面肌痉挛微血管减压术中异常肌反应变化特点与术后疗效关系探究

目的探究面肌痉挛患者微血管减压术(MVD)中异常肌反应(AMR)的变化特点与术后疗效的关系。方法回顾性分析73例MVD术中采用AMR全程定量化监测患者的AMR变化特点,减压操作前AMR阈值较基础阈值升高≥1倍为A1组、1倍为A2组,手术结束时AMR完全消失为B1组、未消失为B2组,B2组中AMR阈值较基础阈值升高≥1倍为B2a组、1倍为B2b组,对各组的术后疗效进行对比分析。结果 A1组21例中,19例立即治愈,1例延迟治愈,1例未愈; A2组52例中,35例立即治愈,9例延迟治愈,8例未愈。A1组较A2组疗效好(P=0. 046)。B1组50例中,42例立即治愈,5例延迟治愈,3例未愈; B2组23例中,12例立即治愈,5例延迟治愈,6例未愈。B1组较B2组疗效好(P=0. 003)。B2 a组的治愈比例较B2 b组高(分别为14/16、3/7),差异有统计学意义(P=0. 045)。结论 AMR在术中的变化特点对术者有重要参考意义,AMR在减压前升高、在手术结束时完全消失、未消失但升高较基础阈值≥1倍者术后疗效相对较好。     

显微手术治疗后颅窝血管母细胞瘤（附31例分析）

目的探讨后颅窝血管母细胞瘤（HB）的诊断和显微手术治疗。方法回顾性分析2010年1月~2013年2月经显微手术治疗并经病理学证实的31例后颅窝HB患者的临床资料。结果肿瘤实质部分全切除29例,2例位于延髓者部分残留。术后27例随访3个月至3年,23例恢复正常生活和学习,4例存在轻度小脑共济障碍。结论 MRI是一种诊断后颅窝HB的有效方法;显微手术全切除肿瘤效果良好。     

血管重建术治疗难治性颅内动脉瘤

对于需要闭塞载瘤动脉的难治性颅内动脉瘤,血管重建技术是解决脑血流代偿不足的良好方法.随着显微手术技术的发展,移植血管通畅率的不断提高,血管重建治疗难治性颅内动脉瘤的疗效也在不断提高.     

高位颈段椎管内神经鞘瘤显微手术治疗59例

目的 探讨高位颈段神经鞘瘤显微手术技巧和疗效.方法从2004年1月至2007年12月,对59例均采用后正中入路显微手术治疗,采用德国产Laika显微镜下切除肿瘤,较大肿瘤不能完整切除时,用分块切除或囊内切除,术后常规颈托限制颈部活动,55例术后随访6个月～2年.结果 痊愈54例,症状改善5例,无死亡.55例随访6个月～2年,4例失访.35例术后3～12个月MR检查未见肿瘤残存或复发,42例术后6个月颈椎正侧位及张口位片检查未见脊柱骨性结构变形,脊柱稳定性好.结论 高位颈段神经鞘瘤一旦确诊,就应该及早显微手术治疗.手术安全、效果良好.

Abstract：

Objective To explore surgical techniques and curative effects of microsurgical treatment for neurilemmoma in upper cervical spinal canal. Methods From Jan. 2004 to Nov. 2007, 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach, using German Laika microscope resection of the tumor, large tumors cannot complete resection,block or sac, resection postoperative neck activity conventional neck restrictions, with following observation of 6 months-2 years. Results A complete recovery was achieved in 54 cases, an improvement of symptoms was achieved in 5 cases, no death was encountered. Follow-up observations were carried out in 55 cases from 3 months-2 years (6.5 ± 1.5 months). MRI examinations 3-12 months after operation in 35 cases found no residual or recurrent tumor. X-ray radiography under anteroposterior, lateral, and open-mouth view 6 months after operation in 42 cases showed no spinal deformation and good vertebral stability. Conclusions As long as neurilemmoma in upper cervical spinal canal are diagnosed, a microsurgical treatment should be given as early as possible. Appropriate selection of surgical approach, skillful microsurgical techniques in accordance with pathological types of lesions, and principles of minimal invasion are critical for the operation safety.     

Nanog基因在脑肿瘤干细胞中的表达及意义

目的 探讨Nanog基因在脑肿瘤干细胞(BTSCs)的表达以及生物学意义.方法 无血清悬浮培养法从U87胶质瘤细胞株分离培养BTSCs.免疫细胞化学染色和RT-PCR方法检测U87肿瘤细胞及其BTSCs中Nanog的表达,双重免疫细胞化学染色法检测Nanog/CD133共表达情况.结果 在U87胶质瘤细胞株中成功分离培养出BTSCs,Nanog蛋白在U87肿瘤细胞和BTSCs中的阳性率分别为(64.1±18.2)%和(97.2±1.8)%,且Nanog+/CD133+细胞共表达于部分细胞中;Nanog mRNA相对含量在U87肿瘤细胞和BTSCs中分别为0.3851±0.0771和0.6032±0.1223,差异有统计学意义(P＜0.05).结论 U87细胞株中存在BTSCs.Nanog在U87细胞株中高表达,在BTSCs中表达水平高于U87肿瘤细胞且Nanog与CD133存在共表达,表明Nanog与BTSCs关系密切.

Abstract：

Objective To detect the expression of Nanog in glioma cell line U87 and the relationship with BTSCs.Methods BTSCs were isolated from glioma cell line U87 and cultured in simplified serum-free neural stem cell medium by nanosphere suspension culture method spheres,and purified continuously through the monoclonal formation experiment.The immunofluorescence staining of cells was employed to identify the BTSCs and differentiated cells.The expression of Nanog mRNA was examined by RT- PCR and Nanog protein was detected by immunocytochemistry in U87 and BTSCs respectively.Double immunocytochemistry staining was used to detect the co- expressions of Nanog/CD133.Methods BTSCs were isolated ,cultured and purified successfully from glioma cell line U87.Both Nanog mRNA and protein were expressed in U87 and BTSCs.The expression rate of immunopositive cells was (64.1 ±18.2)% in U87 and (97.2±1.8)% in BTSCs respectively(t =5.719,P =0.000).The Nanog+/CD133+ cells could be found co-expressed in U87 and BTSCs by using double immunocytochemistry s taining.The relative level of Nanog expression was 0.3851 ±0.0771 in U87 and0.6032±0.1223 in BTSCs(t =4.770,P =0.000).Conclusion BTSCs exist in glioma cell line U87 in vitro.The levels of Nanog expression in BTSCs were higher than that in U87.Nanog expression was associated with the genesis and differentiation state of glioma.The overexpression of Nanog and co- expression of Nanog/CD133 showed that it might contribute to the existence of BTSCs,which lay a foundation to the further explore its role in biological behaviour of glioma.Expression of Nanog in U87 indicated the close relationship between glioma and stem cell,and suggested Nanog may play a critical role in the development of glioma.     

颅内海绵状血管瘤的临床治疗经验

目的 探讨颅内海绵状血管瘤(ICCA)的治疗策略.方法 回顾性分析55例经病理证实的颅内海绵状血管瘤病人的临床资料.其中采用常规开颅方式手术30例,神经导航手术19例,立体定向手术6例.结果 全切除52例,大部切除3例.术后无死亡,无颅内出血.术后主要并发症为感染、脑水肿和脑梗死,对症治疗后均好转.结论 神经导航手术是...     

颅眶沟通性肿瘤的显微外科治疗

目的探讨颅眶沟通性肿瘤显微手术治疗的效果及其相关技巧。方法 2000年5月至2011年5月对27例颅眶沟通性肿瘤患者进行了手术治疗。根据肿瘤的生长方式及对眼眶的累及情况选用不同的手术入路,其中经额颞眶顶入路手术17例,眶上-翼点入路5例,改良翼点入路5例。结果肿瘤全切除21例,次全切除4例,部分切除2例;肿瘤全切除率为77.8%(21/27)。术后病理学检查示脑膜瘤19例,转移癌2例,视神经胶质瘤1例,视神经纤维瘤4例,泪腺混合瘤1例。术后随访6年,2例死亡,22例仍存活,3例随访半年后失去联系。结论颅眶沟通性肿瘤首选的治疗方法为手术,选择合适的手术入路、娴熟的显微手术操作对于全切除肿瘤及减少术后并发症十分重要。     

微血管减压术后复发性三叉神经痛的原因分析及再手术对策

目的对微血管减压术后复发性三叉神经痛进行再次手术,术中探查复发的致病原因。方法对6例复发性三叉神经痛的患者进行再手术探查,1例进行了微血管再减压术,5例进行了感觉根部分切断术。结果 1例患者为垫棉位置不理想,重新减压手术,5例血管减压充分,但明显有蛛网膜增厚、垫棉与神经根粘连、包裹,锐性分离困难,只能行感觉根部分切断。术后均疼痛消失,切断患者遗留有面部麻木。结论垫棉粘连可能是导致复痛的主要原因,感觉根部分切断术是该种情况下的首选。