Comparative study of suture and laser-assisted anastomoses in rat sciatic nerves

Conventional suture repair of peripheral nerves results in a fibrotic reaction that is detrimental to nerve regeneration. As an alternative procedure known as "laser-assisted" repair, a laser can be used, along with a reduced number of sutures, to reanastomose served peripheral nerves. To explore the long-term implications of this technique, the right sciatic nerves of Sprague-Dawley rats were surgically cut and reanastomosed either by means of four epineurial sutures or two epineurial sutures and CO2 laser welds. Tensile strength, electrophysiology, histology, and functional studies were performed up to 11 months postoperatively. Tensile strength measurements indicate no long-term disadvantage with the laser-assisted technique, although the short-term tensile strength is lower than with conventional suture repair. The conduction velocities of the repaired nerves were similar for both techniques; however, laser-assisted repaired nerves were found to have lower stimulation thresholds and reduced branching compared to the suture repaired nerves. The measured functional recovery was similar for both repair techniques.     

神经电生理监测下听神经瘤显微手术中面神经的保护

目的总结分析术中神经电生理监测结合显微手术操作技巧在听神经瘤手术中预防面神经损伤的作用。方法选取我科2011～2012年施行乙状窦后入路显微手术的大型及中型听神经瘤（肿瘤直径≥2.4 cm）患者62例,术中应用神经电生理监测技术对手术进行综合监护,同时密切留意骨性解剖、蛛网膜解剖、神经与血管解剖关系。术后随访6个月,评估肿瘤切除程度并根据House-Brack-mann面神经功能分级对患者面神经功能进行评估。结果肿瘤全切除58例（93.5%）,次全切除4例（6.5%）;无围手术期死亡患者。面神经功能评定：Ⅰ级57例（91.9%）,Ⅱ级5例（8.1%）。结论对于大型和中型听神经瘤患者,术中进行综合电生理监护,同时操作时注意典型的解剖位置与熟练的显微手术技术,可达到较高的肿瘤全切除率,并尽可能地保全面神经功能。     

单操作孔胸腔镜胸顶部良性肿瘤的治疗体会

〔摘 要〕 目的：探讨单操作孔胸腔镜胸顶部良性肿瘤手术的可行性。方法：收集 2017 年 1 月至 2021 年 3 月在深圳大 学第一附属医院行单操作孔胸腔镜手术治疗的胸顶部良性肿瘤患者 7 例,分析其临床效果及并发症。结果：所有患者肿瘤 均顺利完整切除,神经鞘瘤 4 例,节细胞神经瘤 2 例,脉管瘤 1 例。手术时间 85 ~ 145 min,平均（111.3 ± 21.0）min;术 中出血量 20 ~ 50 mL,平均（37.1 ± 12.5）mL;术后引流量 80 ~ 240 mL,平均（161.4 ± 54.3）mL。2 例霍纳综合征,其 中 1 例术后 1 月逐渐减轻,1 年后随访部分功能恢复,另 1 例术前即有霍纳综合征,而术后病情加重,1 年后随访无缓解; 2 例术侧上肢疼痛、麻木及活动受限,锻炼及理疗后逐渐缓解。无其它并发症发生。结论：单操作孔胸腔镜手术对经挑选的 胸顶部良性肿瘤病例,创伤小、安全、有效。     

伽玛刀治疗听神经瘤失败后再手术的方法及疗效分析

目的探讨伽玛刀治疗听神经瘤失败后再行手术治疗的方法及其效果。方法 20例听神经瘤患者接受伽玛刀治疗后不同时期复查MRI发现肿瘤继续生长或临床症状加重,采用枕下乙状窦后入路行听神经瘤切除术。结果术中发现肿瘤与面神经及周围结构粘连明显。肿瘤全切及近全切除共18例(占90%),次全切除共2例(占10%)。面神经解剖保留18例(占90%),功能保留16例(占80%)。结论采用枕下乙状窦后入路肿瘤切除术是挽救伽玛刀治疗听神经瘤失败后的有效方法,面神经功能保护满意。     

Long-term use of cellular phones and brain tumours: increased risk associated with use for > or =10 years

Aim

To evaluate brain tumour risk among long‐term users of cellular telephones.

Methods

Two cohort studies and 16 case–control studies on this topic were identified. Data were scrutinised for use of mobile phone for ⩾10 years and ipsilateral exposure if presented.

Results

The cohort study was of limited value due to methodological shortcomings in the study. Of the 16 case–control studies, 11 gave results for ⩾10 years'' use or latency period. Most of these results were based on low numbers. An association with acoustic neuroma was found in four studies in the group with at least 10 years'' use of a mobile phone. No risk was found in one study, but the tumour size was significantly larger among users. Six studies gave results for malignant brain tumours in that latency group. All gave increased odd ratios (OR), especially for ipsilateral exposure. In a meta‐analysis, ipsilateral cell phone use for acoustic neuroma was OR = 2.4 (95% CI 1.1 to 5.3) and OR = 2.0, (1.2 to 3.4) for glioma using a tumour latency period of ⩾10 years.

Conclusions

Results from present studies on use of mobile phones for ⩾10 years give a consistent pattern of increased risk for acoustic neuroma and glioma. The risk is highest for ipsilateral exposure.     

两种MRI序列对听神经瘤成象的比较与评价

为选择中等场强的ＭＲＩ听神经瘤成像最佳序列。收集手术和病理证实的听神经瘤１３５例，分析序列Ⅰ、Ⅱ对内听道中心层面、三叉神经显示率及ＭＲ征象的显示情况。结果：序列Ｉ择内听道中心层面及三叉神经的显示均优于序列Ⅱ，序列Ⅱ在显示肿瘤内囊变、出血、不肿优于序列Ｉ；对肿瘤钙化、肿瘤血管、脑干移位的观察，两者相仿。结果显示：序列Ｉ在中等场经下作为听神经瘤成像的首选序列，并中运用到小脑角区ＭＲＩ成像。     

The current state of the radiological diagnosis of acoustic neuroma

Summary Thin, overlapping section, contrast-enhanced, axial and coronal CT, with additional highresulution (HR) treatment of the sections through the internal auditory canal, was performed on 31 patients clinically suspected of acoustic neuroma. With this technique 13 acoustic neuromas protruding more than 10 mm and eight acoustic neuromas protruding between 2 and 10 mm outside the internal auditory canal were unequivocally diagnosed. O₂CT cisternography was performed on ten patients. An intracanalicular neuroma was diagnosed in three cases with this technique, also a small extracanalicular neuroma in one case, and an acoustic neuroma was definitely excluded in six cases. It is concluded that O₂CT cisternography is the diagnostic procedure of choice for the detection of purely intracanalicular neuromas and the definite exclusion of acoustic neuroma. HR CT proved superior to polytomography for the evaluation of the internal auditory canal and should be performed in every case suspected of acoustic neuroma. A protocol for the radiological investigation of patients suspected of acoustic neuroma is given     

经乙状窦后入路小脑前下动脉显微解剖学研究

目的 研究小脑前下动脉(AICA)的显微解剖学特点及临床应用价值。方法 取6具尸头,经乙状窦后入路,用手术显微镜、神经内镜观察AICA的行程、分支、分布及其与周围结构的关系。结果 共观察到15支AICA,无AICA缺如,AICA发出四组重要的分支:桥延支、内听动脉、回返穿通支和弓状下动脉。AICA紧贴面听神经腹侧行走,并发出分支营养神经。结论 AICA与脑干、面听神经关系密切。听神经瘤手术中应妥善保护其主干及分支,以提高面听神经功能保留率。