侧脑室肿瘤的显微手术治疗策略

目的探讨侧脑室肿瘤不同显微手术入路的应用及手术治疗策略。方法回顾性分析武汉协和医院神经外科于2006年3月~2013年4月行显微手术治疗的42例患者的临床资料,包括手术入路、结果及预后情况等。42例患者年龄1.25~67岁,平均35.8岁。所有患者均行显微手术治疗,其中7例经额中回、2例经纵裂-胼胝体前、18例经顶上小叶、15例经颞叶皮质入路手术。结果本组28例(66.7%)全切除,11例(26.2%)次全切除,3例(7.1%)大部分切除。术后死亡2例(4.8%)。随访38例患者,随访时间39~97月,平均70月。格拉斯哥预后评分(GOS)1分8例,3分2例,4分3例,5分25例。结论侧脑室肿瘤位置深在,局部解剖关系复杂,需综合考虑肿瘤位置、大小、生长方向等因素以确定手术入路。采用合适的手术入路及熟练的显微手术技巧,可以使大部分侧脑室肿瘤患者获得较好的疗效。     

三磷酸腺苷结合盒转运体成员2在人脑胶质瘤中的表达及其与神经巢蛋白表达的关系

Objective To study the expression of ATP-binding cassette superfamily G member 2 ( ABCG2) and its relationship with the malignant degree and expression of nestin in human gliomas. Methods Fifty-two gliomas of different WHO grades and 8 normal brain tissues were detected for the mRNA expression of ABCG2 by using real-time quantitive polymerase chain reaction (PCR). And the protein expression of ABCG2 and nestin was detected by immunohistochemistry. Results The mRNA of ABCG2 was overexpressed in gliomas as compared with that in normal brain tissues (P<0. 05), and up-regulated with the increase of pathologic degrees (P<0. 05 ). The positive protein expression rate of ABCG2 in 52 gliomas was 32.7%. The positive rate was significantly higher in grade Ⅲ-Ⅳ than in grade Ⅰ -Ⅱ (x2 =4. 62, P < 0. 05). And the expression level of ABCG2 was obviously related with the expression of nestin (x2= 7. 60,P < 0.05). Conclusion The expression level of ABCG2 was obviously related with glioma pathological grade and the expression of nestin. Brain tumor stem cells may have some homology with nerve stem cells.     

睫状神经营养因子对不全视神经损伤的保护效应

目的 观察睫状神经营养因子(CNTF)对猫视神经不全损伤后的神经保护效应.方法 制作猫视神经不全损伤模型;CNTF组分别给予CNTF 8μl(1g/L)玻璃体内注射,对照组给予生理盐水8μl;术后15d双侧上丘、外侧膝状体显微注射DiI 5μl逆行神经示踪;术前、术后3、15、30d行视觉诱发电位(P-VEP)检测;术后30 d原位心脏灌注;视网膜铺片,视网膜神经节细胞计数;取术侧视神经组织,光镜和电镜观察视神经形态变化.结果 对照组术侧眼PVEP P-100较CNTF组振幅明显减低,潜伏期明显延长,差异有统计学意义(P<0.01);与手术组相较.CNTF组视网膜神经节细胞存活数[(1256±124)个/mm2]明显高于对照组[(632±61)个/mm2](P<0.01),神经结构更加完整.结论 视神经不全损伤后CNTF玻璃体注射具有视神经保护效应.     

经胼胝体-脉络膜裂入路的显微解剖学研究

目的 探讨经胼胝体-脉络膜裂入路的显微解剖学特征和临床应用价值.方法 显微镜下对12例成人尸头湿标本进行侧脑室、第三脑室区显微解剖,观察侧脑室、脉络丛、脉络膜裂及第三脑室顶的解剖学特点;在3例成人尸头新鲜标本上模拟经胼胝体-脉络膜裂入路手术,观察与本人路相关的重要解剖结构并测量相关距离.结果 脉络丛位于侧脑室底部内侧,脉络膜裂位于丘脑和穹窿之间,可借助与之相连的脉络丛进行辨认.切开脉络膜裂穹窿带到达第三脑室顶中间帆后,于两侧大脑内静脉间分离打开第三脑室顶即到达第三脑室腔.经测量,大脑内侧缘冠状缝处至胼胝体沟的距离为(39.12±3.94)mm,大脑内侧缘冠状缝处至室间孔的距离为(61.53±4.02)mm,室间孔后缘至穹窿与胼胝体融合处的距离为(28.65±2.23)mm,前后连合的距离为(25.94±2.16)mm,室间孔至乳头体的长度为(19.62±1.79)mm.结论 与其他手术人路相比,经胼胝体-脉络膜裂入路循自然裂隙进入第三脑室,具有路径直接、术野暴露广泛等特点,值得临床推广应用.     

三磷酸腺苷结合盒转运体成员2在人脑胶质瘤中的表达及其与神经巢蛋白表达的关系

Objective To study the expression of ATP-binding cassette superfamily G member 2 ( ABCG2) and its relationship with the malignant degree and expression of nestin in human gliomas. Methods Fifty-two gliomas of different WHO grades and 8 normal brain tissues were detected for the mRNA expression of ABCG2 by using real-time quantitive polymerase chain reaction (PCR). And the protein expression of ABCG2 and nestin was detected by immunohistochemistry. Results The mRNA of ABCG2 was overexpressed in gliomas as compared with that in normal brain tissues (P<0. 05), and up-regulated with the increase of pathologic degrees (P<0. 05 ). The positive protein expression rate of ABCG2 in 52 gliomas was 32.7%. The positive rate was significantly higher in grade Ⅲ-Ⅳ than in grade Ⅰ -Ⅱ (x2 =4. 62, P < 0. 05). And the expression level of ABCG2 was obviously related with the expression of nestin (x2= 7. 60,P < 0.05). Conclusion The expression level of ABCG2 was obviously related with glioma pathological grade and the expression of nestin. Brain tumor stem cells may have some homology with nerve stem cells.     

磁性纳米粒标记的神经干细胞不同移植途径对大鼠脑损伤治疗的实验研究

目的 探讨脑损伤后不同移植途径神经干细胞的迁移及分布情况并进行对比研究.方法 体外培养的胚胎神经干细胞,采用Feeney自由落体脑创伤模型制成大鼠脑损伤模型,超顺磁性氧化铁纳米颗粒(SPIO)标记神经干细胞,并将其分别经枕大池穿刺注射入脑损伤大鼠蛛网膜下腔的脑脊液中及经立体定向脑内注射移植,分别进行大鼠运动功能缺失的神经功能评价、磁共振示踪及大鼠脑切片普鲁士蓝染色.结果 接受神经干细胞移植的两组大鼠神经运动功能评分均较损伤对照组明显提高(P<0.05),两移植组大鼠神经运动功能评分无明显差别.接受神经干细胞移植的两组大鼠神经运动功能评分均较损伤对照组明显提高(P<0.05),两移植组大鼠神经运动功能评分无明显差别.标记组移植经枕大池移植的神经干细胞即刻的MRI即可观察到大鼠脑内的移植标记细胞,移植后2周脑挫伤即可见到低信号影,组织切片的普鲁士蓝染色与MRI结果相符.结论 经枕大池移植的神经干细胞具有远距离迁移能力,并能像脑内移植一样明显有助于大鼠神经运动功能的恢复.用MRI活体示踪移植磁化标记神经干细胞在TBI模型大鼠脑内迁移和分布是可行的.     

Superparamagnetic Iron Oxide Labeling of Spinal Cord Neural Stem Cells Genetically Modified by Nerve Growth Factor-β

This study established superparamagnetic iron oxide （SPIO）-labeled nerve growth fac-tor-β （NGF-β） gene-modified spinal cord-derived neural stem cells （NSCs）. The El4 rat embryonic spinal cord-derived NSCs were isolated and cultured. The cells of the third passage were transfected with plasmid pcDNA3-hNGFβ by using FuGENE HD transfection reagent. The expression of NGFβ was measured by immunocytochemistry and Western blotting. The positive clones were selected, allowed to proliferate and then labeled with SPIO, which was mediated by FuGENE HD transfection reagent. Prussian blue staining and transmission electron microscopy （TEM） were used to identify the SPIO particles in the cells. The distinctive markers for stem cells （nestin）, neuron （β-Ⅲ-tubulin）, oligodendrocyte （CNPase） and astrocyte （GFAP） were employed to evaluate the differentiation ability of the labeled cells. The immunocytochemistry and western blotting showed that NGF-β was expressed in spinal cord-derived NSCs. Prussian blue staining indicated that numerous blue-stained particles appeared in the cytoplasma of the labeled cells. TEM showed that SPIO particles were found in vacuolar structures of different sizes and the cytoplasma. The immunocytochemistry demonstrated that the labeled cells were nestin-positive. After differentiation, the cells expressed β-Ⅲ-tubulin, CNPase and GFAP. It was concluded that the SPIO-labeled NGF-β gene-modified spinal cord-derived NSC were successfully established, which are multipotent and capable of self-renewal.     

一期双侧开颅手术治疗多发性颅内动脉瘤

目的探讨多发性颅内动脉瘤(MIA)的一期双侧开颅手术治疗及其疗效。方法采用冠状切口一期双侧开颅手术治疗MIA患者23例,共48个动脉瘤,其中夹闭动脉瘤45个,包裹动脉瘤3个。结果术后复查DSA或CT血管造影均示动脉瘤夹闭满意。术后肢体偏瘫5例,脑脊水6例,均经治疗后好转。术后随访5月～5年,患者恢复良好20例,中残3例;本组无死亡病例,无动脉瘤复发。结论对于需双侧开颅才能完全处理的MIA,术前经充分评估后,采用一期双侧开颅手术是安全有效的。     

丁基苯酞治疗轻中型颅脑损伤患者记忆及智力障碍的临床观察

目的观察丁基苯酞对轻中、型颅脑损伤患者记忆和智力障碍的治疗作用。方法将60例轻、中型颅脑损伤患者按随机数字表随机分为常规对照组和丁基苯酞（NBP）治疗组,治疗前、后分别用韦氏记忆量表和简明智力状态检查量表评估患者记忆力和智力。结果NBP治疗组治疗前、后记忆商分别为63.77±7.88和74.13±7.10,两者间差异显著（P〈0.05）;智力状态评分分别为17.33±4.52和24.60±3.71,两者间差异显著（P〈0.05）。对照组治疗前、后记忆商分别为63.87±7.90和68.57±9.02,两者间差异显著（P〈0.05）;智力状态评分分别为17.56±5.06和22.03±5.45,两者间差异显著（P〈0.05）。NBP治疗组对记忆商和智力状态评分的提高效果好于对照组,差异具有显著性（P〈0.05）。结论NBP可有效促进轻、中型颅脑损伤患者的记忆力和智力恢复。     

右丙亚胺对颅脑损伤大鼠脑组织水和离子含量的影响

目的 探讨右丙亚胺(Dexrazoxane,DEX)对颅腩损伤(traumatic brain injury,TBI)的大鼠脑组织水和离子含量的影响.方法 选择SD大鼠36只,计算机编号随机抽取方法 分成止常对照组(n=6)、假手术组(n=10)、损伤组(n=10)和DEX治疗组(n=10),应用液压冲击方法 制作TBI模型.DEX组在制作模型后即刻给予DEX,3 d后将大鼠处死观察脑组织基底节区域的铁染色情况,以及该区域的水及钠钾离子的变化情况.结果 损伤组大鼠脑皋底节区域在TBI后3 d铁染色明显增强,铁染色阳性细胞比例明显上升,水及钠离子含量也明显上升,而钾离子则没有明显变化.应用DEX治疗后的TBI大鼠铁阳性细胞比例,水及钠离子含量都有明显的下降,显著低于损伤组(P<0.05).结论 DEX可以降低TBI后的水及钠离子含量,这直接影响到脑组织的水肿,其机制可能与降低脑组织的铁沉积有关.