电解可脱性弹簧圈栓塞颅内动脉瘤30例

目的总结电解可脱弹簧圈(GDC)栓塞颅内动脉瘤的经验。方法回顾性分析采用GDC栓塞30例(共32个)颅内动脉瘤的临床资料。结果术中动脉瘤破裂1例,致密填塞导致血管小分支闭塞1例。术后死亡1例,发生短暂性神经功能缺失1例。结论正确处理术中并发症,熟悉动脉瘤和载瘤动脉的解剖关系,提高栓塞技术等,有助于减少颅内动脉瘤血管内治疗的并发症与提高治愈率。     

两种弹簧圈在动脉瘤栓塞治疗中的对比研究

目的通过观测栓塞颅内破裂动脉瘤时术中破裂的发生确认Matrix弹簧圈的特性,评价其临床应用的安全性,为临床应用提供指导。方法回顾性分析单中心2003年9月至2005年9月应用单纯基质电解脱弹簧圈(Matrix)和1999年10月至2003年9月应用电解可脱性弹簧圈(GDC)血管栓塞治疗颅内破裂动脉瘤的两组病例,观察并对比两组病例术中破裂的发生率。结果 102例应用Matrix弹簧圈栓塞的颅内动脉瘤9例发生术中破裂,253例应用GDC栓塞的颅内动脉瘤7例发生术中破裂,两组病例术中破裂发生率分别为8.8%和2.8%,差异显著(P<0.01)。Matrix栓塞组发生术中破裂的病例中动脉瘤直径小于5 mm和前交通动脉瘤的比例明显高于GDC。结论和GDC相比,Matrix弹簧圈的硬度高,柔顺性低,在应用Matrix栓塞远段动脉瘤、小动脉瘤或者二者兼而有之的动脉瘤时,其术中破裂的风险性高于裸金属弹簧圈,应慎重。     

复杂性颅内动脉瘤的血管内治疗

目的 探讨复杂性颅内动脉瘤血管内治疗方法的选择及其效果评价.方法 对2005年1月～2007年1月收治的经DSA确诊的复杂性颅内动脉瘤12例进行了经皮穿刺血管内治疗,其中椎动脉瘤1例,基底动脉瘤4例,后交通动脉瘤1例,眼动脉瘤2例,颈动脉海绵窦段动脉瘤2例,前交通动脉瘤2例,分别采用了球囊,GDC,水解弹簧圈,Neuroform支架辅助水解弹簧圈或GDC栓塞技术.其中1例眼动脉瘤合并颈动脉海绵窦动静脉瘘,1例颈动脉海绵窦段动脉瘤破裂引起海绵窦动静脉瘘合并大脑中动脉动静脉瘘.结果 8例100%弹簧圈致密填塞,2例95%以上填塞,1例获90%填塞,1例行球囊动脉瘤栓塞术.1例眼动脉瘤因发生颈内动脉斑块脱落于大脑中动脉术后出现脑梗塞灶引起肢体偏瘫,经治疗后好转;1例眼动脉瘤行球囊动脉瘤栓塞术3月后复发,因经济困难而行开颅手术治疗,其余病例血管内治疗术后临床症状消失或好转.12例随访3月-24个月,无再出血或症状加重.结论 血管内治疗是复杂性颅内动脉瘤治疗的主要方法之一,只要选择合适的病例及适当的栓塞技术和栓塞材料,将会获得满意的临床效果.但血管内治疗仍然有与栓塞技术及材料相关的并发症,长期疗效有待于进一步随访.     

电解可脱式弹簧圈栓塞颅内动脉瘤的临床观察

电解可脱弹簧圈(Guglielmi detachable coil,GDC)栓塞颅 内动脉瘤是近10年发展起来的新技术,操作简便,创伤小, 术后恢复快,可达到近似手术夹闭的效果,对部分不能手术或 手术失败的病例,GDC栓塞治疗可能是仅有的办法,本组报道 GDC栓塞治疗10例12个动脉瘤的体会。 1 材料与方法 1.1 一般资料 2000-08-2003-11,共对10例(12个颅内 动脉瘤)患者施行了GDC栓塞术,男6例,女4例,年龄21 -72岁,平均45.3岁,9例为破裂动脉瘤,均表现为自发性 蛛网膜下腔出血。按Hunt-Hess分级:Ⅰ级2例,Ⅱ级3例, Ⅲ级3例,Ⅳ级1例,Ⅴ级1例。3例未破裂动脉瘤表现为动     

28例颅内动脉瘤患者栓塞治疗的疗效观察

目的 观察颅内动脉瘤栓塞治疗的疗效。方法 对28例颅内动脉瘤患者用GDC进行栓塞治疗，其中26例为破裂的动脉,Hunt-Hess分级：I级2例，Ⅱ级10例，Ⅲ级10例，Ⅳ级4例，Ⅴ级2例。结果 动脉瘤90％栓塞18例，95％栓塞8例，100％栓塞2例。22例得到3－18个月的随访，无再出血。结论 动脉瘤栓塞治疗“0时间窗”要领值得提倡，娴熟的微导管技术可减少术中并发症的发生，动脉瘤栓塞前的快速降颅压措施应慎重。     

小型颅内动脉瘤的临床特点及血管内栓塞治疗

目的总结小型颅内动脉瘤的临床特点以及血管内栓塞的技术要点与疗效。方法对45例小型颅内动脉瘤患者采用电解可脱性弹簧圈(GDC)或Trufill DCS Orbit微型三维填塞型水解铂金弹簧圈进行动脉瘤囊内栓塞。结果45个动脉瘤中41个瘤腔100%闭塞,3个95%闭塞,1个90%闭塞。术后44例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级29例,Ⅱ级11例,Ⅲ级3例,Ⅳ级1例,Ⅴ级1例;全组死亡率2.2%。栓塞术中并发脑血管痉挛6例。术后随访3-69个月均无再出血及复发。结论对小型颅内动脉瘤采用GDC或Truffill DCS Orbit微型三维填塞型水解铂金弹簧圈进行血管内囊内栓塞疗效可靠;根据小型颅内动脉瘤的临床特点进行栓塞是提高治愈率、降低并发症及死亡率的重要方法。     

颅内动脉瘤破裂急性期的电解可脱式弹簧圈栓塞治疗技巧与并发症

目的总结颅内动脉瘤破裂急性期的电解可脱式弹簧圈(GDC)栓塞治疗操作技巧、并发症及其防治经验。方法1998年10月至2002年10月我科用GDC栓塞治疗破裂急性期颅内动脉瘤41例,动脉瘤大小3.6～25mm;位于Willis环前循环39例,后循环2例。结果术后造影100%栓塞33例,90%～99%栓塞5例,90%以下栓塞3例。产生与栓塞技术相关的并发症6例,与蛛网膜下腔出血相关的并发症5例。平均住院时间12 d;术后随访12～48个月,无再出血,恢复良好36例,中度致残,生活能自理4例,死亡1例。结论GDC栓塞治疗急性期的破裂颅内动脉瘤安全有效。正确处理术中并发症,提高栓塞技术有助于减少术后并发症,提高治愈率。     

应用新型球囊Hyperglide或Hyperform辅助弹簧圈技术栓塞治疗颅内宽颈动脉瘤(附22例分析)

目的探讨采用新型MTI球囊重塑技术栓塞治疗颅内宽颈动脉瘤的可行性及有效性。方法总结22例26个宽颈动脉瘤的栓塞治疗经验。均采用新型球囊Hyperglide或Hyperform置于载瘤动脉处,同时将微导管置于动脉瘤内,充盈球囊以封闭瘤颈口后将合适的弹簧圈推送进入动脉瘤内,重复进行充盈球囊和填塞过程,直至动脉瘤致密填塞。结果19例23个动脉瘤成功填塞;1例前交通动脉瘤因血管迂曲致球囊不能到位而改用其他技术栓塞;另1例前交通动脉瘤因球囊选择不当,瘤颈封堵不完全,导致部分弹簧圈移位进入载瘤动脉;1例动脉瘤术中破裂出血,病人死亡。结论新型球囊重塑技术有助于达到宽颈动脉瘤致密、有效的栓塞。     

未破裂颅内动脉瘤的临床特点及血管内栓塞治疗

目的总结未破裂颅内动脉瘤的临床特点以及用电解可脱性弹簧圈(GDC)血管内栓塞治疗的技术要点、并发症及其防治经验,并客观评价其必要性、安全性及治疗效果。方法采用电解可脱性弹簧圈对46例未破裂颅内动脉瘤患者进行动脉瘤囊内栓塞。结果成功栓塞46个动脉瘤,其中100%闭塞42个,95%闭塞3个,90%闭塞1个,全组无死亡。术中并发脑血管痉挛2例,弹簧圈末端逸出1例,1例复发者经二次填充GDC栓塞而治愈。术后随访12~72个月,临床症状均消失,20例有颅神经压迫症状者18例完全恢复正常,另2例为永久性动眼神经不全麻痹,全组术后均无破裂出血。结论对未破裂颅内动脉瘤早期诊断和早期治疗是必要的,采用电解可脱性弹簧圈进行动脉瘤囊内栓塞的方法安全实用、疗效可靠。     

电解可脱弹簧圈栓塞治疗颅内宽颈动脉瘤

目的 总结电解可脱弹簧圈栓塞治疗60例67个颅内宽颈动脉瘤的体会,探讨颅内宽颈动脉瘤介入治疗方法、技术操作要点、存在问题及临床应用前景。方法 60例颅内动脉瘤患者中54例为破裂动脉瘤。采用双弯塑形、横向成篮、分部填塞及篮外填塞等方法治疗55例,瘤颈重塑形技术2例,血管内支架结合GDC 3例。结果 栓塞程度:颅内动脉瘤完全栓塞54个(54/67),栓塞90％以上9个(9/67),栓塞90％以下4个(4/67)。术中出血2例(2/60),死亡2例(2/60)。结论 GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。改进栓塞技巧及瘤颈塑形技术等方法,可以明显提高宽颈动脉瘤的完全栓塞率,血管内支架结合GDC可能成为治疗颅内梭形及宽颈动脉瘤的有效方法。     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

A projection to the striatum from the medial subdivision of the posterior group of the thalamus in the cat

Injections of wheat germ agglutinin-conjugated horseradish peroxidase in the lateral part of the caudate nucleus or the putamen of the cat result in retrograde thalamic cell-labeling in the rostral extension of the medial subdivision of the posterior group (POM). Autoradiography after [³H]amino acid injection of POM reveals a dense and discontinuous distribution of axons in the lateral half of the caudate and putamen concentrated at their middle rostrocaudal levels. This newly discovered thalamostriatal projection of POM may account for somatosensory activity observed in striatal cells.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Evidence for the collateral innervation of the esophagus and the heart from neurons in the compact formation of the nucleus ambiguus of the rat

We investigated whether the heart receives collateral projections from the neurons which innervate the esophagus with a retrograde double-labeling method using two fluorescent tracers. Following injections of True Blue (TB) into the esophagus and Diamidino Yellow (DY) into the heart, about 21.9% of the labeled esophageal motoneurons in the compact formation of the nucleus ambiguus (AmC) were retrogradely double labeled. No single-labeled cardiac motoneurons were found in the AmC. The present results provide anatomical substrates for the esophagocardiac reflex.     

Role of the paraventricular nucleus in the projection from the nucleus of the solitary tract to the olfactory bulb

Electrophysiological experiments were performed on anesthetized rats to determine the effects of lesions of the paraventricular nucleus on the amplitude of evoked potentials recorded in the periglomerular layer of the olfactory bulb after nucleus of the solitary tract electrical stimulation. Lesions of the paraventricular nucleus enhance the amplitude of both the positive and negative components of the evoked potential in the olfactory bulb. The pathway from the paraventricular nucleus to the olfactory bulb seems to exert a suppressive influence over the projection from the nucleus of the solitary tract to the olfactory bulb under these conditions.     

On the origin of the serotonergic input to the intermediate lobe of the rat pituitary

Single stimulations of the vagina and cervix were performed between proestrus and the first day of diestrus with a stimulator designed to grade the intravaginal penetration of a rod. The percent incidence of pseudopregnancy after this stimulation was exponentially related to the extent of intravaginal penetration and was also affected by the stage of the cycle at which the stimulation was performed. At 10.00 h on proestrus, an exponential increase in the incidence of pseudopregnancy was observed with shallow penetrations, while an exponential decrease was found when deeper penetrations were applied. Such negative exponential correlation had disappeared at 22.00 h on proestrus. At that time, also, some responses were elicited by very shallow penetrations (17 mm) and all the animals responded to penetrations of 20 mm or more. Sensitivity to cervicovaginal stimulation at 10.00 h on estrus was lower than that at 22.00 h on proestrus and it was even lower at 10.00 h on the first day of diestrus. The response to 18 mm of penetration was studied every 3 h between 10.00 h on proestrus and 10.00 h on estrus, and then every 12 h until 10.00 h on the first day of diestrus. This stimulation was usually ineffective to induce pseudopregnancy, except for a brief period encompassing the night between proestrus and estrus, when a peak in the incidence of responses was reached. This peak sensitivity could be advanced following the s.c. administration of 250 and 500 ng of LH-RH at 11.00 h on proestrus. Other doses were ineffective. The peptide (500 ng) was unable to induce pseudopregnancy in rats that received no cervicovaginal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the development of the stratification of the inner plexiform layer in the chick retina

This study investigated the development of the subdivision of the chick inner plexiform layer (IPL). The approach included an immunohistological analysis of the temporal and spatial expressions of choline acetyltransferase, of the neural-glial-related and neural-glial cell adhesion molecules (NrCAM and NgCAM, respectively) and axonin-1, and of inwardly rectifying potassium (Kir) channels in 5- to 19-day-old (E5-E19) embryos. Ultrastructural investigations evaluated whether synaptogenesis accompanies the onset of differentiation of the IPL. We found that the differentiation of the IPL started at E9. Distinct cholinergic strata appeared, NrCAM immunoreactivity showed a poorly defined stratification, and Kir3.2 was expressed in the IPL and in the inner nuclear layer. From E10 until late E14, NgCAM- and axonin-1-immunoreactive strata emerged in an alternating sequence from the outer to the inner IPL. During this period, the NrCAM pattern sharpened, and eventually five bands of weaker and stronger immunoreactivity were found. Conventional synapses formed at the beginning of E9, and stratification of the IPL also began on the same day at the same location. Synaptogenesis and stratification followed a gradient from the central to the peripheral retina. The topographic course of differentiation of the IPL generally corresponded to the course of maturation of ganglion and amacrine cells. Synaptogenesis and the expression of G-protein-gated Kir3.2 channels accompanied the onset of stratification. These events coincide with the occurrence of robust and rhythmic spontaneous neuronal activity. The subsequent differentiation of the IPL seemed to be orchestrated by several mechanisms.