硬性内镜辅助下的颅内动脉瘤显微手术

目的 探讨硬性内镜在颅内动脉瘤手术中的应用,分析其优缺点.方法 回顾性分析63例患者66个动脉瘤的显微手术,其中63个破裂动脉瘤,3个未破裂动脉瘤.多数患者在内镜辅助下完成动脉瘤夹闭术,包括动脉瘤夹闭前后对载瘤动脉、瘤颈及瘤周穿通支的观察,以确定最佳夹闭位置和程度.结果 内镜能更好地观察瘤周局部解剖结构,保证首次最佳夹闭,5例第一次夹闭后,经内镜发现夹闭不佳而重新调整动脉瘤夹,其中1例颈内后交通动脉瘤夹闭不全;1例颈内动脉眼动脉瘤夹闭不全;1例颈内后交通动脉瘤夹闭动脉瘤同时夹闭后交通动脉;2例前交通动脉瘤夹闭穿通支.在使用内镜过程中造成1例轻度颞叶脑挫伤,在所有过程中未造成动脉瘤破裂出血.结论 在颅内动脉瘤夹闭过程中辅助使用内镜,能更好地观察动脉瘤及其周围的局部解剖结构,提高动脉瘤夹闭手术的质量.     

三维CT血管造影对颅内动脉瘤夹闭术后的评价意义

目的 探索颅内动脉瘤夹闭术后方便、安全、可靠的评价方法 ,研究三维CT血管造影(3D-CTA)对术后评价的临床意义. 方法 回顾性分析我院自2006年1月至2007年3月收治颅内动脉瘤患者120例,显微手术夹闭52例,术后采用3D-CTA随访手术患者20例,其中多发动脉瘤1例,动脉瘤数21个(前交通动脉瘤11个,后交通动脉瘤7个,大脑中动脉M3段1个,脉络膜前动脉1个,大脑前动脉A1段起始部1个),随访2～38周,平均(15±11)周,观察术后瘤夹位置,载瘤动脉近段与远段通畅情况,瘤体及瘤颈残留等. 结果 3D-CTA显示动脉瘤夹位置良好19例,瘤央冈合并弹簧圈放射状伪影难以准确显示1例:载瘤动脉近段及远段通畅良好20例,可清楚分辨出瘤夹与载瘤动脉之间关系,未发现动脉瘤体残留. 结论 3D-CTA可作为动脉瘤夹闭术后随访评价的重要方法 ,具有重要的临床应用价值.     

一侧翼点入路夹闭两侧脑动脉瘤

两侧脑动脉瘤手术时,首先应该处理破裂的动脉瘤,然后最理想的是在同一术野中夹闭对侧未破裂动脉瘤,这样对患者损伤小。对于脑底动脉环半侧的动脉瘤(颈内动脉、前交通动脉、大脑中动脉和脑底动脉分叉部附近的动脉瘤)加上对侧颈内动脉瘤(颈-眼动脉、颈-后交通动脉、颈-脉络膜前动脉和颈内动脉分叉部动脉瘤等),如果适当选择病例,从一侧翼点入路夹闭对侧颈动脉瘤是可能的。作者报告了2例。一例为右侧大脑中动脉瘤加左侧颈-后交通动脉瘤;另一例为左侧颈-后交通动脉瘤加右侧颈-脉络膜前动脉瘤。这两例均由一侧翼点入路,处理了同侧动脉瘤后,在同一术野中夹闭了对侧动脉瘤的瘤蒂。本文主要探讨手术入路问题并报告了病例。     

微血管多普勒超声在颈内动脉瘤手术中的应用

目的 探讨微血管多普勒超声(MVD)在颈内动脉瘤手术中的应用.方法 采用探头频率20MHz、直径1.5 mm,对32例颈内动脉瘤患者(共计36个动脉瘤)进行动脉瘤夹闭前后血流动力学监测.术后血管造影进行评估.结果 所有患者均能在动脉瘤顶或瘤体部监测到涡流样或毛刺样血流信号、闻及杂音.动脉瘤夹闭术后即刻监测,发现载瘤动脉狭窄8例,闭塞1例;动脉瘤夹闭不全2例,均经调整瘤夹位置,显示载瘤动脉远段的血流频谱形态和音频信号正常,术后经DSA/CTA证实.以上情况的发生与动脉瘤大小及载瘤动脉有粥样硬化斑块有关.结论 MVD可作为颅内动脉瘤手术的常规检测方法,尤其对瘤颈粗、甚至无明显瘤颈的巨大型动脉瘤手术具有指导意义.     

低位型后交通动脉动脉瘤显微夹闭术中前床突磨除的意义

目的探讨经硬膜外磨除前床突在低位型后交通动脉动脉瘤显微夹闭术中的临床意义。方法回顾性分析2014年12月至2016年3月行显微夹闭术治疗的21例低位型后交通动脉动脉瘤的临床资料,21例术中均经硬膜外途径磨除前床突以促进术野显露。结果 21例动脉瘤均夹闭满意,其中6例动脉瘤因被前岩床皱襞遮挡,辅以切开电灼扩大操作空间后顺利放置瘤夹。术后随访6个月,GOS评分5分18例,4分3例。结论磨除前床突有利于低位型后交通动脉动脉瘤的瘤颈暴露、载瘤动脉的临时阻断以及动脉瘤夹的放置。     

一侧翼点入路治疗颅内多发动脉瘤的显微外科解剖学研究

目的探讨翼点入路手术治疗颅内多发动脉瘤的可行性，为临床一期开颅夹闭多发动脉瘤奠定解剖学基础。方法14例经颈内动脉灌注的成人尸头模拟翼点入路，研究前循环常见位置动脉瘤：眼动脉（OA）、后交通动脉（PCoA）、颈内动脉（ICA）分叉部和大脑中动脉（MCA）分歧部动脉瘤通过对侧翼点入路显露的可能性，及相关解剖结构的测量，结合临床手术治疗多发动脉瘤患者资料，探讨一期夹闭多发动脉瘤的可行性。结果通过对侧翼点入路，模拟各部位动脉瘤显露成功率分别为：眼动脉64％；后交通动脉42％；颈内动脉分叉部100％；大脑中动脉分歧部57％。眼动脉和部分后交通动脉暴露需要切开大脑镰和松解对侧视神经。大脑中动脉分歧部能否暴露取决于M1段长度，M1〈14mm时可成功暴露。结论翼点入路可以完成对侧特定指向、特定位置的动脉瘤的夹闭，视神经的长度、动脉瘤的指向等解剖学参数对于评估多发动脉瘤一期夹闭的可行性具有重要意义。     

颈内动脉床突段微小动脉瘤治疗体会

目的 探讨颈内动脉床突段微小动脉瘤的治疗方法.方法 回顾性分析经临床和影像学方法确诊的18例颈内动脉床突段微小动脉瘤患者资料,其中颈内动脉-眼动脉瘤患者4例,3例行血管内治疗,1例行开颅夹闭;颈内动脉后交通动脉瘤患者10例,3例行血管内治疗,7例行开颅夹闭;颈内动脉脉络膜前动脉瘤患者3例,1例行血管内治疗,2例行开颅夹闭;1例颈内动脉分叉部动脉瘤患者行开颅夹闭.结果 1例颈内动脉-眼动脉瘤患者行弹簧圈栓塞治疗后破裂出血,死亡;1例行支架辅助弹簧圈栓塞治疗颈内动脉后交通动脉瘤患者术中破裂,疏松填塞,术后再次破裂出血,死亡;1例行单纯弹簧圈栓塞治疗颈内动脉后交通动脉瘤患者术中弹簧圈逸出,后行开颅夹闭,恢复好;其余病例预后均良好.结论 颈内动脉床突段微小动脉瘤中眼动脉瘤以支架辅助弹簧圈疏松栓塞治疗为宜,开颅夹闭是治疗颈内动脉床突上段微小动脉瘤的首选.     

翼点微骨孔入路治疗颅内前循环动脉瘤

目的探讨应用微骨孔入路治疗颅内前循环动脉瘤的临床效果。方法2000年11月～2001年12月采用翼点微骨孔入路治疗前循环动脉瘤病人83例,共86个动脉瘤。其中颈内动脉眼段动脉瘤3例,颈内动脉C2段动脉瘤40例,颈内动脉分叉部动脉瘤4例,前交通动脉瘤19例,前动脉水平段动脉瘤2例,中动脉水平段5例,中动脉分叉部动脉瘤13例。结果成功治疗前循环动脉瘤病人83例,共夹闭86个动脉瘤。术后出现肢体活动障碍4例,占4.8%;无手术死亡。术后80例复查脑血管造影,显示动脉瘤消失。无与开颅入路相关的并发症。本组均未输异体血液,术中采用自体血回收后输血26例。结论翼点微骨孔入路夹闭颅内前循环动脉瘤,可以降低手术中的医源性损伤并获得满意的手术效果。     

颞浅动脉-大脑中动脉分流术在颅内复杂动脉瘤手术中的应用

目的 探讨颞浅动脉（STA）-大脑中动脉（MCA）分流术在颅内复杂动脉瘤手术中的应用效果。方法 回顾性分析开颅夹闭术治疗的2例颅内复杂动脉瘤的临床资料。夹闭动脉瘤前,先行STA-MCA分流术。结果 1例破裂动脉瘤,DSA显示右侧颈内动脉后交通段巨大动脉瘤（责任动脉瘤）+左侧颈内动脉后交通段镜像动脉瘤,伴双侧胚胎型大脑后动脉,先行STA-MCA分流术,再行动脉瘤孤立术。1例未破裂动脉瘤,DSA显示MCA分叉部大型动脉瘤位,MCA M2段下干粗大,上干纤细,上干起始部均成为瘤颈的一部分,先行STA-MCA分流术,再行动脉瘤夹闭术。2例术后均无明显神经功能障碍,CTA示动脉瘤不显影、吻合口通畅,CTP显示脑灌注良好;术后6个月,改良Rankin量表评分0分1例,1分1例。结论 STA-MCA分流术能够延长安全临时阻断的时间,在动脉瘤孤立和载瘤动脉闭塞后提供保护性血流,在理想情况下双支STA分流术还可以提供高流量血流,替代复杂的桡动脉或大隐静脉分流术,简化手术操作。这项技术有利于提高颅内复杂动脉瘤的治愈率,降低手术并发症的发生率。     

颅内动脉瘤的直接手术(附40例分析)

分析40例颅内动脉瘤的直接手术,39例以蛛网膜下腔出血为首发症状,血管造影发现44个动脉瘤,大多数位于颈内动脉和前交通动脉。多数行瘤颈结扎或夹闭,术后造影17例动脉瘤消失,随访26例均恢复良好,在各种方法中直接手术宜优先选用瘤颈结扎法。     

Nervenkitt: notes on the history of the concept of neuroglia

The evolution of concepts concerning the identity and the functions of neuroglia is traced. Some of the main ideas in the works of Virchow, Deiters, Golgi, Lenhossék, Lugaro, Ramón y Cajal, del Río-Hortega, Achúcarro, Penfield, and others are highlighted.     

Effects of Family Interventions on Burden of Relatives of Psychiatric Patients in The Netherlands: A Pilot Study

In this study, the effects of psychoeducational family support groups in the Netherlands on relatives' burden were investigated, using a quasi-experimental design. The experimental group consisted of 119 participants of 19 family support groups, the control group of 45 relatives of once-only informational meetings. Subjects from both groups filled in a questionnaire before the group started and one year later. While controlling for confounding variables in multiple regression analyses, significant effects of family support groups were found on elements of burnout and burden.     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

Outcome and neurological sequelae of patients after tetanus

From 1969-1985, 106 people contracted tetanus in Finland. The outcome of the disease was good in 78 cases (returned to work), poor in 27 (12 died, 5 institutionalized and 10 retired) and unknown in 1. Poor outcome was the result of a disease requiring respirator treatment. Other clinical factors significantly correlated with poor outcome were blood pressure lability, hyperglycemia, hyperthermia, tachycardia and anticoagulation therapy. Forty people who were representative of the whole series with regard to sex, age and severity of disease attended a follow-up study on average 7 years and 4 months later. Forty age- and sex-matched controls had the same examinations, and compared with them, the 40 patients still had significantly more muscle fatigue and cramps, nervousness, decreased mental capacity and difficulties in balance, speech and memory. They also had more clinical findings, such as peripheral paresis, muscular atrophy, decreased or absent tendon reflexes and decreased mental capacity than the controls.     

Psychology in Cognitive Science: 1978–2038

This paper considers the past and future of Psychology within Cognitive Science. In the history section, I focus on three questions: (a) how has the position of Psychology evolved within Cognitive Science, relative to the other disciplines that make up Cognitive Science; (b) how have particular Cognitive Science areas within Psychology waxed or waned; and (c) what have we gained and lost. After discussing what’s happened since the late 1970s, when the Society and the journal began, I speculate about where the field is going.     

Supervision of mental health care in the Netherlands

Summary In the Netherlands the Inspectorate of Mental Health has to supervise the quality of mental health care that is given to its citizens. A shortage of inspectors hampers effective accomplishment of this task, and government budget cuts have increased this problem. Another obstacle is the absence of standarized methods of supervision and clear norms for medical practice. This paper describes the efforts of the Inspectorate to develop a new technique of supervision to solve this problem, the so-called frames of reference.     

Perceptual Pragmatism and the Naturalized Ontology of Color

This paper considers whether there can be any such thing as a naturalized metaphysics of color—any distillation of the commitments of perceptual science with regard to color ontology. I first make some observations about the kinds of philosophical commitments that sometimes bubble to the surface in the psychology and neuroscience of color. Unsurprisingly, because of the range of opinions expressed, an ontology of color cannot simply be read off from scientists’ definitions and theoretical statements. I next consider two alternative routes. First, conceptual pluralism inspired by Mark Wilson's analysis of scientific representation. I argue that these findings leave the prospects for a naturalized color ontology rather dim. Second, I outline a naturalized epistemology of perception. I ask how the correctness and informativeness of perceptual states is understood by contemporary perceptual science. I argue that the detectionist ideal of correspondence should be replaced by the pragmatic ideal of usefulness. I argue that this result has significant implications for the metaphysics of color.     

Italian neurology: past, present and future

This short history of the Italian Society of Neurology focuses on its founders and leading personalities. The article also considers the present and the future of Italian neurology, emphasising in particular the scientific impact of Italian neurological research on the main international journals and the activities undertaken to increase the role of neurologists.