远外侧入路切除枕大孔腹外侧区肿瘤

目的探讨枕大孔腹外侧区肿瘤手术技巧,以合理的入路、最小的创伤获得最大的显露、更高的切除率。方法选择斜坡和枕大孔区腹外侧肿瘤12例,其中神经鞘瘤5例,胆脂瘤3例,脑膜瘤2例,室管膜瘤1例,脊索瘤1例。运用远外侧入路及其改良法显微镜下切除该区位于低位脑干和上颈髓腹外侧不同性质的肿瘤。结果手术全切除8例,次全切及大部分切除4例。均恢复良好。结论远外侧入路是切除枕大孔腹外侧区病变的一种良好的入路。     

枕下远外侧经髁入路至脑干腹侧区的显微解剖

目的 对经枕下远外侧经髁入路至脑干腹侧区进行显微解剖研究.方法 成人湿性头颅标本10例(20侧),模拟枕下远外侧经髁入路进行分层解剖,并比较磨除枕骨髁对脑干腹侧区暴露范围的影响.结果 采用倒"U"形切口暴露充分,术中寻找枕下三角、寰椎横突、头外侧直肌等解剖标志定位深层结构.与不磨枕骨髁比较,磨除部分直至全部枕骨髁后水平暴露距离分别增加10.9 mm和12.6 mm,手术深度分别降低13.5 mm和20.5 mm.结论 经枕下远外侧经髁入路磨除部分枕骨髁能够明显改善脑干腹侧区的暴露,术中应根据病变特征进行适量的枕骨髁磨除.

Abstract：

Objective To investigate the exposed areas in brainstem ventral region via the suboccipital far-lateral transcondylar approach.Method Ten(20 sides) adult cadaveric specimens which perfused with colored silicone were studied.Stepwise dissections via the suboccipital far-lateral transcondylar approach to ventral region of brainstem and the different exposures were compared by resecting the occipital condyle gradually.Results The inverse "U" shape could provide with a sufficient operative exposure.The deep layer structure intraoperative process by identifing with those anatomical markers of suboccipital triangle, transverse process of the atlas and rectus capitis lateralis was localized.Compared with the no-resecting occipital condyle, the exposures of ventral-lateral region of brainstem increased 10.9 mm and 12.6 mm, the operative depth decreased 13.5 mm and 20.5 mm by resecting occipital condyle from partial to total length respectively.Conclusions Suboccipital far-lateral transcondylar approach could improve the exposure extent of ventral region of brainstem by resecting occipital condyle, however it was improtant to decide an optimal extent of occipital condyle to resect intraoperatively accroding to the lesion feature.     

脑干肿瘤的手术治疗

手术治疗6例脑干肿瘤病人，次全切除2例，大部切除1例，部分切除3例。术后临床表现明显改善1例，改善3例，无变化2例，无一例术后死亡。作认为脑干肿瘤手术治疗成功的关键在于手术适应证的选择。弥漫性脑干肿瘤不适合手术治疗，局限性脑干肿瘤，囊性脑干肿瘤，颈髓延髓交界处脑干肿瘤及背侧外生性脑干肿瘤适合手术治疗。其中囊性脑干肿瘤，颈髓延髓交界处脑干肿瘤，背侧外生性脑干肿瘤常能做到肿瘤的全切除或次全切除。     

经第四脑室底部入路切除脑干肿瘤的体会

经第四脑室底部入路切除脑干肿瘤的体会张光璞，李龄随着影像学检查及手术技术的进步，使得原来一直视为手术禁区的脑干肿瘤已更多地受到神经外科的重视。从提高手术质量的要求来看，本文就桥脑与延脑的手术入路问题作以下探讨。临床资料１．一般资料：１９９１～１９９４...     

远外侧锁孔入路切除枕骨大孔腹侧区肿瘤临床研究

目的 采用显微锁孔入路切除枕骨大孔腹侧区肿瘤，重点探讨手术入路及手术技巧。方法 总结我院1999年6月至2006年6月采用显微锁孔入路切除8例枕骨大孔腹侧区肿瘤的经验。手术入路：远外侧经髁后入路5例，远外侧经髁入路3例。结果8例肿瘤全切除6例，次全切除2例，无一例死亡。结论 远外侧入路是切除枕骨大孔腹侧区肿瘤的最佳手术入路。经髁后和部分经髁锁孔入路足够暴露和切除枕骨大孔腹侧区肿瘤。     

枕下远外侧入路手术切除颅颈交界区腹侧及腹外侧肿瘤

目的 探讨枕下远外侧入路在颅颈交界区腹侧及腹外侧肿瘤切除术中的应用效果。方法 回顾性分析2012年12月至2017年12月采用枕下远外侧入路手术治疗的17例颅颈交界区（腹侧3例,腹外侧14例）肿瘤的临床资料。结果 17例术中均暴露良好、充分。14例肿瘤全切（9例脑膜瘤、5例神经鞘瘤）,2例脊索瘤及1例骨源性肿瘤次全切除。术后7例出现原有后组神经功能障碍加重,3例出现新的后组神经功能障碍,术后6个月内恢复8例,2例残留永久性神经功能障碍。术后发生脑脊液漏3例、颅内感染2例,均经积极治疗后好转,无术后颅内血肿、脑积水及临床死亡病例。术后随访0.5~31个月,1例脊索瘤复发。结论 枕下远外侧入路手术是切除颅颈交界区腹侧及腹外侧肿瘤的安全、有效的方法,可依据病灶情况采取个体化的术式。     

远外侧入路手术切除下斜坡和颅颈交界区腹侧脑膜瘤

脑膜瘤是下斜坡、颅颈交界区腹侧区域最常见的良性肿瘤，由于其位于颅底深部，周围有脑干及重要血管和神经，手术切除难度大。随着神经放射和显微外科技术的发展，患者肿瘤全切除率逐年增高，病死率逐渐下降。我院1995年10月至2004年10月采用显微外科手术治疗下斜坡和颅颈交界区腹侧脑膜瘤患者14例，所有病例术后随访半年，现总结如下。     

远外侧入路切除枕大孔前方肿瘤

枕大孔前方肿瘤,即延髓腹侧肿瘤,部位深、手术显露困难,是神经外科高难度、高危险手术,具有较高的死亡率、致残率。目前国内、外学者对该部位病变的手术入路已作了许多临床研究,认为远外侧入路有利于切除枕大孔区前方病变。我科1998年～2004年5月,采用远外侧入路切除枕大孔区前方肿瘤6例,报告如下。     

脑干肿瘤手术切除后远期疗效观察

自1991年1月至1999年12月,我院对21例脑干肿瘤患者行手术治疗,经17例长期随访,效果较为理想,现报道如下:     

枕下远外侧入路切除枕大孔前方及外侧肿瘤

目的 探讨枕下远外侧入路显微外科切除枕骨大孔区前方及外侧肿瘤的手术方法。方法 自1995年9月至2002年10月应用枕下远外侧入路切除枕骨大孔区前、外侧肿瘤10例，其中脑膜瘤5例、复发性脊索瘤2例、舌下神经鞘瘤2例、颈静脉球瘤1例。结果 本组10例中，肿瘤全切除6例、次全切除3例、大部分切除1例、术后出现后组颅神经麻痹2例，无手术死亡。结论 该入路可增加术野空间，从更大程度上显露肿瘤组织，有利于减少对脑干和重要血管、神经的牵拉。     

Cytoarchitectonic delineation of the ventral lateral thalamic region in the monkey

The cytoarchitecture of the ventral lateral region of the primate thalamus has been appraised in the frontal, parasagittal and horizontal planes. A morphologically distinct region, possessing a sparse and diffuse distribution of large and small neurons is identified. The region includes several nuclei previously separately named by Olszewski⁴⁵. These are nuclei VPLo, VLc, X, VLps, and some cellular extensions into the VLo nucleus. The whole zone is continuous, and it is shown that no clear separation exists between any of the previously identified sub-nuclei. Connectional grounds are given for suggesting that this region should be considered as a common cerebellar relay nucleus to motor cortex.Morphological criteria for distinguishing the cellsparse nucleus from adjacent nuclei are given. These cytological criteria provide a basis for the experimental analysis of cortical and subcortical connectivity of the ventral lateral thalamic region. Close attention was paid to the border between the VPLo nucleus and the VPLc nucleus. VPLc is separated from VPLo by a clear border, and no transitional zone can be detected in the parasagittal or horizontal planes. Previous ambiguities in the delineation of the VPLo-VPLc border probably stem from analysis in the frontal plane, in which the border is not clear.     

肿瘤干细胞与脑胶质瘤干细胞的研究现状

以往认为，肿瘤是由体细胞突变而成，每个肿瘤细胞都可以无限制地生长。但这无法解释肿瘤细胞似乎具有无限的生命力以及并非所有肿瘤细胞都能无限制生长的现象。肿瘤细胞生长、转移和复发的特点与干细胞的基本特性十分相似，因此，有学者提出肿瘤干细胞的理论，这一理论为我们重新认识肿瘤的起源和本质，以及临床肿瘤治疗提供了新的方向和视觉角度。其中的脑胶质瘤起源于脑胶质瘤干细胞（brain gliomastem cells．BGSCs）的学说对正确认识和理解脑胶质瘤的发生、发展及其生物学行为如侵袭性、转移、肿瘤的耐药性等均具有十分重要的理论意义和潜在的应用价值。[第一段]     

Visual function in the ventral lateral geniculate nucleus of the cat

The visual receptive fields of 293 single units in the ventral lateral geniculate nucleus of the cat were studied. In addition to the wide variety of types described by others, a group of units responding differentially to color was identified that included units responding particularly to blue and others with opponent color properties. Some units with spontaneous firing and without definite visual receptive fields were inhibited by stimulation of the optic chiasm (OX). A study of latency of firing to OX stimulation suggested that these cells were driven by retinal ganglion cells of the W type. One-third of all units studied were binocularly driven.     

脑肿瘤干细胞的生物学特性

脑肿瘤居成人恶性肿瘤发病率前十位，同时也是儿童因实体肿瘤而死亡的主要肿瘤类型，其发病率和死亡率不断升高．严重地威胁着人类健康和生命。据2004年美国癌症协会报道．美国每年有18000个原发脑肿瘤确诊病例，仅1／3病例存活超过5年。虽然外科手术和其他治疗措施进展很快，但仍很难治愈．经手术、放疗和化疗治疗后，病人几乎无一例外地出现肿瘤复发。在过去的20多年中，脑胶质瘤的治疗一直无明显进展[2]。最近研究发现，脑肿瘤中存在着具有干细胞自我更新特性的细胞亚群即脑肿瘤干细胞（brain tumor stem cell，     

The visual field representation of the rat ventral lateral geniculate nucleus

The representation of the visual field in the ventral lateral geniculate nucleus (LGNv) was studied in rats anesthetized with urethane by recording the response of single units to visual stimulation. Receptive fields of LGNv units were plotted on a campimeter, 60 cm in diameter, which was placed 30 cm from the contralateral eye. LGNv neurons responded mainly to stimulation of the contralateral eye with on-tonic characteristics. Few neurons responded only to stimulation of the ipsilateral eye and no binocular interaction was observed. Retinotopic organization was clearly seen in the LGNv; the nasal visual fields were represented dorsally, the temporal fields ventrally, and the upper to lower visual fields were in the rostrolateral to caudomedial parts of the LGNv. A given point in the visual field is represented along a line running through the LGNv in a rostrocaudal direction. Almost the entire horizontal extent of the contralateral visual field was represented in the LGNv, whereas vertically the visual field between 40 degrees above and 20 degrees below the distribution axis was represented. The major axis of the strip of the visual field containing all the RF centers, which is referred to as the distribution axis, inclined nasally up and temporally down at an angle of 10.4 degrees to the 0 degree horizontal meridian line. The representation of the distribution axis in the retina was in accordance with the major axis of retinal ganglion cell distribution (Fukuda, '77; Schober and Gruschka, '77).     

Sensitivity to GABA of neurons of the dorsal and ventral lateral geniculate nuclei in the rat

GABA was applied iontophoretically to dorsal and ventral lateral geniculate (LGd and LGv) neurons in rats. Spontaneous discharges were readily suppressed in both species of neurons. While in LGd neurons, evoked discharges by optic nerve stimulation were suppressed as readily as were spontaneous discharges, LGv neurons were characterized in that evoked discharges were much more resistant than spontaneous discharges.     

R1 responses of the trigeminofacial reflex in lesions extrinsic to the brain stem

Isolated or prevalent impairment of the trigeminofacial reflex (tfr) has been described both in pontine lesions and in lesions extrinsic to the brain stem. No satisfactory explanation of this finding in extrinsic lesions has ever been put forward. In a series of patients with lesions outside the brain stem together with selective or prevalent R ₁ impairment reported here this finding can be explained by the peculiar anatomy of the various nerve fibers in the trigeminal sensory root.

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Sommario Una compromissione isolata o prevalente delle risposte R ₁ del riflesso trigemino facciale (rtf) è stata descritta sia nelle lesioni intrinseche del tronco dell'encefalo, che nelle estrinseche. Una giustificazione a tale reperto, in corso di lesioni estrinseche, non è tuttavia riportata in letteratura. Vengono qui riferiti i dati relativi ad una serie di soggetti con lesioni estrinseche del tronco encefalico, associate a compromissione esclusiva o prevalente di R ₁.Tale reperto può essere giustificato alla luce della particolare situazione anatomica delle varie fibre nervose sensitive componenti la radice del trigemino.