CT指导下基底节区脑出血锥颅抽吸治疗有效性与安全性的临床研究

目的：了解CT指导下基底节区脑出血锥颅抽吸治疗的有效性与安全性，并对影响锥颅治疗脑出血患者预后的一些相关因素进行分析。方法：回顾性分析2000年12月1日－2002年6月1日我院病案首页数据库中所有CT指导下行锥颅抽吸治疗的基底节出血病例以及同期符合锥颅抽吸治疗手术指征而行内科保守治疗的基底节出血患者。在患者出血后30d进行疗效评定。采用等级资料秩和检验、X^2检验、方差分析以及多元判别分析进行统计学分析。结果：锥颅抽吸与内科保守治疗基底节出血疗效上有显著性差异。X^2检验表明，两组患者在死亡率上有显著性差异（P＜0．05），同时，单因素检验表明锥颅手术时间为影响脑出血锥颅抽吸治疗患者30d预后的危险因素（P＜0．05），但多元逐逐步判断别分析显示脑出血后锥颅时间并不是影响生存的主要危险因素，结论：CT指导下基底节区脑出血锥颅抽吸治疗的有效性与安全性优于内科保守治疗，脑出血后锥颅治疗时间可能对患者预后一定的影响。     

通过磁共振成像和神经电生理的影像融合实现癫痫的三维立体定位

目的 在完善的医学影像存储与传输系统中使用MR影像输出和神经电生理的数据信息进行结合，从而提高对癫痫病的诊断正确率，并将对病人病情正确判断的信息进人放疗设备的三维立体定向放射治疗计划系统。方法 使用脑电图工作站对脑电图数据进行回放，同时用Brainvoyager软件对病人的MR检查资料进行重建，在Base2000中将重建的影像数据与数字脑电图数据坐标结合，生成适合病人头部的三维模型。对临床诊断确诊的12～54岁的癫痫患者30例（其中男18例，女12例）进行磁共振图像与神经电生理信息融合后获得三维立体定位。结果 对应的数据信息在三维模型中可呈现病人脑部的真实情况，立体直观地呈现病灶的准确位置。三维立体定向引导下手术切除病灶的成功率大幅度提高，30例病人在发病时间上以每周为单位均有不同程度的减少，其中8例病人术后6个月停止发病，手术获得成功。结论 磁共振影像与神经电生理信息的融合，很大程度上提高了癫痫病诊断的整体水平。对于癫痫病的研究及提高手术成功率有着至关重要的意义。     

树鼩丘脑颅内定位

本实验对55例树鼩颅脑进行测量,其中14例作全脑冰冻连续切片,观察和测量了丘脑的外形和大个,丘脑距APO额切面,HO_4平面和正中矢状面的距离。为从体表上测定树鼩丘脑在颅内的位置提供了一些数据。     

立体定向手术戒毒后动机形成障碍原因分析及治疗

目的分析立体定向双侧伏隔核射频毁损术后患者动机形成障碍的原因,以提高手术质量,指导康复治疗。方法随访术后反馈动机形成障碍的16例阿片类药物依赖患者,评估手术疗效,分析障碍的类型、程度、持续时间、转归过程,部分复查CT、MRI,总结靶点位置。结果注意力下降10例,主动性下降7例,交流减少6例,兴趣减少3例,12例多种障碍类型并存。3例伴有其他并发症者症状较轻。4例术后CT或MRI结果提示平均毁损灶体积约12mm×10mm×7mm。3个月以上的心理行为治疗可减轻障碍程度。结论该类并发症与毁损灶的部位过深、体积过大、反复用药后奖赏阈升高有关,通过靶点精确定位、毁损体积控制可能达到收益和风险的平衡。加强联合型学习是该并发症康复治疗的有效手段。     

Copulatory behavior is controlled by the sexually dimorphic nucleus of the quail POA

The medial preoptic nucleus (POM) of the quail preoptic area is sexually dimorphic and testosterone sensitive. Stereotaxic implantation of needles filled with crystalline testosterone demonstrated that the POM is a critical site of steroid action in the control of copulatory behavior. Only implants located in the POM reliably restored the behavior in castrated birds. Implants around the nucleus weakly activated the behavior; those which were distant by more than 200 microns were totally inactive. Electrolytic lesions confirmed the role of the POM in the control of copulatory behavior. The percentage of the POM which was lesioned was highly correlated to the behavioral deficit while the absolute size of the lesion was not. Electrolytic lesions in or around POM also significantly decreased the volume of the nucleus suggesting that the afferents and efferents of the nucleus are required for its full development. The total volume of the POM was correlated with the sexual behavior of the birds. The morphological changes in POM observed following exposure to testosterone probably represent the signature of the behavioral effects of the steroid. The sexually dimorphic testosterone-sensitive POM is therefore an excellent animal model to study the brain-steroid interactions which mediate the activation of male reproductive behavior.     

立体定向脑内窥镜手术操作体会

目的为了减少脑组织损伤、并能在直视下进行手术，临床应用脑内窥镜处理脑深部病变。方法采用ＣＴ引导立体定向技术，应用ＡＥＳＣＵＬＰ及ＨＢ－２型神经内窥镜，治疗脑深部病变５４例患者；其中包括脑肿瘤切除３０例，脑内异物摘除８例，脑囊肿摘除５例，脑脓肿摘除３例，脑内病变活检２例，脉络丛烧灼治疗脑积水２例，脑内血肿清除及取出脑内寄生虫各２例。结果手术有效率９６％（术后１个月）。术后无昏迷、偏瘫、颅内感染等严重并发症。结论立体定向脑内窥镜手术具有一定的临床应用价值和较好的发展前景。     

Rat stereotaxic surgery without earbars

Described here is a rat headholding device intended for use in stereotaxic surgery. The assembly consists of a mouthpiece that accommodates the upper incisors and fits against the lateral and occlusive surfaces of the upper molars and of a contoured extension that is clamped down against the snout. To determine whether the apparatus could provide adequate stereotaxic support, we compared measures of skull displacement during surgery when using the “snoutclamp” and when using conventional earbars. Although the snoutclamp did not hold the head as rigidly as the earbar assembly did, the loss of accuracy was small. We judge that the snoutclamp can be used effectively as an alternative headholding device for many applications of stereotaxic surgery.     

A chronic headholder minimizing facial obstructions

An easily fabricated, chronically implanted headholder providing unobstructed access to the head region is described. The apparatus is particularly useful when multisensory stimuli are employed.     

Differences in localization of substantia nigra vs interaural line in Wistar and Sprague Dawley rats

The position of substantia nigra anterior to the interaural line has been correlated with body weight in Wistar rats. A regression line y=0.0050x+1.36 makes it possible to locate the substantia nigra in different sized rats ranging between 140 g and 460 g. This equation is not valid for Sprague Dawley rats. The position of bregma anterior to the interaural line has also been examined. A fairly good correlation was found for Sprague Dawley rats while the position of bregma in Wistar rats was much more variable.     

Electrophysiological methods for the identification of thalamic nuclei

Summary To increase the precision of the anatomical localization in stereotaxic neurosurgery, three techniques are now in common use to identify the thalamic nuclei: electrophysiological recording, local stimulation, reversible local blockade. A comparison is made between the results obtained by these three methods.Translated from a paper presented at the Joint Meeting of the German and French Neurological Societies, Munich 1970.