恶性实体肿瘤脑膜转移的研究进展

 恶性实体肿瘤脑膜转移发生率约5 %～8 %,是恶性肿瘤的致死性并发症。其临床表现不典型,误诊率高,诊断复杂,主要依据脑脊液相关检查及神经影像学检查。尽管采用放、化疗的多学科综合治疗,但属姑息治疗,疗效仍不理想,患者生存期极短。     

Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis

Background There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM).Objective To test nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture.Materials and methods CT scans of patients with a clinical suspicion of TBM who had undergone lumbar puncture for CSF culture spanning a period of 4 years were reviewed for the presence of nine recently described criteria for the presence of abnormal basal enhancement. The radiologists were blinded to the final diagnosis based on CSF culture against which the criteria were tested. The criteria have been named: the ‘Y-sign’, ‘linear enhancement’, ‘double lines’, ‘infundibular recess of the third’, ‘ill-defined edge’, ‘nodular enhancement’, ‘join the dots’, ‘contrast filling the cisterns’, and ‘asymmetry’.Results A total of 65 patients were included in the study, 34 with culture-proven TBM and 31 with other diagnoses. Four individual criteria had a specificity of 100%, but the sensitivities of these criteria ranged from 15% to 53% only. Three other criteria had specificities of 97% and sensitivities ranging from 62% to 82%. The presence of more than one criterion in the same patient showed a specificity of 97% and sensitivity of 91%.Conclusions Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present. These criteria need to be tested for inter- and intraobserver variability to prove their clinical usefulness.     

中枢神经系统脑脊膜黑色素细胞瘤三例及文献复习

目的 探讨中枢神经系统脑脊膜黑色素细胞瘤(PMM)临床及病理学特征.方法 结合文献复习,回顾性分析3例中枢神经系统原发的脑脊膜黑色素细胞瘤.结果 2例肿瘤位于椎管内,1例位于小脑脑桥角.肿瘤外观呈黑色,部分肿瘤包膜完整.光镜下见瘤细胞由上皮样细胞和梭形细胞混合而成,细胞无明显异型,核仁明显.大部分瘤细胞质内含有大量黑色素颗粒.例1、例3肿瘤核分裂像无或偶见(0～1个/10 HPF),例2核分裂像较多(2～3个/10 HPF).免疫表型HMB45、MelanA和S-100蛋白呈阳性表达.例1、例2肿瘤完全切除,例3部分切除,随访均无复发.结论 原发性脑脊膜黑色素细胞瘤是一种罕见的交界性或低度恶性肿瘤,具有一定的病理学特征,可局部复发或发生恶变,需要与原发或转移的恶性黑色素瘤、黑色素性脑膜瘤及黑色素性神经鞘瘤进行鉴别.     

Regulation of the expression of the proenkephalin gene in cultured meningeal fibroblasts: opposite effects of α1- and β2-adrenoceptors

Meningeal fibroblasts express the proenkephalin gene during embryonal development but terminate the expression shortly before birth. When brought into primary culture at postnatal day 1, the fibroblasts again express the gene. Activation of protein kinase A reduces this expression and thus may contribute to its prenatal termination. Since the noradrenergic innervation of the meninges begins around the time of birth, it was investigated in the present study, how adrenergic agonists affected the levels of proenkephalin mRNA in cultured fibroblasts. The ₂-adrenoceptor agonists salbutamol and procaterol increased the levels of endogenous cAMP and diminished the concentration of proenkephalin mRNA indicating that the cultured fibroblasts possessed this -subtype. In contrast, noradrenaline increased the level of proenkephalin mRNA in a concentration-dependent manner. This effect was independent of endogenous cAMP and was mediated by ₁-adrenoceptors. The data indicate that the noradrenergic innervation of the meninges at the time of birth is not responsible for the termination of the proenkephalin gene expression.     

脑膜脑膨出的诊断与外科治疗

目的探讨脑膜脑膨出的诊断和选择最佳手术入路。方法对１９８６年１月～１９９７年８月收治的１１例患者（额筛型５例,基底型５例,枕后型１例）进行临床分析。结果额筛型发病年龄小,基底型多以脑脊液鼻漏、反复发作性脑膜炎为首发症状,多有外伤史。颅鼻联合入路１１例次,一期成功１０例次;单纯前额开窗１例次,一期未成功,二期联合入路成功;鼻侧切开２例次,１例一期未成功,二期联合入路成功。所有病例随访至１９９７年１０月,随访时间２个月～１１年６个月,平均４年８个月,无复发。结论颅鼻联合入路可提供良好视野,易找到并修复颅底缺损,便于切除颅外膨出部及一期整形,是治疗脑膜脑膨出的理想手术入路。     

中丝蛋白在脑膜和脑膜瘤上的表达

本文以免疫组化方法研究了中丝蛋白在正常脑膜(蛛网膜颗粒)和脑膜瘤上的表达。脑膜细胞不仅表达了波形蛋白,而且表达了角蛋白、反应了其间皮和上皮的特性。4例上皮型脑膜瘤共同表达了波形蛋白和角蛋白,显示其双相的分化。由于脑膜和脑膜瘤有共同的中丝蛋白表达特征,我们认为脑膜瘤来自脑膜细胞的异常增生。     

Intracranial dural metastasis of Ewing's sarcoma: a case report.

Although intracranial dural metastasis of Ewing's sarcoma is a very rare finding, its imaging characteristics are similar to those of its primary form in the central nervous system. Thus, this tumor must be considered in the differential diagnosis of extra-axial dural masses.     

MR增强后液体衰减反转恢复序列对柔脑膜病变的诊断价值

目的评价MR液体衰减反转恢复（FLAIR）序列对柔脑膜病变的诊断价值。方法分析17例柔脑膜病变的MR平扫FLAIR、增强FLAIR和增强T1WI表现并比较三者对病变高信号的显示。结果柔脑膜病变在MR平扫FLAIR、增强FLAIR和T1WI上均呈沿脑沟、脑池弥漫或局部分布的异常脑回样或线样高信号。增强FLAIR与增强T1WI对病变显示的比较：7例只在增强FLAIR显示病变；7例二者均明显显示病变；2例二者均显示病变，但前者优于后者；另有1例结核性脑膜脑炎的双侧大脑半球脑沟弥漫性病变只在增强FLAIR显示，脑池病变二者均显示但前者优于后者。增强与平扫FLAIR对病变显示的比较：9例只在增强FLAIR显示病变；4例二者均明显显示病变；3例二者均显示病变但前者优于后者；另有1例结核性脑膜脑炎的脑池病变只在增强FLAIR显示，双侧大脑半球脑沟弥漫性病变二者均显示但前者优于后者。结论增强FLAIR显示柔脑膜病变优于平扫FLAIR和增强T1WI，对于平扫FLAIR和（或）增强T1WI怀疑柔脑膜病变时，增强FLAIR是必要的检查序列。     

Spontaneous intracranial hypotension: use of unenhanced MRI

We report a case of spontaneous intracranial hypotension diagnosed with unenhanced cranial MRI, showing laminar subdural fluid and engorgement of the hypophysis and perisellar sinuses. Cerebrospinal fluid pressure was low. MRI was normal after resolution of symptoms. Prior reports emphasise the enhancing pachymeninges seen in this syndrome. We maintain that, when subdural collections and perisellar engorgement are detected on unenhanced MRI in the proper clinical setting, contrast enhancement may not be necessary for the diagnosis. Received: 23 June 1999 Accepted: 13 August 1999     

硬脑膜动静脉瘘介入治疗的临床分析

目的：总结硬脑膜动静脉瘘（DAVF）患者的介入治疗特点,以提高疗效。方法：回顾性分析135例DAVF患者的临床资料。结果：治愈74例,好转53例,8例无效,其中1例死于颅内出血。结论：DAVF的临床表现和预后与其静脉引流类型密切相关,颈动脉压迫法及选择性血管内栓塞是安全有效的治疗方法。