汉族人白细胞介素-6-174G/C基因多态性与颅内动脉瘤的关联性研究

目的 探讨汉族人白细胞介素-6-174G/C(IL-6-174G/C)基因多态性与颅内动脉瘤(IA)的相关性.方法 用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术对182例颅内动脉瘤患者(颅内动脉瘤组)和182名健康者(对照组)的IL-6-174G/C的基因多态性进行分析,运用统计学方法分析基因与疾病的相关性.结果 IL-6-174G/C基因型的分布频率与对照组比较有统计学意义(P<0.001),IL-6-174(G/C)G等位基因频率为69.51%,对照组为56.87%,两组比较有统计学差异(P<0.001).结论 IL-6-174G/C基因多态性与颅内动脉瘤的发病有一定关系,考虑C等位基因频率增高与颅内动脉瘤的发病有关.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

星形细胞瘤不同区域血管生成模式的组织形态学观察

目的 通过对星形细胞瘤水肿区和瘤体区的组织学观察,探讨其不同区域的血管生成,并观察拟态血管的形态学基础.方法 对照磁共振精确留取51例星形细胞瘤水肿区和瘤体区组织后行CD34-PAS双染色.结果 在水肿区发现CD34-PAS双染呈CD34、PAS均阳性的管道样结构,均为血管或微血管.在4例胶质母细胞瘤瘤体区发现除了占绝大多数的CD34、PAS均为阳性的血管或微血管外,还有:(1)拟态血管(PAS阳性且CD34阴性的物质形成的管状结构,其两侧有瘤细胞排列,内含红细胞);(2)PAS阳性且CD34阴性的物质形成内含红细胞的管状结构,其两侧无明显细胞排列;(3)PAS阳性和部分CD34阳性的血管或微血管;(4)PAS阳性且CD34阴性的血管或微血管.结论 大部分星形细胞瘤水肿区和瘤体区血管生成模式仍然以血管或微血管形式存在,而一些高度恶性的星形细胞瘤瘤体区出现的拟态血管可能是血管生成不良的表现.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

组织蛋白酶D在星形细胞瘤中心区、周缘区和水肿区的表达情况

目的 探讨组织蛋白酶D(CathD)在人脑星形细胞瘤瘤体中心区、周缘区和瘤周水肿区的表达情况及临床意义.方法 选择核磁共振检查未见肿瘤坏死或囊变且瘤体区与水肿区有明显分界的41例星形细胞瘤患者,分为复发组13例、未复发组28例.术中对照磁共振FLAIR序列留取瘤体中心区、周缘区和水肿区后行CathD免疫组化染色,对其在不同区域表达水平进行分析.结果 CathD在正常脑组织无或弱表达,其在瘤体中心区、瘤周水肿区和周缘区呈阳性表达,且周缘区[(10.780±1.557)分]高于中心区[(2.610±0.945)分],差异有统计学意义(P<0.05).在瘤体周缘区复发组CathD表达[(11.539±1.127)分]强于未复发组[(10.429±1.620)分],差异有统计学意义(P<0.05),而在瘤体中心区复发组与未复发组CathD表达差异无统计学意义(P>0.05).结论 周缘区和水肿区CathD明显表达提示瘤周水肿区可能是瘤细胞易于发生浸润的区域:中心区CathD相对低表达说明该区细胞外基质已被降解殆尽,是肿瘤侵袭较早发生的区域;周缘区和水肿区CathD表达情况可作为一种判断肿瘤复发的指标.     

骨瓣成形开颅治疗慢性硬膜下血肿17 例临床分析

目的：加深对慢性硬膜下血肿的认识,引导临床选择有效的治疗方法。方法：回顾性分析骨瓣成形开颅 治疗的17例慢性硬膜下血肿,分析其影像学资料、术中发现、术后并发症,探讨开颅手术治疗慢性硬膜下血肿的适 应证。结果：分隔型血肿13例,血肿内缘的反“3”形压迹及腔内条索状分隔为其特征性影像学表现;机化型血肿4 例,血肿MRI T1,T2呈高信号,其内网状分隔、增厚内膜呈低信号。单纯钻孔引流不充分,骨瓣成形开颅清除血肿 完全,除1例复发外,无严重手术并发症。结论：结合术前影像学资料,部分慢性硬膜下血肿可首选骨瓣成形开颅手 术治疗。     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.