神经内镜造瘘术治疗小儿鞍上池蛛网膜囊肿(附15例报告)

目的 探讨脑室囊肿造瘘联合囊肿桥前池造瘘术(VCC)在治疗小儿鞍上池蛛网膜囊肿(SACs)的有效性和安全性.方法 总结2008年1月至2011年10月天津市环湖医院收治的15例小儿鞍上池囊肿患者,全部病例应用神经内镜脑室囊肿联合囊肿脑池造瘘手术,手术前后进行对比分析,评价指标包括脑积水症状缓解,鞍上池囊肿引起的内分泌改变,影像学脑积水缓解程度,囊肿缩小程度,视交叉和脑干恢复情况,导水管开放.结果 全部病例造瘘手术顺利完成,术中观察到导水管开放,术后脑积水症状改善明显,内分泌症状中多饮多尿缓解最明显,影像学检查脑积水缓解,囊肿缩小,视交义位置下降并后移,脑干位置部分恢复,造瘘口和(或)导水管可见脑脊液流动影像,上述指标术前后对比差异有统计学意义.结论 神经内镜囊肿造瘘沟通脑室和囊肿以及囊肿与脑池的手术方式有效地解决了由鞍上池囊肿引起的各类症状,该术式有效且安全.     

囊肿-腹腔分流术治疗儿童中线部位巨大蛛网膜囊肿

目的 总结囊肿-腹腔分流手术治疗儿童中线部位巨大蛛网膜囊肿的临床经验.方法 回顾性分析2005年1月至2011年12月应用囊肿-腹腔分流手术治疗的儿童中线部位巨大蛛网膜囊肿的临床资料,总结分析其发病特点合并畸形及预后情况.结果 17例患儿接受囊肿-腹腔分流手术,多因头围增大就诊或孕期超声发现囊肿,多伴有邻近脑组织的发育不良,可有一定程度的生长发育落后,经分流手术后症状消失,发育改善.结论 儿童中线部位巨大蛛网膜囊肿早期进行分流手术简单、有效,预后较好.     

鞍上蛛网膜囊肿的诊断和治疗(3例报告)

蛛网膜囊肿约占颅内占位病变的1%,即鞍上蛛网膜囊肿以往资料仅有个案报导。随着电子计算机断层摄影(cT)的出现,本症能较早发现并于术前即可确诊。但由于其常伴有脑积水而易被误     

立体定向引导神经内镜下鞍上池蛛网膜囊肿的治疗（附17例临床分析）

目的对鞍上池蛛网膜囊肿安全、有效治疗方法的探讨。方法应用立体定向引导在神经内镜下行鞍上池蛛网膜囊肿造瘘和桥前池造瘘术17例。结果经过随访6个月～8年,17例术后均改善,其中12例症状完全消失,5例症状减轻,无并发症及死亡病例。结论立体定向引导神经内镜下行鞍上池蛛网膜囊肿造瘘和桥前池造瘘术,安全、有效、经济等优势。     

神经内镜手术治疗鞍上蛛网膜囊肿专家共识

一、背景鞍上蛛网膜囊肿约占颅内蛛网膜囊肿的10%,多见于儿童[1-2]。随着对其起源和病理机制的认识深入,其治疗策略以及手术技术也不断完善。目前,鞍上蛛网膜囊肿的治疗首选应用神经内镜技术经侧脑室额角入路囊壁部分切除+囊肿-脑室或脑池造瘘术;其他手术方式包括囊肿-腹腔分流术、开颅囊肿切除术及立体定向引导下囊肿开窗术等,因其具有并发症发生率高、创伤大或有效率低等缺点,均已很少采用[3-9]。     

后颅窝蛛网膜囊肿临床治疗分析

目的 探讨后颅窝蛛网膜囊肿的治疗策略。方法 回顾性分析后颅窝蛛网膜囊肿手术治疗患者15例,结合文献复习,对其治疗作分析。结果 15例患者中,行开颅手术9例,囊肿腹腔分流手术6例。开颅术患者3例继发脑积水,再次行分流手术后缓解;分流术患者1例分流管位置不佳,1例未解决其继发脑积水问题而再次行脑室-腹腔分流术。随访3个月～2a,8例囊肿变小,其中开颅组5例,分流组3例,1例复发。结论 对症状性后颅窝囊肿可考虑手术治疗,其手术指征应严格把控。对有占位效应而无明显症状的儿童后颅窝囊肿患者,早期手术有助于脑组织发育,但手术指征仍有争议,具体手术与否应个体化考虑。传统开颅手术在后颅窝囊肿治疗中创伤大,效果欠佳,有继发脑积水风险。神经内镜手术逐渐替代传统开颅手术,成为后颅窝囊肿手术首选,囊肿腹腔分流为不可缺少的治疗选择。     

四叠体池蛛网膜囊肿

目的:探讨四叠体池蛛网膜囊肿的临床特征和治疗方法。方法:对11例四叠体池蛛网膜囊肿进行了回顾性总结分析。所采用的手术方法有:①脑室分流手术;②囊肿-腹腔分流术;③囊肿切除;④囊肿切除加囊肿-脑池分流术,或囊肿部分切除(即囊肿开窗术),或囊肿切除加脑室-脑池分流术。结果:其主要临床表现以颅内压增高症和中线综合征为主。上述方法中单纯囊肿壁切除只能使部分病人的病情缓解,脑室分流或囊肿切除加脑室分流手术的疗效较好。结论:四叠体区蛛网膜囊肿常合并梗阻性脑积水,单纯囊肿切除不能解除多数病人的梗阻性脑积水。作者根据囊肿是否与蛛网膜下腔相通提出:对交通性蛛网膜囊肿采用单纯性脑室分流术,对非交通性者采用囊肿切除加脑室分流手术的治疗方法。     

鞍上蛛网膜囊肿

鞍上蛛网膜囊肿是一种罕见疾病,儿童发病较成人多见.其临床特征类似于鞍区及第三脑室肿瘤.电子计算机断层扫描(CT)能较早地发现并可能在术前确诊.手术预后尚满意.本文收集有关文献个案报告共54例.考虑到此症在诊治上以及与婴儿脑积水鉴别诊断上都有一定的参考价值,现综述如下.一发病因素及发病机制     

桥前蛛网膜囊肿:诊断及神经内镜治疗

颅内蛛网膜囊肿占颅内占位性病变的1%，其中约10%位于鞍上，第三脑军区域。现代MRI和神经内竟检查显示其主体位于鞍上区，但并非起源于第三脑室，垂体窝或鞍上区，而是起源于桥前池，并向上发展。在MRI广泛应用前，这些囊肿被称作第三脑室囊肿、鞍上蛛网膜囊肿或鞍上-桥前珠网膜囊肿。基于囊肿的起源，作者支持采用Sweasey等提出的“桥前蛛网膜囊肿”这一名称。     

神经内镜治疗颅内蛛网膜囊肿的手术体会(附12例分析)

1对象与方法我院2005年4月～2006年4月,应用神经内镜治疗颅内蛛网膜囊肿12例,其中男7例,女5例;年龄6～15岁,平均10岁。病程5个月～5年。临床表现：颅高压7例,癫疒间1例,颞部膨隆3例;外伤后偶然发现1例（同时伴额颞部硬膜下积液）。影像学检查示蛛网膜囊肿位于外侧裂8例,鞍上2例,侧脑室2例。不同程度脑积水3例。[第一段]     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.