神经外科导航系统的临床应用

介绍ＡＳＡ－６０１Ｖ神经外科导航系统的研制和初步临床应用,方法应用ＡＳＡ－６０１Ｖ神经外科导航系统完成２４例神经外科手术,分析该系统的优点及其精确性。结果本组２４例导航手术中,大脑重要功能区病变１２例,额叶３例,顶叶４例,鞍区和颞叶各２例,多发性病灶１例。术后２仅２例发生短期肌力降低,手术病死率为零。     

导航系统在神经外科的应用

目的：探讨神经外科导航系统在显微神经外科手术中的作用。方法：应用德国BrainLAB公司生产的BrainSCAN神经外科导航系统，对68例颅内病变患者进行导航系统引导下的显微手术。并对其精确性进行分析。结果：本组68例导航手术中，胶质瘤32例，脑膜瘤9例，神经纤维瘤7例，垂体瘤6例，颅咽管瘤2例，局限性癫痫8例，脑转移瘤1例，脑脓肿2例，炎性肉芽肿1例，全切除42例（61.7%)，次全切除15例（22.1%)，大部切除11例（16.2%)，无手术死亡及严重并发症，导航系统的精度误差平均为2.7mm。结论：在显微手术中应用导航系统可以精确完成术前病灶定位。设计最佳手术入路，精确并快速寻找病灶，确定病灶切除范围，保护重要结构。提高手术的成功率，减少手术并发症。     

外科治疗顽固性癫痫10例报告(摘要)

我院于１９９２年５月～１９９６年５月对药物治疗无效的１０例癫痫患者分别施行了致痫病灶切除术治疗５例，胼胝体前部纤维切断术３例，脑立体定向术１例，慢性小脑刺激术１例。术后并发症：２例病人作者单位：２２５００３武警江苏总队医院神经外科术后出现轻偏瘫。疗效...     

神经导航手术操作系统在中枢神经系统疾病中的应用研究

目的 评价神经导航手术操作系统在显微神经外科手术中的应用价值,包括定位的精确性,应用范围,最佳手术入路设计,安全可靠性。方法 对65例颅内及椎管内病变患者在神经导航手术操作系统下行显微神经外科手术治疗。结果 所有病灶均精确定位,平均误差为1.7mm,所有手术入路设计可在术前完成,避开功能区,使病灶完整或最大限度切除,同时保留正常脑组织及重要结构。结论 神经导航系统应用于显微神经外科手术中,准确性高,可靠性强,切除病灶彻底。副损伤小。特别是对于深部病变可精确定位,经脑沟、脑裂显微手术入路,术后病人恢复快。术中存在脑组织移位的问题．但在可接受范围内,本组病例无由此引起的不良后果。     

神经外科导航辅助下邻近功能区脑胶质瘤的手术治疗

目的 总结神经导航系统在邻近重要功能区手术切除脑胶质瘤的价值.方法 应用德国Brain-LAB公司VV2神经导航系统辅助切除大脑半球邻近脑功能区胶质瘤56例,并对神经外科导航应用于脑胶质瘤切除手术的优越性、精确性和注意事项进行分析和总结.结果 本组病例中,平均注册误差为1.6±0.5mm,术后近期复查CT或MRI证实肿瘤影像学全切率为87.5%,患者临床症状均得已改善,肢体活动等重要神经功能与术前比较均未受明显影响,手术并发症少.短期随访3～13个月期间,5例复发.结论 神经导航系统辅助手术切除邻近重要功能区胶质瘤具有定位准确、精确性好、具有微侵袭等特点,有助于提高脑胶质瘤的全切率及降低手术并发症,相对提高病人生存质量和疗效.     

神经导航系统手术中脑移位的参照点校正法

目的 介绍神经导航系统在手术中的应用和克服脑移位的方法。方法 应用SurgiScope神经外科导航系统进行术前计划和手术，以脑皮层或其它参照点进行术中校正，顺利完成手术。结果 本组11例导航手术，其中位于大脑重要功能区附近6例。该系统使用中精确度良好。通过移位校正，在临床实际手术中，仍呆达到实际手术可接受的精确度，手术效果良好，无手术死亡。结论 神经外科导航系统不仅可以确定最佳手术入路，而且可精确完成术中定位，减少手术副损伤。以参照点校正法进行脑移位校正后，其定位精确度仍在手术可接受范围内，此方法简单且容易实施，因而可利用此方法在术中确定病灶及其毗邻组织结构。     

癫痫的治疗体会(摘要)

近几年我们对８２例癫痫病人中的２８人行手术治疗，其中２３例蛛网膜囊肿行病灶清除，２例钙化斑切除，３例先天性脑发作者单位：０６３０００河北省承德医学院附属医院神经外科育不全软化灶切除，部分病人配合多处软膜下横切术，术后均应用氯硝安定治疗３～６个月。手术...     

立体定向脑内窥镜手术50例临床分析

目的：探讨立体定向脑内窥镜手术临床应用价值。方法：对位于脑深部或重要功能区的病变，采用ＣＴ引导立体定向技术施行脑内窥镜手术５０例；其中包括脑瘤切除，异物、囊肿、脓肿或囊虫摘除，脑内病变活检，血肿排空，脉络丛烧灼等手术。术中成功应用了双套管法和钬激光。结果：手术有效率９６％（术后１月）。无手术死亡及术后昏迷、偏瘫、颅内出血和感染等严重并发症。结论：此方法使以往立体定向穿刺的不可视性，变为可视性操作；扩大了手术范围，提高了手术安全性     

脑内窥镜立体定向手术40例

采用ＣＴ引导立体定向技术，施行脑内窥镜手术４５例，包括脑肿瘤切除２５例，脑囊肿摘除８例，脑内异物摘除６例，脑脓肿摘除３例，脉络丛烧灼治疗脑积水２例，脑内寄生虫取出１例。病变均位于脑深部或重要功能区。术中应用钬激光和Ｎｄ：ＹＡＧ激光效果良好。手术有效率９５％（术后１月）。术后无昏迷、偏瘫、颅内感染等严重并发症。     

神经导航下锁眼手术切除脑内病灶

目的　探讨神经导航下脑内占位性病灶锁眼手术的精确性和有效性。方法　对 1 2例颅内病灶采用锁眼开颅显微手术切除 ,利用神经外科导航系统对手术切口及骨窗的设计、病灶术中定位和手术路径的引导。结果　 1 0例病灶手术全切除 ,2例病灶手术次全切除。神经导航系统精确度高 ,平均误差为 0 .8mm ,所有病例术中定位准确 ,术后神经系统功能保留良好。结论　在神经导航引导下的脑内小病灶采用锁眼开颅手术可以达到病灶定位准确 ,手术创伤小和神经功能保护良好的微侵袭神经外科手术目的     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.