脉络丛肿瘤临床特点分析

目的总结脉络丛肿瘤（CPT）的临床特点和诊治经验。方法本组31例CPT中，28例为脉络丛乳头状瘤，3例为脉络丛癌．全部行显微手术治疗。结果肿瘤全切24例，次全切除6例，大部分切除1例，无手术死亡病例。术后9例患者复查CT示脑积水改善不明显。结论脑积水是CPT的突出表现，与肿瘤大小及性质不一致，手术缓解率不高。虽然脉络丛肿瘤大多为慢性起病．但仍有少数表现为急症。     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

非定型锁孔微创手术入路治疗颅内病变

目的 探讨和评价非定型锁孔微创手术入路在治疗颅内病变中的方法、外科技巧及价值。方法 回顾性分析我们3年中33例采用非定型锁孔微创手术入路治疗的患者临床资料，其中脑膜瘤7例，海绵状血管瘤7例，胶质瘤（Ⅰ级）6例，转移瘤5例，脑脓肿3例．炎性肉芽肿3例，脑动静脉畸形2例。结果 采用简易CT定位22例．立体定向引导下定位5例，神经导航引导下定位6例。全切除率为93．9％．次全切除率6．1％。2例切口有轻微感染表现，予处理后痊愈。无手术死亡者。结论 对合适的病例采用非定型锁孔手术具有微创、美容、手术操作方便和术后恢复快等优点。结合简易CT、立体定向和神经导航引导下定位能达到病变定位准确，使手术操作精确，并发症低，全切除率高。     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

基于QST分型的颅咽管瘤与第三脑室底脑膜层次的关系

目的探索基于QST分型的、累及第三脑室底的颅咽管瘤与第三脑室底脑膜层次的关系及临床意义。方法回顾性分析2018年1月至2019年10月南方医科大学南方医院神经外科在神经内镜下行肿瘤全切除术治疗累及第三脑室底的原发性颅咽管瘤患者的临床资料(共17例,其中Q型6例,S型3例,T型8例),所有患者术中均留取肿瘤组织标本。正常鞍区标本来源于同期该院行人工引产或自然流产的胎儿(8例)。对以上标本进行苏木素-伊红(HE)和免疫荧光双标染色,应用波形蛋白抗体标记硬脑膜,Ⅰ型胶原蛋白抗体标记蛛网膜,胶质纤维酸性蛋白抗体和层粘连蛋白抗体标记软脑膜,以CK18抗体标记腺垂体,以CK5/6抗体标记颅咽管瘤。观察胎儿脑组织标本的脑膜染色情况以及不同QST分型的颅咽管瘤组织与第三脑室底脑膜的层次关系。结果8例胎儿标本均成功标记硬脑膜、蛛网膜、软脑膜。颅咽管瘤标本HE染色及免疫荧光双标染色结果显示,所有Q型肿瘤(6/6)与第三脑室底之间存在硬脑膜(鞍膈);所有S型肿瘤(3/3)与第三脑室底之间存在蛛网膜和软脑膜;T型肿瘤与第三脑室底之间存在3种病理学形态关系,分别命名为卯榫样、地幔样及护城河样关系,所有T型肿瘤(8/8)与第三脑室底之间有软脑膜分隔,但在肿瘤起源点处,软脑膜可逐渐消失。当肿瘤极度挤压第三脑室空间时,第三脑室室管膜仍可保持完整。结论不同QST分型的颅咽管瘤均可累及第三脑室底,且与第三脑室底之间存在不同的脑膜层次;这些脑膜层次是手术安全切除累及第三脑室底的颅咽管瘤的天然屏障。     

听神经瘤与周边蛛网膜的解剖关系及临床意义

听神经瘤是桥小脑角区最常见的肿瘤,占颅内肿瘤的7．79％～10．64％,占桥小脑角区肿瘤的85％～92％,其治疗主要以手术切除为主。随着显微外科技术的发展和术中面听神经电生理监测技术的运用,如今听神经瘤的手术全切除率为92％～100％,手术死亡率降至1％以下;术后面神经解剖保存率为83％～98％,耳蜗神经解剖保存率为67％～84％,听力保存率为20％～49％。听神经瘤的治疗不仅在于切除肿瘤,而且术中、术后神经功能的保留和恢复已成为手术成功与否的重要指标。掌握听神经瘤与其周边蛛网膜的解剖关系对显微手术术中找出适当分界面,保护神经、血管、脑干,降低病残率,提高手术疗效具有重要的临床意义。     

术中肌电监测对累及第四脑室底面肿瘤切除中后组脑神经核团的保护研究

目的 探讨术中肌电监测在累及第四脑室底面肿瘤切除术中,后组脑神经核团的保护作用.方法 2007年2月至2008年4月治疗23例累及第四脑室底面的肿瘤,其中巨大髓母细胞瘤8例,室管膜瘤7例,脑干起源外生性胶质瘤3例,脑干背侧血管网状细胞瘤2例,脑干海绵状血管瘤3例.全部患者通过显微手术切除肿瘤,术中全程监测后组脑神经肌电活动.对患者术后脑神经功能状态、手术过程和监测情况分析.结果 肿瘤全切除17例,次全切除6例,无后组脑神经功能障碍6例,轻度后组腩神经损伤13例,中度后组腩神经损伤4例,无严重损伤者.术中全部患者在正常麻醉和肌松药状态下,可以稳定引出各种刺激诱发的后组脑神经核团兴奋性肌电活动.结论 术中肌电监测可以有效避免后组脑神经核性损伤,为第四脑室底面肿瘤切除提供客观依据.     

视交叉后颅咽管瘤的手术治疗

目的探讨视交叉后部颅咽管瘤的显微手术经验。方法根据影像学所示肿瘤生长部位及扩展方向选择适当手术入路,对84例视交叉后部颅咽管瘤病人进行手术切除,并对术中技术要点及术后反应进行分析。结果本组全切除63例(75.0%),近全切除20例(23.8%),大部切除1例(1.2%)。术后最常见的肿瘤残留部位是肿瘤与第三脑室底部前端连续处。术后最常见的下丘脑反应为尿崩症(72例,85.7%)及低钠、高钠血症(63例,75.0%)。围手术期死亡2例(2.4%)。对64例随访5年,复发9例。结论根据肿瘤生长方向及大小选择合适的手术入路,多数颅咽管瘤可以得到良好的长期控制。     

雌激素替代治疗时大鼠动脉雌激素受体及一氧化氮合酶活性的变化

目的观察激素替代治疗时大鼠动脉雌激素受体(ER)的表达及一氧化氮合酶(NOS)的活性。方法建立大鼠雌激素替代治疗模型,用放射配体结合分析法检测主动脉ER的含量,血红蛋白还原酶法检测主动脉中NOS的活性：结果卵巢切除去势组大鼠动脉ER的结合容量及NOS活性显低于假手术组;切除卵巢后补充雌激素鼠动脉ER的结合容量及NOS活性都显高于单纯卵巢切除去势组。结论雌性大鼠去势2个月后,主动脉表达ER显减少,NOS活性显减低,补充适量雌激素能使去势大鼠动脉NOS的活性显增强,ER的含量维持在正常水平。这可能是雌激素对绝经后妇女心血管保护作用的重要机制。