经额部纵裂入路显微外科手术治疗鞍区病变35例报告

目的探讨经额部纵裂入路显微外科手术治疗鞍区病变的手术方法及手术技巧。方法应用经额部纵裂入路显微外科手术切除脑膜瘤13例,垂体瘤10例,颅咽管瘤5例,三脑室前部海绵状血管瘤破裂出血1例,视神经胶质瘤1例,夹闭前交通动脉瘤5例。结果脑膜瘤全切除12例,近全切除1例;垂体瘤全切除7例,近全切除3例;颅咽管瘤近全切除5例;前交通动脉瘤5例均成功夹闭;三脑室前部海绵状血管瘤破裂出血1例全切除;视神经胶质瘤1例大部切除。结论经额部纵裂入路对前颅底、鞍区重要解剖结构有良好暴露,有利于术中对大脑前动脉、颈内动脉、前交通动脉、垂体柄、视交叉、下丘脑及重要穿通血管等结构的保护,防止术后垂体、下丘脑功能障碍,也可避免传统的额底入路对嗅神经、直回的损伤。     

10例尸头标本经额纵裂入路及鞍区的显微解剖学研究

目的对尸头标本经额纵裂入路及鞍区的显微解剖学进行研究。方法将经10%甲醛固定的10例成人尸头标本(经红、蓝乳胶血管灌注处理)作为对象,显微镜下对其行模拟经额纵裂入路鞍区手术,对该入路中的解剖结构进行观察。结果经额纵裂入路可清晰的显露鞍区结构包括嗅神经、视神经、视交叉、垂体柄、颈内动脉及分支、前交通动脉复合体、下丘脑和终板等。结论经额纵裂入路利于手术视野的暴露,鞍区显微解剖结构为手术的设计和改进提供依据。     

内镜经鼻腔入路治疗前颅底中线区和鞍上病变的解剖学观察

目的 观察内镜经鼻腔人路手术治疗前颅底中线区和鞍上病变的解剖学特点.方法 在10例成人尸头标本上模拟内镜下经鼻腔至前颅底中线区和鞍上的手术入路.采用经双鼻孔-鼻中隔黏膜间入路,前、后组筛窦和双侧上、中鼻甲根据需要决定是否切除.研究该人路下的手术可及范围、路径、各区域的解剖特点,确立术中具有指导意义的解剖标志等.结果 以两侧颈内动脉-视神经隐窝(OCR)的连线定位,在鞍结节、蝶骨平台处磨开骨质,可暴露前达额窦、两侧达眶内侧壁的整个前颅底中线区域,向鞍上可以显露鞍上池、视交叉池、终板池及其内的重要组织结构,并可经终板进入第三脑室.测定了鼻小柱至蝶窦口、鞍底、鞍结节、OCR内缘、筛后动脉、筛前动脉的距离,两侧OCR内缘间的距离.结论 内镜下经鼻腔入路视角明显扩大,手术可及范围得到极大扩展,且具有可以直接到达病变区域、避免对脑组织、血管的牵拉等优点.     

颅咽管瘤显微手术治疗22例

目的研究颅咽管瘤显微全切的手术技巧。方法在22例患者中,18例取翼点入路,2例经额下入路,1例经额部纵裂从胼胝体至穹窿间系入三脑室前部切除肿瘤,1例经额部纵裂经终板切除肿瘤。结果17例达到肿瘤全切除,3例近全切除,2例大部全切除。结论选择合适的手术入路,保护下丘脑结构和功能,达到肿瘤全切除是治疗肿瘤取得良好效果的关键。     

颅咽管瘤几种手术入路的临床比较

笔者收集从1998年4月～2006年1月采用四种不同入路(额下入路、翼点入路、经纵裂入路、经胼胝体—透明隔间隙—穹隆间入路)切除颅咽管瘤27例资料,总结报告如下:1.临床资料1.1一般资料27例患者中男15例,女11例。年龄2～56岁。病程1个月～5年。单侧或双侧视力下降伴颞侧视野缺损18例,内分泌障碍21例,头痛等颅高压症状13例,下丘脑损伤嗜睡3例。1.2影像学资料视交叉下方,三脑室前的肿瘤4例,向鞍旁发展外侧型8例,鞍后及向三脑室前部生长的肿瘤15例。1.3病理报告27例病理诊断均为颅咽管瘤。2.手术方法2.1额下入路常规单侧额下开颅,骨瓣下至眶脊,内…     

额底前纵裂入路垂体腺瘤切除术19例回顾

目的探讨额底前纵裂入路垂体腺瘤的手术适应症与优缺点。方法分析经额底前纵裂入路切除垂体腺瘤的病例资料。结果肿瘤全切14例,大部切除5例,术后患者视力改善17例,尿崩或电解质紊乱12例,经治疗后得到控制2例,长期服用溴隐亭,随访时间,12～42个月,14例病情得到控制,5例复发,行术后r-刀治疗后肿瘤基本控制。结论对于巨大垂体腺瘤,且肿瘤向鞍区及第三脑室内生长者,经额底前纵裂入路切除垂体腺瘤具有一定优势。     

三脑室底上型颅咽管瘤的手术治疗(附10例分析)

目的探讨一种切除三脑室底上型颅咽管瘤的手术治疗方法。方法总结经胼胝体-透明隔-穹隆间入路切除三脑室底上型颅咽管瘤10例的临床资料。结果肿瘤全切除9例,近全切除1例,无手术死亡。结论该入路是切除三脑室底上型(包括三脑室前部及三脑室内)颅咽管瘤的最佳入路,术野暴露清楚,直视下操作,减少了术后并发症的发生。     

2种术式治疗重型脑室出血并铸型的效果对比观察

目的 探讨重型脑室出血并铸型的临床治疗方法.方法 回顾分析脑室外引流及显微镜下经纵裂-胼胝体手术入路治疗50例重型脑室出血并铸型的临床资料.其中22例(第1组)行脑室外引流治疗,另28例(第2组)行早期显微镜下经纵裂-胼胝体手术入路治疗.术后比较2组手术效果.结果 随访3个月日常生活活动能力(ADL)预后分级:第1组Ⅰ级(良好,继续工作)4例,Ⅱ级(中残,生活能自理)3例,Ⅲ级(重残,生活不能自理)2例,V级(植物生存)6例;第2组Ⅰ级12例,Ⅱ级5例,Ⅲ级2例,V级5例.结论 早期显微镜下经纵裂-胼胝体手术入路是治疗脑室出血并铸型的一种有效方法,手术在直视下操作,盲区小,使患者生存质量提高,降低病死率,具有较好的临床价值.     

鞍结节脑膜肿瘤治疗术的路径选择方法分析

鞍结节脑膜肿瘤是起源于鞍结节、前床突、鞍隔和蝶骨平台的脑膜瘤,约占颅内脑膜肿瘤的5%～10%。因其毗邻垂体、垂体柄、颈内动脉、视神经等重要结构,并且肿瘤所处位置较深,致手术难度加大,并且还会出现较多的术后并发症。目前,鞍结节脑膜肿瘤的显微手术路径主要分为经鼻和经颅两大类,而经颅又可发展出额外侧入路、纵裂入路、眶上锁孔入路、额底入路、翼点入路等5种不同手术路径。本文选取鞍结节脑膜肿瘤患者64例,对其不同的手术路径选择方法进行分析,现报道如下。     

鞍区肿瘤术后并发急性梗阻性脑积水的处理

目的 探讨鞍区肿瘤术后并发急性梗阻性脑积水的原因及处理措施.方法 回顾分析医院2001年1月至2008年5月收治的69例鞍区巨大肿瘤开颅手术患者中4例患者并发急性梗阻性脑积水的原因及处理方法.结果 4例患者中有3例在切除肿瘤时通过终板显露了第三脑室,4例在打开Lilliquist膜后均有较多血性脑脊液流入基底池;3例患者急诊于局部麻醉下行侧脑室穿刺置管外引流术,术后1周内经夹闭引流管观察24 h证实无颅高压征象后拔除引流管,次日开始隔日行腰椎穿刺放血性脑脊液,效果满意.结论 经额下翼点联合入路切除鞍区肿瘤时,打开终板和Lilliquist膜后,出血多时未用生理盐水反复冲洗置换血性脑脊液和脑棉保护是鞍区巨大肿瘤开颅术后并发急性梗阻性脑积水的主要原因,积极行侧脑室穿刺置管外引流术及反复多次腰椎穿刺引流,是治疗的有效措施.     

经终板入路显微切除视交叉后颅咽管瘤

目的：探讨视交叉后颅咽管瘤的手术入路和显微手术技巧。方法：采用终板入路显微切除颅咽管瘤7例，结果：所有病例皆达全切除，效果良好，随访2个月－2年未见肿瘤复发，结论：应用熟练的显微技巧，经终板入路彻底切除视交叉后颅咽管瘤对下丘脑无明显损伤，可以取得良好的临床疗效。     

Bed nucleus of the stria terminalis: Site for the antinatriorexic action of tachykinins in the rat

The present study investigated the sensitivity of the posterior part of the medial division of the bed nucleus of the stria terminalis (BNST) to the antinatriorexic action of the tachykinin eledoisin in the rat. Salt appetite was evoked by sodium depletion following furosemide-induced natriuresis. The results obtained show that bilateral injection of eledoisin into the BNST evokes a very potent antinatriorexic effect, a statistically significant inhibition being observed even at the dose of 3.1 ng/BNST. On the other hand, when eledoisin was injected into the lateral ventricle, just above the BNST, much larger doses were required to elicit comparable inhibition of salt appetite. The antinatriorexic effect of eledoisin into the BNST is apparently behaviorally selective, since the same doses, which inhibited salt appetite, did not significantly affect the intake of 10% sucrose solution in the sodium-depleted animal. Present results suggest that the BNST is a site of action for the effect of tachykinins on salt appetite.     

Androgen Receptors in the Posterior Bed Nucleus of the Stria Terminalis Increase Neuropeptide Expression and the Stress-Induced Activation of the Paraventricular Nucleus of the Hypothalamus

The posterior bed nuclei of the stria terminalis (BST) are important neural substrate for relaying limbic influences to the paraventricular nucleus (PVN) of the hypothalamus to inhibit hypothalamic-pituitary-adrenal (HPA) axis responses to emotional stress. Androgen receptor-expressing cells within the posterior BST have been identified as projecting to the PVN region. To test a role for androgen receptors in the posterior BST to inhibit PVN motor neurons, we compared the effects of the non-aromatizable androgen dihydrotestosterone (DHT), the androgen receptor antagonist hydroxyflutamide (HF), or a combination of both drugs implanted unilaterally within the posterior BST. Rats bearing unilateral implants were analyzed for PVN Fos induction in response to acute-restraint stress and relative levels of corticotrophin-releasing hormone and arginine vasopressin (AVP) mRNA. Glutamic acid decarboxylase (GAD) 65 and GAD 67 mRNA were analyzed in the posterior BST to test a local involvement of GABA. There were no changes in GAD expression to support a GABA-related mechanism in the BST. For PVN neuropeptide expression and Fos responses, basic effects were lateralized to the sides of the PVN ipsilateral to the implants. However, opposite to our expectations of an inhibitory influence of androgen receptors in the posterior BST, PVN AVP mRNA and stress-induced Fos were augmented in response to DHT and attenuated in response to HF. These results suggest that a subset of androgen receptor-expressing cells within the posterior BST region may be responsible for increasing the biosynthetic capacity and stress-induced drive of PVN motor neurons.     

Quantifying fear potentiated startle using absolute versus proportional increase scoring methods: implications for the neurocircuitry of fear and anxiety

Abstract Rationale. The fear-potentiated startle paradigm [increased startle in the presence of a conditioned fear stimulus (CS)] has become increasingly popular as a tool for evaluating the potential efficacy of putative anxiolytic compounds. However, when the tested compounds also influence baseline startle, it is unclear how comparisons with control groups can best be made. Objective. To evaluate the validity of absolute difference (startle amplitude on CS minus non-CS test trials) vs. proportional increase (the absolute difference score divided by startle amplitude on non-CS test trials) scoring methods. Methods. The effect on proportional increase and absolute difference scores of baseline shifts that occur with or without concomitant increases in fear was evaluated in rats. A reliable measure should yield similar scores across shifting baselines, provided that fear levels remain constant. Results. Preexisting baseline differences, and those brought about by different startle-eliciting noise burst intensities, by strychnine injections, or by CRH infusions, each increased absolute difference scores without markedly influencing proportional change scores. These baseline differences were not associated with different fear levels. Increases in baseline startle brought about by unsignaled footshocks or by a second CS – increases which are associated with increased fear – partially occluded additional CS-induced increases using either measure. Conclusions. Across different baselines, CS-elicited fear is most accurately reflected in proportional change scores. Under certain conditions saturation effects may interfere with an accurate assessment using either measure. However, these same saturation effects may provide opportunities to explore the neural circuitry of fear and anxiety in novel ways. Electronic Publication     

Noradrenergic Synaptic Function in the Bed Nucleus of the Stria Terminalis Varies in Animal Models of Anxiety and Addiction

Lewis rats show increased anxiety-like behaviors and drug consumption compared with Sprague-Dawley rats. Prior work suggests norepinephrine (NE) signaling in the bed nucleus of the stria terminalis (BNST) could have a role in mediating these phenotypes. Here, we investigated NE content and dynamics in the ventral BNST (vBNST) using fast-scan cyclic voltammetry in these two rat strains. We found that NE release evoked by electrical stimulus and its subsequent uptake was dysregulated in the more anxious Lewis rats. Because addiction is a multifaceted disease influenced by both genetic and environmental factors, we hypothesized NE dynamics would vary in these strains after the induction of a physical dependence on morphine. Following naloxone-precipitated morphine withdrawal, NE release and uptake dynamics were not changed in Lewis rats but were significantly altered in Sprague-Dawley rats. The alterations in Sprague-Dawley rats were accompanied by an increase in anxiety-like behavior in those animals as measured with the elevated plus maze. These studies suggest novel mechanisms involved in the development of affective disorders, and highlight the noradrenergic system in the vBNST as a common substrate for the manifestation of pathological anxiety and addiction.     

PACAP in the BNST Produces Anorexia and Weight Loss in Male and Female Rats

Recent gene association studies have implicated pituitary adenylate cyclase-activating peptide (PACAP) systems in several psychiatric disorders associated with stressor exposure, and we have argued that many of the behavioral consequences of repeated stressor exposure may depend on the expression of PACAP in the bed nucleus of the stria terminalis (BNST). One behavioral consequence of the activation of stress systems can be anorexia and subsequent weight loss, and both the activation of central PACAP systems as well as neuronal activity in the BNST have also been associated with anorexic states in rodents. Hence, we investigated the regulation of food and water intake and weight loss following BNST PACAP infusion. BNST PACAP38 dose-dependently decreased body weight, as well as food and water intake in the first 24 h following infusion. Because different BNST subregions differentially regulate stress responding, we further examined the effects of PACAP38 in either the anterior or posterior BNST. Anterior BNST PACAP38 infusion did not alter weight gain, whereas posterior PACAP38 infusion resulted in weight loss. PACAP38 infused into the lateral ventricles did not alter weight, suggesting that the effects of BNST-infused PACAP were not mediated by leakage into the ventricular system. These data suggest that PACAP receptor activation in posterior BNST subregions can produce anorexia and weight loss, and corroborate growing data implicating central PACAP activation in mediating the consequences of stressor exposure.     

Phasic vs Sustained Fear in Rats and Humans: Role of the Extended Amygdala in Fear vs Anxiety

Data will be reviewed using the acoustic startle reflex in rats and humans based on our attempts to operationally define fear vs anxiety. Although the symptoms of fear and anxiety are very similar, they also differ. Fear is a generally adaptive state of apprehension that begins rapidly and dissipates quickly once the threat is removed (phasic fear). Anxiety is elicited by less specific and less predictable threats, or by those that are physically or psychologically more distant. Thus, anxiety is a more long-lasting state of apprehension (sustained fear). Rodent studies suggest that phasic fear is mediated by the amygdala, which sends outputs to the hypothalamus and brainstem to produce symptoms of fear. Sustained fear is also mediated by the amygdala, which releases corticotropin-releasing factor, a stress hormone that acts on receptors in the bed nucleus of the stria terminalis (BNST), a part of the so-called ‘extended amygdala.'' The amygdala and BNST send outputs to the same hypothalamic and brainstem targets to produce phasic and sustained fear, respectively. In rats, sustained fear is more sensitive to anxiolytic drugs. In humans, symptoms of clinical anxiety are better detected in sustained rather than phasic fear paradigms.     

顶花板凳果化学成分及药理活性研究进展

目的对黄杨科板凳果属植物顶花板凳果(Pachysandra terminalis Sieb.et Zucc.)化学成分的化学结构及生物活性研究进行文献整理,为顶花板凳果的深度研究开发提供参考依据。方法主要对1964~2016年国内外有关顶花板凳果化学成分的化学结构及生物活性研究的文献进行归纳、梳理、分析和总结。结果 1964年以来,国内外学者已从顶花板凳果中分离得到多种生物碱及非生物碱,并对其抗菌、抗肿瘤、抗氧化、抗溃疡以及免疫抑制等方面的生物活性进行了研究。结论在药理学指导下的化学成分研究将成为顶花板凳果研究的重要方向,这不仅可为阐明顶花板凳果中化学成分的生物效应和药用价值提供依据,更能为加快顶花板凳果及板凳果属植物的开发和利用提供依据。     

扩大终板入路切除鞍上第三脑室内外颅咽管瘤的临床疗效分析

目的　探讨扩大终板入路行显微手术切除鞍上第三脑室内外颅咽管瘤的临床效果及安全性。方法　回顾性分析行扩大终板入路显微手术的38例鞍上第三脑室内外颅咽管瘤患者的临床资料,其中男22例,女16例;影像学提示单纯囊性14例,单纯实质性12例,囊实性12例,CT提示肿瘤伴有钙化15例。收集其术前和术后影像学资料、激素水平、视力视野和病理结果等。结果　38例患者中行扩大终板入路显微手术全切34例（89.5%）,次全切除为3例（7.9%）,部分切除1例（2.6%）,无手术相关死亡病例。术后1个月内视力好转或无变化患者31例。术后随访（54.5±7.3）个月,肿瘤复发4例,其中2例接受再次手术治疗,2例接受放射治疗。结论　扩大终板入路显微手术切除鞍上第三脑室内外颅咽管瘤,肿瘤全切率高,术后并发症少且有利于对垂体柄视神经的保护。     

Circumventricular Organs: Gateways to the Brain Multisynaptic Neuronal Pathways From The Submandibular And Sublingual Glands To The Lamina Terminalis In The Rat: A Model For The Role Of The Lamina Terminalis In The Control Of Osmo- And Thermoregulatory Behaviour

1. The putative regulatory role of the lamina terminalis in the central control of salivation was investigated in the rat using the viral‐tracing technique and Fos‐immunohistochemistry. 2. Neurons situated in the lamina terminalis, such as the vascular organ of the lamina terminalis (OVLT), median preoptic nucleus (MnPO) and subfornical organ (SFO), were retrogradely labelled after pseudorabies virus injections into the submandibular or sublingual gland. 3. Viral tracing combined with glandular denervation showed that lamina terminalis structures sent efferents, in particular, to the parasympathetic side of submandibular gland innervation. 4. Saliva lost under heat stress has severe implications for the body fluid economy of rats and a key to the understanding of the central regulation of heat‐induced salivation may be the integrative role of the lamina terminalis processing thermoregulatory and osmoregulatory information.