proprieties, while the chorion facing the myocutaneous flap. We collected data on demographics, neurological status, comorbidities, and surgical outcomes. Additionally, we created a score – dura mimicking score– and reviewed postoperative imaging and pathological specimens.ResultsThe majority (96%) of AM grafts were integrated into native dura. Thirteen patients scored as excellent and 11 good on our “dura mimicking score”, showing tissue integration ability but no cerebral cortex adhesion. The histopathological analysis showed that AM had thick plates of dense fibrous tissue with small reactive vessels, reactive fibroblasts, and lymphocytes infiltrate. The AM group's first outcomes were not different from the biological substitute patients but higher integration rate to the dura and less adhesion to the myocutaneous flap in AM patients.ConclusionsWe documented the anti-adhesive, protective, and integrative properties of AM dural substitute patches in patients who underwent decompressive craniectomies, comparing the intraoperative differences and postoperative outcomes to biological dural substitutes.     

Main anastomoses of external carotid artery branches with the beds of the internal carotid and the vertebral artery and a role of pharmacological tests in the determination of their functional value at tumor embolization

In 21 patients with meningovascular tumors (meningiomas, angiofibromas, etc.), 53 vessels were tested during preoperative embolization of extracranial tumors. Two groups of drugs were superselectively intraarterially administered in turn--first barbiturates, such as thiopental sodium, 15-20 mg in 2 ml of sodium chloride solution, to detect anastomoses with cerebral vessels, then local anesthetics (lidocaine, 10-20 mg in 2 ml of sodium chloride solution, to reveal the vessels feeding cranial nerves. If drug tests were negative, the afferent was embolized with under 300 microns particles. If they were positive this was done with only large particles (above 300 microns). Injection of thiopental sodium into the occipital artery provided a positive result in 1 (1.8%) of the 53 cases. There were no complications after negative tests, followed by embolization. Drug provocative tests during embolization of the vessels feeding extra- and intracranial tumors make it possible to reduce the risk for persistent ischemic events associated with the entry of artificial emboli into the cerebral vessels and vasa nervorum and to conduct the optimum embolization of afferents.     

Golgi-electron microscopic study of sprouting endothelial cells in the neonatal rat cerebellar cortex

Intraparenchymal postnatal development of the CNS vasculature proceeds by a process of vascular 'budding' or 'sprouting' from existing endothelial cells and elongation of these immature vessels. A modified Golgi technique combined with gold toning and deimpregnation was used to identify and characterize sprouting endothelial cells in the neonatal rat cerebellar cortex with light and electron microscopy. Sprouting endothelial cells were the terminal endothelial cells of immature, developing blood vessels and they had characteristic morphologic features. The most distinctive feature was an array of tentacular processes (0.1-0.2 micron in diameter and ca. 20 microns in length) which radiated from the apex of these cells in the presumed direction of vessel growth. Cytoskeletal microtubules and microfilaments were the characteristic organelles of these tentacles. Sprouting endothelial cells were thin (1-3 microns in diameter). lacked a vessel lumen and basement membrane, had abundant cytoplasmic organelles and a prominent nucleus and were closely associated with the subterminal endothelial cell without interendothelial gaps. The developing blood vessels had a blood-brain barrier which excluded intravenously injected colloidal carbon from the neuropil.     

Flexion-induced cervical myelopathy associated with fewer elastic fibers and thickening in the posterior dura mater

Two patients with a condition clinically resembling juvenile muscular atrophy of distal upper extremity (Hirayama disease) showed forward protrusive movement of the posterior cervical dura matter during neck flexion. The dura displacement was characteristically limited in an approximately central portion of the posterior dura, which is different from Hirayama disease, which exhibits whole posterior dura displacement. Interestingly, the restricted dura in these patients showed thickening with reduced elastic fibers, indicating that the decreased stretchability of the posterior dura had caused motor dominant cervical myelopathy.     

Lymphatic capillaries in the meninges of the human optic nerve.

OBJECTIVE: Although many anatomical studies of the orbit and the optic nerve have been performed, lymphatic capillaries in the dura of the human optic nerve have never been reported. This study was performed to determine whether or not lymphatic capillaries are present in the dura of the human optic nerve. MATERIALS AND METHODS: This postmortem study was carried out in seven subjects without ocular disease. The subjects were obtained no later than 6 hours after death, following qualified consent for autopsy. The dura of the human optic nerve was studied with light microscopy, scanning electron microscopy, and transmission electron microscopy. In some cases, india ink was injected into the subarachnoid space as a marker. RESULTS: Lymphatic capillaries in the dura of the human optic nerve were morphologically demonstrated with histological criteria (fenestrated endothelium, lack of a basal membrane, and absence of blood cells in the lumen of the vessels). The highest concentration of lymphatic capillaries was found in the bulbar part of the dura behind the ocular globe. Using light microscopy and transmission electron microscopy, ink was seen within the lumen of the lymphatic capillaries. The dura itself was not stained with the marker. CONCLUSION: The presence of lymphatic capillaries in the dura of the human optic nerve was demonstrated with light microscopy, transmission electron microscopy, and scanning electron microscopy.     

自制生物型人工硬脑膜与美国进口同类产品的比较

目的通过对临床病人及犬的开颅手术,观察应用自主创新人工硬脑膜的预后,并与应用美国进口同类产品(脑膜卫士)比较。方法选择临床手术病人39例,24例应用自创材料,15例应用脑膜卫士修补硬脑膜;选择犬10只,分为5组,分别为1、6、12、24个月及更长时间,每组犬各2只,每只犬于左右头顶分别应用自创材料与脑膜卫士修补硬脑膜。手术后对比观察不同修补材料的效果。结果犬解剖显示,应用自创材料的外表面与颅骨膜有少许丝状粘连、易分离,与周边缝合的硬脑膜已完全愈合,不可分辨,不能分离。从自创材料及脑膜卫士两种修补材料内表面来看,前者生长更接近硬脑膜,与脑表面无粘连或偶有丝状粘连。组织学镜下显示,两种修补材料与硬脑膜之间无嗜中性粒细胞、淋巴细胞等炎症细胞反应,无囊壁形成。自创材料内表面可见上皮细胞覆盖,上皮下可见纤维组织增生,纤维母细胞增生,该材料被降解,总量明显减少,内部可见毛细血管。结论用自创材料做硬脑膜修补手术后,该型材料的特性使其能产生上皮,不形成与脑组织的粘连,并逐渐被自体组织替代,达到具有实际意义的硬脑膜重建。     

Surgically treated paroxysmal hemifacial spasm]

Two patients with paroxysmal hemifacial spasm were treated surgically with good result. In one of them the anterior inferior cerebellar artery was separated with lyophilized dura from the brain stem and from the pontine site of origin of the facial nerve. In the second case the whole facial nerve was dissected from its origin from the brain stem to the internal porus acusticus and lyophilized dura was inserted between the vestibular artery and the lateral part of the facial nerve.     

Identification of Lyve-1 positive macrophages as resident cells in meninges of rats

Meningeal immunity along with its associated lymphatic vasculatures is widely discussed recently. Lymphatic vessels in meninges drain interstitial fluid into the deep-cervical lymph nodes. The vessels are composed of cells that express the cardinal marker for lymphatic endothelium—the lymphatic vessel hyaluronan receptor-1 (Lyve-1). However, studies also show the presence of nonendothelial Lyve-1 expressing cells in certain tissues. Therefore, we were curious if nonendothelial Lyve-1+ cells are also present in dura mater of meninges. We show that Lyve-1+ endothelial cells are distributed adjacent to the blood vessels in the brain dura mater of rats. We did not observe any lymphatic vessels in spinal dura mater. Interestingly, we also observed isolated population of nonlymphatic Lyve-1+ cells in both brain and spinal dura mater. Morphologically, the Lyve-1+ cells were extensively pleomorphic, sometimes elongated or round. Surprisingly, the thoracolumbal meningeal Lyve-1+ cells were predominantly round in morphology. Using endothelial specific marker VEGFR3 and macrophage markers CD68 and CD169, we observed that the isolated Lyve-1+ cells lacked endothelial cell signature, but were either CD68+ or CD169+ macrophages. Moreover, we observed that the Lyve-1+ cells colocalized with collagen fibers in the meninges, and some of Lyve-1+ cells had intracellular collagen. The study for the first time demonstrates the presence of Lyve-1 positive macrophages in the lymphatic and nonlymphatic regions in the meninges of rats.     

静脉性脑梗死的临床和影像特点分析

目的 分析静脉性脑梗死的临床与影像学特点,旨在提高认识以利于早期诊断和治疗。方法 回顾性分析2例静脉性脑梗死的临床表现、影像特征。结果 1例急性起病,以偏瘫、癫痫发作为主要表现,头MRI示双侧多发梗死或出血性梗死灶,且随着病情的好转病灶可缩小甚至消失。1例亚急性起病,进行性加重,主要表现为意识水平的下降,头MRI示双侧弥漫分布的多发DWI高信号病灶,增强示脑膜强化,脑表面血管增多。2例患者病初均有头痛症状。结论 早期头痛症状、头MRI示双侧多发梗死或出血性梗死灶、双侧多发DWI高信号病灶、增强示脑膜强化、脑表面血管增多等临床和影像特点有助于静脉性脑梗死的早期诊断。     

Myoendothelial junctions in human brain arterioles

BACKGROUND: The purpose of this work was to determine whether myoendothelial junctions were present in human brains. SUMMARY OF REPORT: We examined vessels of approximately 30-70 microns i.d. from the brains of five autopsied adult patients. Myoendothelial junctions were found in vessels throughout this range, in both surface arterioles and penetrating arterioles, and were classified into three types. The number of myoendothelial junctions, expressed per unit length of vessels, was five times greater in the smallest than in the largest vessels. Thus, we found 1.62 junctions per millimeter length in arterioles less than 60 microns diameter and 0.31 junctions per millimeter length in arterioles greater than 220 microns diameter. CONCLUSIONS: These findings provide an anatomic basis for communication between endothelial cells and smooth muscle of brain microvessels in humans. The function of this intercellular communication is not yet known; however, findings in animals suggest that endothelium may be required for propagated constriction in brain vessels. The existence of myoendothelial junctions in human brain provides a basis for the hypothesis that propagated constriction depends on transmission of some message or messenger between endothelial cells and muscle.