周围神经束膜吻合术——探讨有关运动束与感觉束的区别方法

分析21例(27根)神经手术时比较运动束和感觉束的区别方法,认为电刺激在区别神经功能性质,陈旧性损伤中神经束完全或部分中断,术时或术后判断神经束有无错对等较准确。特别观察正中神经大鱼际肌支的移行情况,显示有较大变异,不完全符合新氏图,认为电刺激法的优点较多,特别适用神经的低位损害,而高位损害仍需靠新氏图指引。     

弓形束扩散张量纤维束示踪成像研究进展

弓形束是人类语言网络的重要组成部分。扩散张量纤维束示踪成像(DTT)是目前在体无创性显像大脑白质纤维束的最常用方法。本文对DTT在显像弓形束解剖结构和功能特性基础研究,以及神经外科手术临床研究中的进展进行简要概述,但其准确性尚待进一步研究。     

功能磁共振和弥散张量纤维束成像中的人脑皮质桥小脑束

The anatomical organization of the corticopontocerebellar tract(CPCT) in the human brain remains poorly understood.The present study investigated probabilistic tractography of the CPCT in the human brain using diffusion tensor tractography with functional magnetic resonance imaging.CPCT data was obtained from 14 healthy subjects.CPCT images were obtained from functional magnetic resonance imaging and diffusion tensor tractography,revealing that the CPCT originated from the primary sensorimotor cortex and descended to the pontine nucleus through the corona radiata,the posterior limb of the internal capsule,and the cerebral peduncle.After crossing the pons through the transverse pontine fibers,the CPCT entered the cerebellum via the middle cerebral peduncle.However,some variation was detected in the midbrain(middle cerebral peduncle and/or medial lemniscus) and pons(ventral and/or dorsal transverse pontine fibers).The CPCT was analyzed in 3 dimensions from the cerebral cortex to the cerebellum.These results could be informative for future studies of motor control in the human brain.     

痛性肌束震颤综合征

骨骼肌自发性肌束收缩是常见的,仅当其很频繁出现或伴有肌无力和萎缩时才认为是病理的。由于自发性肌束活动是肌萎缩侧索硬化的明显特征并能提示预后严重,因此,有倾向认为其具有报警作用。但在较良性的神经肌肉疾病中,亦有肌肉运动单位的频繁的局部或广泛的自发性收缩的很多记     

异体神经束移植的评价

作者设计此实验的目的是观察异体神经束移植与整根神经移植之差别。一、用光学显微镜方法观察异体神经束移植与自体神经束移植的比较: 实验材料与方法选四种纯种大白鼠(Fisher,Levis,Wister及Buffalo)共100头,体重300—500克,年龄3—5 (1/2)月。每两只鼠编成一组。手术暴露两鼠的双侧大腿一段坐骨神经(从坐骨神经孔出来向下     

感觉神经束膜炎的临床研究进展

本文综合分析国外文献已报道的２１例感觉神经束膜炎患者的病因、可能的发病机制、临床表现、病理特征、诊断依据、鉴别诊断、治疗方案及疗效，介绍感觉神经束膜炎的临床研究进展。     

神经束膜囊肿的显微外科治疗

目的研究神经束膜囊肿的临床表现及影像学特点,确定适宜的治疗方法.方法对6例神经束膜囊肿患者的临床特点、治疗方法进行回顾性分析.结果6例患者,其中3例术后骶神经疼痛症状消失,2例明显减轻,1例以麻木表现者无明显变化,憋气及改变体位时无明显疼痛.3例2～3个月恢复.随访2个月～5年,未见囊肿复发.结论神经束膜囊肿临床少见,MRI仍是最灵敏、最有效的诊断方法.对于有典型骶神经根症状的患者,采用显微外科技术,行囊肿切除或部分切除、囊肿内减压术,可显著改善临床症状.     

双侧脑桥出血后双侧皮质脊髓束压迫的弥散张量纤维束成像验证

Bilateral spontaneous pontine hemorrhage is rare.In addition,bilateral corticospinal tract(CST) involvement in the pons may accompany serious motor sequelae.A 45-year-old right-handed woman was admitted for bilateral pontine hemorrhage.The patient presented with moderate quadriparesis at stroke onset and quickly recovered to the point of being able to extend the muscles of all four extremities against resistance,at 2 weeks from onset.At 4 weeks after stroke onset,she was able to perform all fine motor activities,as well as to walk with a normal gait.Diffusion tensor tractography results showed that the CSTs of both hemispheres originated from the primary sensorimotor cortex and descended through the corona radiata,the posterior limb of the internal capsule,midbrain,anterior pons,and the anterior medulla,along the known pathway of the CST.However,at midbrain and pons,the CSTs were compressed posterolaterally.The contralateral primary sensorimotor cortex,centered on the precentral knob,was activated during movement of either hand of the patient,as shown by functional MRI,which indicates the preservation of lateral CST.Findings from this study suggest that diffusion tensor tractography may be helpful in the elucidation of the CST status in patients with pontine hemorrhage.     

内侧纵束综合征1例报告

内侧纵束综合征亦称核间性眼肌麻痹,典型者少见。现报告如下:患者,男性,70岁。主诉头晕、复视、右半身麻木1天入院。患者于入院前1日晨起感头晕、恶心、视物模糊,复视(水平复视),同时感右半身麻木无力。在单位卫生所给予维脑路通400mg静点一次,未见好转,于次日来我院。既往曾患腔隙性脑梗死,无神经系统体征。查体:神清、语利,右利,右眼轻度外展位。同向注视时双眼内收均不到边,会聚反射正常。向右注视时右眼可见水平眼震。双侧瞳孔等大等圆,对光反射灵敏。额纹、鼻唇沟对称,余颅神经未见异常。四肢肌力、肌容积、肌张力均正常,腱反射对称,未…     

硬脑膜下血肿清除前后皮质脊髓束的状态：弥散张量成像证据

Abstract Subdural hematoma can cause compression or damage to the neural tracts in the brain; however, very little is known about this injury. We report on a patient with subdural hematoma who was evaluated by diffusion tensor imaging prior to and after trephination and drainage of subdural hematoma. A 58-year-old male patient and ten age-matched normal control subjects were evaluated. The patient showed mild hemiparesis for 3 weeks prior to surgery. His hemiparesis recovered to a nearly normal state at 5 weeks post-surgery when the follow up diffusion tensor image was acquired. Two diffusion tensor image parameters, fractional anisotropy and apparent diffusion coefficient, were measured along the corticospinal tract. Pre-operative diffusion tensor image showed that the corticospinal tract of the affected hemisphere seemed to be injured or compressed. However, the follow up diffusion tensor image showed recovery of this corticospinal tract to a normal state. It would appear that diffusion tensor images are a useful tool for evaluation of the effects of subdural hematomas on neural tracts. Key Words: subdural hematoma; diffusion tensor imaging; hemiparesis; corticospinal tract     

Kernohan's notch phenomenon demonstrated by diffusion tensor imaging and transcranial magnetic stimulation

Kernohan's notch phenomenon is the ipsilateral hemiplegia caused by compression of the contralateral cerebral peduncle against the tentorial edge by a supratentorial mass. Diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) could be useful for exploring the state of the corticospinal tract (CST). This report attempts to demonstrate Kernohan's notch phenomenon in a patient with subdural haematoma by using DTI and TMS. One patient and six normal control subjects were recruited. The patient showed severe right hemiplegia even though the subdural haematoma was located in the right hemisphere. Brain CT at the time of onset showed right transtentorial herniation, and T2 weighted images at 6 weeks after onset showed a leucomalacic lesion on the left cerebral peduncle. DTI and TMS were performed at 6 weeks after onset. The fractional anisotrophy value of the left midbrain and medulla of the patient was found to be decreased in comparison with that of the control subjects. On fibre tractography for the CST, an interruption was observed in the left midbrain and medulla. The motor evoked potential obtained from the right hand muscle showed delayed latency, low amplitude and a higher excitatory threshold, thus indicating that the CST of the left hemisphere had been damaged. It seems that the CST had been damaged at the left midbrain, although subdural haematoma and transtentorial herniation had occurred in the right hemisphere in this patient. This report demonstrates Kernohan's notch phenomenon in this patient using DTI and TMS.     

Kernohan's notch phenomenon in chronic subdural hematoma: MRI findings.

We report two cases of Kernohan's notch phenomenon secondary to chronic subdural hematoma detected by MRI. In the first case, the patient was drowsy with an oculomotor palsy and a hemiparesis ipsilateral to the chronic subdural hematoma. MRI in the post-operative period showed no abnormal signal or deformity of the crus cerebri. The neurological signs immediately resolved after trephination. In the second case, the patient was admitted with progressive decrease in their level of consciousness and ipsilateral hemiparesis with the chronic subdural hematoma. MRI on admission revealed an abnormal signal in the contralateral crus cerebri against the chronic subdural hematoma. After surgery, the mental state gradually recovered to normal with some degree of residual hemiparesis. In patients with chronic subdural hematoma, a compressive deformity of the crus cerebri, without abnormal signal on MRI, may predict a better neurological recovery in patients with Kernohan's notch phenomenon.     

Delayed neural degeneration following gamma knife radiosurgery in a patient with an arteriovenous malformation: A diffusion tensor imaging study

Gamma knife surgery (GKS) is a proven modality for the treatment of arteriovenous malformations (AVMs), but neural degeneration is a serious complication of GKS. In this study, we report on a patient who displayed delayed neural degeneration following GKR, using diffusion tensor imaging (DTI). A 43-year-old male patient was diagnosed with an intraventricular hemorrhage (IVH) due to rupture of an AVM in the right middle cerebellar peduncle, and exhibited cognitive impairment, quadriparesis, and ataxia after IVH onset. He underwent GKS 5 weeks after onset. Brain MRIs performed at 6 weeks, 7 months, and 21 months post-onset revealed encephalomalactic lesions in the right pons, middle cerebellar peduncle, and medulla oblongata. DTI at 6 weeks post-onset suggested neural injuries of the right corticospinal tract (CST), right middle cerebellar peduncle (MCP), and right inferior cerebellar peduncle (ICP). DTI at 7 months suggested that the right CST and right ICP had recovered to some extent, which concurred with improved clinical manifestations. However, at 21 months, four neural tracts (right CST, right MCP, and both ICPs) appeared to have degenerated, which was in-line with aggravation of corresponding clinical manifestations. Experiences of this patient suggest DTI is a useful technique for the detection of neural degeneration after GKS.     

Chronic subdural hematoma presenting as ataxic hemiparesis

A 57-year-old man was admitted for a typical left ataxic hemiparesis syndrome. He presented no vascular risk factor, with normal blood pressure. CT scan showed a frontoparietal right subdural hematoma. After surgery, the symptomatology disappeared completely. This observation reveals that subdural hematoma must be considered as a possible etiology of ataxic hemiparesis syndrome. The physiopathology is discussed.     

Effects of minimally invasive techniques for evacuation of hematoma in basal ganglia on cortical spinal tract from patients with spontaneous hemorrhage: observed by diffusion tensor imaging

Abstract

Objective: To observe the effect of minimally invasive removal of intracranial hematoma in basal ganglia on cortical spinal tract (CST).

Methods: Twenty-seven patients with intracerebral hemorrhage (ICH) in basal ganglia were selected and divided into a minimally invasive treatment group (13 patients) and a medical treatment group (14 patients) randomly: the volume of hematoma was 30–50 ml, with an average of 39.20 ± 4.85 ml in minimally invasive group and 38.70 ± 6.33 ml in medical treatment group. All patients underwent the whole brain diffusion tensor imaging (DTI) in 1 week after onset; fractional anistropy (FA) values of CST in internal capsule and cerebral peduncle ipsilateral and contralateral to the hematoma side in minimally invasive group were determined and then compared with those in medical treatment group.

Results: The minimally invasive treatment group showed that FA values of CST in internal capsule and cerebral peduncle on the affected side were 0.524 ± 0.045 and 0.534 ± 0.020, respectively, and in medical treatment group, FA values were 0.425 ± 0.050 and 0.468 ± 0.040, respectively. FA values of internal capsule and cerebral peduncle CST in minimally invasive treatment group were significantly increased as compared with the medical treatment group, and a significant difference was noted. In minimally invasive group, we obtained pre-operative DTI in five patients; FA values of CST in internal capsule and cerebral peduncle ipsilateral to the hemorrhage side were 0.428 ± 0.032 and 0.515 ± 0.048, respectively, 1 week after the hematoma was evacuated FA values of CST in internal capsule and cerebral peduncle increased significantly. Therefore, minimally invasive surgery for evacuation of intracranial hematomas could reduce the damages to CST. At the same time, the CST which was oppressed and displaced by hematoma restored to normal position largely or completely after the minimally invasive removal of intracranial hematoma.

Conclusions: The changes of CST could be visualized by DTI in patients with ICH. Minimally invasive removal of intracranial hematoma could effectively reduce the injury to the CST and could restore the CST which was oppressed and displaced by the hematoma to the normal position.     

Spontaneous Resolution of a Large Chronic Subdural Hematoma Which Required Surgical Decompression

We report on a case of an 87-year-old woman who showed spontaneous resolution of a large chronic subdural hematoma which required surgical decompression. She had suffered from confused mentality and right side weakness of motor grade II for 10 days. The initial brain CT scan showed a 22 mm thick low density lesion located in the left fronto-temporo-parietal region with midline shift (12 mm) which required emergency decompression. However, because she and her family did not want surgery, she was followed up in the outpatient clinic. Five months later, follow up brain CT showed that the CSDH had disappeared and the patient became neurologically normal. The reasons for spontaneous resolution of CSDH remain unclear. We discuss the possible relation between mechanisms of physio-pathogenesis and spontaneous resolution of a large chronic subdural hematoma (CSH) in an elderly patient.     

Magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma.

OBJECTIVE AND IMPORTANCE: We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained. CLINICAL PRESENTATION: The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (Glasgow Coma Scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe.     

Diffusion Tensor Imaging Following Shunt in a Patient with Hydrocephalus

We report on a patient with hydrocephalus who was evaluated by diffusion tensor imaging (DTI) follow‐up study before and after a shunt operation. A 48‐year‐old male patient and 6 age‐matched control subjects were evaluated. The patient presented with hydrocephalus due to hemorrhage caused by the rupture of a right middle cerebral artery bifurcation aneurysm. Three longitudinal DTIs were acquired from the patient (pre‐shunt, post‐shunt 2 weeks, and post‐shunt 8 weeks). The fractional anisotrophy values in the adjacent structures of the lateral ventricle, which were increased before the shunt operation, were decreased after the shunt operation. We think that DTI could be a useful tool for the evaluation of hydrocephalus.