三叉神经痛微血管减压术中责任血管与磁共振影像的相关性

目的探讨三叉神经痛责任血管微血管减压术前磁共振成像和术中所见血管神经的相关性。方法回顾95例三叉神经微血管减压手术病例术前磁共振成像（3D-CISS、3D-TOF-MRA、3D-T₁增强）资料和手术录像,分析三叉神经痛的责任血管的来源、走行和压迫神经根的形式在微血管减压手术所见与术前磁共振成像关系。结果 86例术前MRI显示神经与血管关系密切,术中均证实。9例术前MRI显示神经与血管关系不密切者,6例术中证实责任血管存在,3例未发现责任血管。手术有效率95.7%（91/95）。结论责任血管在微血管减压术中所见与术前磁共振多序列成像结果有高度的相关性。     

三维时间飞跃法磁共振血管成像在原发性三叉神经痛诊治中的临床价值

目的 探讨三维时间飞跃法磁共振血管成像（3D-TOF-MRA）在原发性三叉神经痛诊治中的应用价值。方法 回顾性分析56例原发性三叉神经痛患者的临床资料,均行微血管减压术治疗,术前均行3D-TOF-MRA检查评估责任血管。结果 48例术前3D-TOF-MRA显示神经与血管关系密切的患者中,46例术中证实责任血管存在;8例术前3D-TOF-MRA显示神经与血管关系不密切的患者中,5例术中证实责任血管存在。术前3D-TOF-MRA像结果判定的敏感性及准确度分别为90.2%与87.5%。结论 3D-TOF-MRA结果与术中所见的责任血管具有高度的相关性,为原发性三叉神经痛的诊治提供了重要的影像学参考依据。     

3D-TOF-MRA成像对微血管减压术术前诊断的价值

目的观察三维时间飞越法磁共振血管成像(3D-TOF-MRA)结合MR重建技术对微血管减压手术(MVD)的价值。方法对11例三叉神经痛,17例面肌痉挛,1例复发性舌咽神经痛,1例三叉神经痛合并面肌痉挛患者采用MVD治疗。术前应用3D-TOF-MRA结合MR重建技术进行检查,寻找和判别责任血管,以指导临床手术。结果术前3D-TOF-MRA检查30例中,28例证实有明显的责任血管,并在术中得到证实;2例三叉神经痛患者3D-TOF-MRA检查、未发现责任血管,其中1例术中发现为三叉神经出脑干区腹侧受到基底动脉明显压迫,另外1例术中可见小脑上动脉有多支细小动脉攀附于三叉神经出脑干区,给予MVD+选择性三叉神经感觉根切断术后症状完全缓解。30例患者中,术后完全缓解26例,明显缓解4例。结论 3D-TOF-MRA结合MR重建技术对于微血管减压术术前责任血管的判定及手术设计具有重要的应用价值。     

3D-Slicer软件评估面肌痉挛神经血管关系的研究

目的对比分析3D-FIESTA联合3D-TOF MRA序列与3D-Slicer软件评估面肌痉挛神经血管关系的准确性。方法回顾性分析40例显微血管减压术(MVD)治疗面肌痉挛病人的临床资料,术前均行3D-FIESTA和3D-TOF MRA序列检查,并应用3D-Slicer软件进行三维重建评估神经血管关系,并预测责任血管,然后与术中所见进行比较。结果评估神经血管关系时,3D-FIESTA联合3D-TOF MRA序列与术中所见一致性的K值为0.263,三维重建与术中所见一致性的K值为0.633,二者无统计学差异(χ~2=9.363,P=0.053);预测责任血管时,3D-FIESTA联合3D-TOF MRA序列与术中所见一致性的K值为0.643,三维重建与术中所见一致性的K值为0.921,二者有统计学差异(χ~2=188.408,P=0.000)。3D-FIESTA联合3D-TOF MRA序列评估神经血管关系的灵敏度和特异度分别为89.7%和100%,而三维重建均为100%。结论使用3D-Slicer软件术前评估面肌痉挛病人神经血管关系及预测责任血管,比3D-FIESTA联合3D-TOF MRA序列更准确,与术中所见更接近,对术前制定手术计划更有帮助。     

术前多模态影像三维重建在神经内镜显微血管减压术中的应用价值

目的探讨术前多模态影像三维重建技术在神经内镜显微血管减压术(MVD)中的应用价值。方法回顾性分析2019年4月至2021年12月潍坊市人民医院神经外科收治的行神经内镜MVD治疗的48例患者的临床资料, 其中, 三叉神经痛(TN)18例, 面肌痉挛(HFS)30例。所有患者术前均行头颅MRI三维循环相位稳态采集快速成像(3D-FIESTA)和三维时间飞跃法磁共振血管成像(3D-TOF-MRA)检查, 并对神经、血管等结构进行影像学三维重建;采用Kappa一致性检验评价术前多模态影像三维重建与神经内镜MVD术中所见的责任血管、责任血管的走行及其与神经或神经根进/出脑干区(REZ)的接触关系、责任血管对神经压迫程度的一致性;根据TN疼痛分级或HFS强度分级评估患者术后1、3、6个月症状的改善程度。结果 48例患者术前多模态影像三维重建显示, 除3例无法确认责任血管外, 其余45例均有明确的责任血管;所有患者的神经内镜MVD手术均顺利完成, 其中46例均有明确的责任血管;多模态影像三维重建判断责任血管的准确率为91.3%(42/46);判断责任血管走行及其与神经或REZ接触关系的准确率为93....     

3D-slicer基于3D-FIESTA及3D-TOF序列在面肌痉挛和原发性三叉神经痛责任血管的诊断及术前评估中的应用

目的 探讨3D-slicer软件在基于3.0T磁共振3D-FIESTA及3D-TOF序列的影像重建对面肌痉挛和原发性三叉神经痛患者责任血管的诊断及在微血管减压手术术前评估中的应用价值。方法 回顾分析2020-06—2023-06于蚌埠医学院第二附属医院神经外科行微血管减压手术患者30例且手术中证实均存在动脉压迫;术前患者行3D-FIESTA及3D-TOF磁共振检查后预判责任血管,再次利用3D-slicer影像处理软件在3D-FIESTA及3D-TOF序列基础上三维重建合成责任血管及走形,比较其诊断的差异及优势。结果 其中面肌痉挛24例,三叉神经痛6例,术中证实24例动脉压迫性面肌痉挛责任血管18例为同侧小脑前下动脉压迫,6例为同侧小脑后下动脉或其分支血管压迫;6例动脉压迫性三叉神经痛患者术中证实责任血管均为同侧小脑上动脉;3D-FIESTA联合3D-TOF对责任血管的诊断率73.3%(22/30),3D-slicer基于3D-FIESTA-C及3D-TOF-MRA序列经三维重建后对责任血管的诊断率96.67%(29/30),差异有统计学意义(χ²=6.405,P&...     

显微手术治疗面肌痉挛合并三叉神经痛（附7例分析）

目的探讨显微手术治疗面肌痉挛合并三叉神经痛的疗效。方法回顾性分析7例面肌痉挛合并三叉神经痛病人的手术经验。均在磁共振检查后行微血管减压治疗,观察术后疗效。结果MRI及术中均见面神经责任血管为小脑前下动脉6例,椎动脉1例;三叉神经责任血管为椎动脉4例,小脑上动脉3例。行微血管减压后,三叉神经痛症状均立即消失;面肌痉挛术后立即消失5例,术后3个月内完全消失2例。结论术前MRI检查可明确诊断并指导手术;微血管减压可有效治疗原发性面肌痉挛合并三叉神经痛。     

3.0 T磁共振联合伪彩色技术在面肌痉挛微血管减压术前评估中的应用

目的探讨3D-TOF-MRA、3D-SPACE联合伪彩色技术在面肌痉挛微血管减压术术前评估中的应用价值。方法对58例单侧面肌痉挛患者行3D-TOF-MRA及3D-SPACE检查,并对图像进行伪彩色处理。所有患者均行面神经微血管减压术,对所获得的影像学资料进行分析,并与手术结果进行对照。结果对伪彩色处理后的图像结果分析显示,患侧神经受血管压迫者的比率为91.5%,明显高于健侧神经受血管压迫者的1.7%。与手术结果对比,伪彩色处理后的图像显示患侧责任血管的敏感度为94.9%,准确度为98.2%。结论 3D-TOF-MRA及3D-SPACE联合伪彩色技术能清晰地显示面神经与责任血管之间的关系,可作为面肌痉挛患者微血管减压术前评估的辅助手段。     

3D-FIESTA联合3D-TOFMRA对三叉神经微血管减压术的指导价值

目的探究三维稳态进动快速成像(3D-FIESTA)及三维时间飞跃法血管成像(3D-TOF MRA)对三叉神经微血管减压术的指导价值。方法分析2012年2月~2015年12月徐州医科大学附属医院脑科医院神经外科行微血管减压术的121例三叉神经痛患者的临床表现、影像资料、术中所见、手术疗效。使用3.0 T磁共振机行3D-FIESTA及3D-TOF MRA序列扫描,重点从轴位、冠状位、矢状位上观察两种序列中患侧三叉神经脑池段与周围血管的位置关系,与手术结果进行对照分析。结果本组119例患者手术中探查到三叉神经REZ区有血管压迫或接触。3D-FIESTA、3D-TOF MRA及3D-FIESTA联合3D-TOF MRA对于判断有无血管压迫或接触的总符合率分别为82.6%、74.4%、98.3%。术前3D-FIESTA联合3D-TOF MRA检查与术中所见结果的差异无统计学意义(P0.05)。3D-FIESTA联合3D-TOF MRA对判断血管类型的准确性明显高于单独3D-FIESTA及3D-TOF MRA,差异有统计学意义(均P0.001)。结论 3D-FIESTA联合3D-TOF MRA可准确判断患侧三叉神经是否有血管接触,明确责任血管及其血管的类型(动脉或静脉),有助于制定手术方案,提高手术疗效;对于三叉神经微血管减压术具有十分重要的意义。     

三叉神经痛合并面肌痉挛1例并文献复习

目的探讨三叉神经痛合并面肌痉挛的临床特点、诊断方法及手术疗效。方法回顾性分析1例三叉神经痛合并面肌痉挛的临床资料,结合文献复习,总结其临床特点、诊断方法、手术方式及术后疗效。结果患者术前MRI 3D-TOF序列提示右侧三叉神经和面神经根区均有血管影存在,对该例患者在电生理监测下行微血管减压手术,术中发现右侧小脑上动脉是三叉神经痛的责任血管,右侧小脑前下动脉是面肌痉挛的责任血管,术后患者三叉神经痛及面肌痉挛症状均完全消失,随访一年余症状未见复发。结论三叉神经痛合并面肌痉挛一般都是血管源性的,术前MRI检查有助于明确诊断和指导手术,微血管减压术是该病唯一的根治性治疗方法。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.