Using the C7-T3 spinous processes as landmarks for the localization of thoracic spinal lesions: technique notes

The authors describe a method of using the C7-T3 spinous processes visualized on MRI as landmarks for localizing thoracic spinal lesions in 19 cases. This method included six steps. First, the “spinous process nearest to the lesion that was visible on the MRI image” was identified. Second, a dashed line was drawn on the image through the tip of the identified spinous process perpendicular to the skin surface. Third, two additional dashed lines parallel to the first dashed line were drawn from the upper and lower margins of the lesion. Fourth, the distances between the identified process and the two additional dashed lines were measured. Fifth, the same “spinous process nearest to the lesion” was identified by palpation and marked on the patient’s skin. Sixth, the upper and lower margins of the lesion were marked on the skin according to the two distances measured in step 4. After the lesion was exposed, the deviations of the lesion margins were measured. All 19 cases of the thoracic spinal lesions were localized correctly using the C7-T3 spinous processes visualized on the MRI images as landmarks without any other evaluation methods. The deviation value for the localization of the tumor margin was 4.1?±?1.47 mm. Using the C7-T3 spinous processes as landmarks is an accurate, simple, and economic method for lesion localization during thoracic spinal surgery.     

NaV1.6 通道在癫痫发病机制中的研究进展

癫痫是一种常见的大脑疾病,其发病机制复杂多样,至今尚未完全明确。但随着电生理学技术的发展,越来越多的研究结果揭示了癫痫与离子通道的联系。离子通道是神经系统兴奋性产生与调节的关键因子,Na_v1.6作为电压门控钠通道（VGSCs）的亚型之一,其介导的持续性Na⁺电流（I_NaP）和复活性Na⁺电流（I_NaR）是神经元兴奋性的重要组成。Na_v1.6通道表达量的改变及基因突变引起的功能异常均在癫痫中发挥重要作用,可见NaV1.6通道功能障碍是癫痫发病机制之一。通过对该通道的进一步研究有助于了解癫痫的发病机制,并找到有效的治疗方法。     

耳前颞下经小脑幕入路切除脑干海绵状血管畸形的疗效及可行性探讨

目的探讨耳前颞下经小脑幕入路切除脑干海绵状血管畸形(cavernous malformations,CM)的疗效。方法回顾性分析30例位于中脑及脑桥上、中部的脑干CM的临床资料,均采用耳前颞下经小脑幕入路,显微外科技术切除病变。术中运用神经电生理监测,部分病例采用神经导航技术定位病灶。结果术后MRI显示病灶均全切除,无手术死亡。术后平均随访时间11.7个月(6~18个月),随访期内MRI复查均未见病灶复发。结论耳前颞下经小脑幕入路能够充分显露并切除位于中脑至脑桥上、中部的CM,且术后脑神经功能障碍、意识障碍、肢体偏瘫等致残性并发症发生率低。但不适用于病变主体位于脑桥下部及延髓的病灶。     

低频脉冲刺激穴位治疗糖尿病周围神经病变42例临床观察

目的 观察低频脉冲刺激穴位治疗糖尿病周围神经病变的临床疗效.方法 将84例糖尿病周围神经病变患者随机分为治疗组和对照组各42例.两组均进行饮食控制、运动锻炼及应用药物控制血糖等基础治疗,对照组口服甲钴胺片,每次0.5mg,每日3次;治疗组用低频脉冲治疗仪刺激双侧脾俞、肾俞、足三里、三阴交、涌泉等穴位,每日1次,每次15 min.两组均治疗2周后评价临床疗效;治疗前后观察临床症状、体征以及神经传导速度的变化.结果 治疗组临床疗效总有效率为76.19％,对照组为35.71％,治疗组优于对照组(P＜0.01).两组治疗后临床症状及体征积分均较治疗前明显降低(P ＜0.05或P＜0.01),且治疗组治疗后较对照组降低明显(P＜0.01).治疗后对照组的腓总神经及胫神经的传导速度改变无统计学意义(P＞0.05),治疗组的腓总神经及胫神经的感觉神经和运动神经传导速度较治疗前明显提高,且治疗组治疗后腓总神经与胫神经运动及感觉神经传导速度均明显高于对照组(P＜0.01).结论 低频脉冲刺激穴位治疗能明显改善糖尿病周围神经病变患者的症状及体征,提高神经传导速度.     

Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years

BackgroundAlthough there has been great development in the anatomical understanding and operative techniques for skull base tumors, controversy still exists regarding the optimal surgical strategies for the FMMs. We report clinical and radiologic features as well as the surgical findings and outcome for patients with FMM treated at our institution over the last 15 years.MethodsWe reviewed 114 consecutive cases of FMM operated between May 1993 and June 2008 in the neurosurgery department at Beijing Tiantan Hospital.ResultsThere were 68 female and 46 male patients (mean age, 52.3 years; range, 28-76 years). Foramen magnum meningiomas were classified as anterior (80 cases), anterolateral (24 cases), and posterolateral (10 cases). Mean duration of symptoms was 11.7 months (ranging from 1.5 to 240 months). Cervico-occipital pain (80.7%) and headache and dizziness (42.1%) were the most common presenting symptoms. The preoperative KPS was 72.5 ± 8.3. Mean maximum diameter of the tumors on MRI was 3.35 cm (range, 1.5-4.7 cm). Posterior midline approach was performed in 10 cases, far-lateral retrocondylar approach in 97 cases, and extended far-lateral approach in 7 cases. Gross total resection was achieved in 86.0% of patients and subtotal resection in 14.0%. Surgical mortality was 1.8%. Follow-up data were available for 93 patients, with a mean follow-up of 90.3 months (range, 1-180 months), of which 59 (63.4%) lived a normal life (KPS, 80-100).ConclusionOur experience suggests that most anterior and anterolateral FMMs can be completely resected by a far-lateral retrocondylar approach without resection of the occipital condyle. Complete resection of the tumor should be attempted at the first operation. Postoperative management of FMM is important for the prognosis.     

Outcomes of Burkitt lymphoma with bone marrow involvement or Burkitt leukemia in Chinese children

Importance:Burkitt lymphoma with bone marrow involvement and Burkitt leukemia behave aggressively.Thus far,there are limited data concerning survival and toxici...