多模态神经导航辅助下手术切除脑运动区胶质瘤1例

正1病例资料女,31岁,因检查发现右侧额叶占位半年入院。入院体格检查未见阳性体征。头颅MRI显示右侧额上回肥大、皮髓质层次破坏,累及中央前回;T1WI呈低信号,T2WI呈稍高信号,增强后无明显强化;病灶大小约为7.5 mm×5.5 mm(图1A)。磁共振弥散张量成像显示大脑皮质脊髓束未见纤维束中断、破坏、移位。磁共振血氧依赖性饱和成像显示邻近肿瘤内侧的中央旁小叶有皮层运动功能激活表现。术前行多模态神经影像融合,显示肿瘤主体位于运动前区,累及中央前回,部分激活的运动皮层位于肿瘤后方,肿瘤被锥体束包绕,未见肿瘤浸润锥体束及明显的锥体束推移(图1B)。3D     

多模态神经导航系统联合神经内镜在颅咽管瘤手术中的临床应用

目的 探讨多模态神经导航系统联合神经内镜手术治疗颅咽管瘤的临床效果及安全性,寻找颅咽管瘤手术治疗的最佳策略。方法 回顾性分析中国医科大学附属第一医院神经外科2017年1月—2019年1月在多模态神经导航系统辅助下经鼻神经内镜切除颅咽管瘤的18例患者的临床资料。分析患者的肿瘤切除程度及术后并发症。结果 16例患者(88. 9%)的肿瘤完全切除,2例患者(11. 1%)的肿瘤次全切除。6例患者(33. 3%)术后出现并发症,其中脑脊液鼻漏1例、尿崩症2例、发热1例、低血钠1例、甲状腺功能下降1例。结论 多模态神经导航系统通过多图像融合和三维重建原理,联合术中多普勒超声和神经电生理监测实时显示病变与邻近血管、神经的空间关系,提高了颅咽管瘤的全切率,减少了术后并发症的发生率。多模态神经导航系统联合神经内镜在颅咽管瘤手术中的应用显著改善了手术效果,并为颅咽管瘤的手术治疗提供了更好的保障。     

神经电生理监测及多模态影像融合技术在面肌痉挛微血管减压术中的应用

目的 探讨神经电生理监测及多模态影像融合技术在面肌痉挛（HFS）微血管减压术（MVD）中的应用效果。方法 回顾性分析2019年6月至2020年6月神经电生理监测及多模态影像融合技术辅助MVD治疗的6例HFS的临床资料。术前应用3D Slicer软件进行多模态影像融合分析责任血管并制定手术方案,术中全程监测侧方扩散反应（LSR）。结果 6例多模态影像融合显示责任血管与术中所见完全相符。6例术中充分减压后LSR波形消失,术后Cohen评分0分4例,1分1例,2分1例;术后随访6个月,颜面部抽搐症状均消失,术后12个月未见症状复发。结论 神经电生理监测联合多模态影像融合可帮助制定手术方案,提高手术疗效。     

多模态MRI、神经导航和超声在脑胶质瘤术中的应用

正脑胶质瘤是中枢神经系统最常见的恶性肿瘤,占原发性颅内肿瘤的50%~60%~([1])。目前,胶质瘤治疗主要采用手术联合放化疗,以及分子靶向治疗等综合治疗。研究显示,胶质瘤切除得越彻底,术后中位生存期越长~([2])。传统的脑胶质瘤手术常依据术前CT、MRI设计方案,术中依据局部脑组织的隆起或凹陷等形态异常、与周围脑组织对比的颜色异常和触摸瘤周质地的变化等来确定病变的位置和范围。这     

神经电生理监测在神经重症病房中的应用

神经电生理监测技术是目前惟一能够直接客观测量脑功能变化的工具［1］,主要包括脑电图（electroencephalogram , EEG）和诱发电位（evoked potentials ,EP）,近年来,随着神经电生理监测技术的不断进步,其在神经重症病房（neurologi‐cal intensive care unit ,NICU ）中的应用越来越广泛,地位也越来越重要,正确掌握神经电生理监测的关键技术,对于准确判断N IC U病人的脑功能损害程度,进行早期干预及改善预后有重要指导意义。本文主要介绍 EEG和 EP在 NICU中的应用,为临床工作提供参考。     

多模态功能神经导航辅助下的术中磁共振在脑功能区胶质瘤手术中的应用

目的探讨多模态功能神经导航辅助下的术中磁共振技术在脑功能区胶质瘤手术中的优势。方法回顾性分析我科收治的186例涉及脑功能区的胶质瘤患者,分为术中磁共振功能神经导航组(A组,简称核磁组)103例和功能神经导航组(B组,简称导航组)83例,选取手术全切率、术后并发症发生率、术后随访结果进行比较。结果核磁组病例手术全切率达90.3%,导航组为55.4%;术后早期并发症发生率核磁组为5.8%,导航组为15.7%;术后随访3～40个月,患者1年生存率核磁组为90.2%,导航组为83.3%。结论术中磁共振技术和功能神经导航技术均为提高胶质瘤全切率的有效技术手段。     

基于多模态磁共振影像的阿尔茨海默病脑网络研究进展

<正>阿尔茨海默病(Alzheimer’s disease,AD)是一种以进行性智能减退为特征的中枢神经系统变性疾病,是最常见的痴呆类型,约占全部痴呆患者的50%%70%[1]。主要表现为全面的认知功能减退,首先出现记忆障碍,随后出现语言、视空间、执行功能障碍、失认及失用等,最终发展为完全性缄默。     

颅内压监测和脑氧监测在颅脑损伤中应用的研究进展

颅脑损伤（TBI）的发病率、致残率及病死率高。继发颅内亚（ICP）增高和脑缺血缺氧严重影响TBI病人的预后。与单纯ICP监测相比,ICP联合脑氧监测可更好地评估病人脑血流灌注及脑组织氧合情况,能为矫正病人脑氧代谢失衡提供及时、准确的依据。本文将简述TBI继发ICP增高和脑缺血缺氧的机制,并就近年来ICP监测和脑氧监测在TBI病人诊疗中单独及联合应用进展进行综述,以期为TBI病人的临床诊治及神经多模态监测研究提供参考。     

肠道菌群与中枢神经系统疾病相关性的研究进展

肠道菌群是近年来的研究热点,其作为人体微生物最大的聚集地,与宿主形成了共生平衡的微生态系统,并通过参与直接作用、代谢产物、宿主免疫等途径,影响着人类的健康。既往传统观念认为中枢神经系统可以作用于肠道,影响肠道微生物群体,但随着菌群测序技术的迅猛发展,越来越多的研究表明肠道菌群还可以反作用于中枢神经系统,与中枢神经系统疾病的发生、发展密切相关,其对这类疾病的诊疗有着巨大的潜在价值。鉴于此,该文重点概述肠道菌群与中枢神经系统疾病之间的关系,及其可能存在的相互作用机制,从而为进一步的研究提供参考。[国际神经病学神经外科学杂志, 2022, 49(5):67-71]     

症状前期鼻咽癌放射性脑损伤的神经影像学研究进展

放射性脑损伤是鼻咽癌放疗后的一种严重并发症,对患者生活质量影响极大。目前临床治疗效果不佳,因而,早期诊断并积极预防放射性脑损伤具有重要的临床意义。近年来,神经影像技术作为一种崭新的成像技术出现已广泛应用于鼻咽癌症状前期放射性脑损伤的研究中。本文就各种神经影像技术在鼻咽癌症状前期放射性脑损伤的脑结构和/或功能中的研究应用进行综述。     

Improved prediction of brain age using multimodal neuroimaging data

Brain age prediction based on imaging data and machine learning (ML) methods has great potential to provide insights into the development of cognition and mental disorders. Though different ML models have been proposed, a systematic comparison of ML models in combination with imaging features derived from different modalities is still needed. In this study, we evaluate the prediction performance of 36 combinations of imaging features and ML models including deep learning. We utilize single and multimodal brain imaging data including MRI, DTI, and rs‐fMRI from a large data set with 839 subjects. Our study is a follow‐up to the initial work (Liang et al., 2019. Human Brain Mapping) to investigate different analytic strategies to combine data from MRI, DTI, and rs‐fMRI with the goal to improve brain age prediction accuracy. Additionally, the traditional approach to predicting the brain age gap has been shown to have a systematic bias. The potential nonlinear relationship between the brain age gap and chronological age has not been thoroughly tested. Here we propose a new method to correct the systematic bias of brain age gap by taking gender, chronological age, and their interactions into consideration. As the true brain age is unknown and may deviate from chronological age, we further examine whether various levels of behavioral performance across subjects predict their brain age estimated from neuroimaging data. This is an important step to quantify the practical implication of brain age prediction. Our findings are helpful to advance the practice of optimizing different analytic methodologies in brain age prediction.     

无创脑水肿动态监护仪在动脉瘤自发性蛛网膜下腔出血患者术后脑水肿监测中的应用

扰动系数是“无创脑水肿动态监护仪”的1个集成参数,是电磁波在大脑组织传递过程中相对衰减程度改变、幅值改变、速度改变、时差改变的集成,通过特定算法复合而成的具体数值,能直观反映颅内病变情况。扰动系数可早期、及时、无创地了解动脉瘤自发性蛛网膜下腔出血患者术后颅内水肿及压力变化,为动脉瘤自发性蛛网膜下腔出血患者术后颅内病情变化提供更优化的监测诊疗手段。     

Aberrant multimodal brain networks in patients with anti-NMDA receptor encephalitis

AimsTo explore large‐scale brain network alterations and examine their clinical and neuropsychological relevance in patients with anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis.MethodsTwenty‐four patients with anti‐NMDAR encephalitis and 26 matched healthy controls (HCs) were enrolled in our study. Based on the multimodal MRI dataset, individual morphological, structural, and functional brain networks were constructed and compared between the two groups at multiple levels. The associations with clinical/neuropsychological variables and the discriminant ability of significant alterations were further studied.ResultsMultimodal network analysis revealed that anti‐NMDAR encephalitis mainly affected morphological and structural networks, but subtle alterations were observed in functional networks. Intriguingly, decreased network local efficiency was observed for both morphological and structural networks and increased nodal centrality in the lateral orbital gyrus was convergently observed among the three types of networks in the patients. Moreover, the alterations, particularly those from structural networks, accounted largely for cognitive deficits of the patients and could distinguish the diseased individuals from the HCs with excellent performance (area under the curve =0.933).ConclusionsThe current study provides a comprehensive view of characteristic multimodal network dysfunction in anti‐NMDAR encephalitis, which is crucial to establish new diagnostic biomarkers and promising therapeutic targets for the disease.     

Biological characteristics of brain natriuretic peptide and its association with central nervous system diseases

OBJECTIVE: To explain the mechanisms of tuhe synthesis, secretion and regulation of brain natriuretic peptide (BNP), and analyze its role in central nervous system diseases. DATA SOURCES: An online search of Pubmed was undertaken to identify articles related to BNP published in English from January 1990 to February 2007 by using the key words of "brain natriuretic peptide (BNP), central nervous system, subarachnoid hemorrhage (SAH), brain edema, epilepsy". Other articles were searched in China Hospital Knowledge Database (CHKD) by concrete name of journals and title of articles. STUDY SELECTION: The collected articles were primarily screened, those about BNP and its association with central nervous system diseases were selected, whereas the obviously irrelative ones excluded, and the full-texts of the other literatures were searched manually. DATA EXTRACTION: Totally 96 articles were collected, 40 of them were enrolled, and the other 56 were excluded due to repetitive studies or reviews. DATA SYNTHESIS: At present, there are penetrating studies on BNP in the preclinical medicine and clinical medicine of cerebrovascular and cardiovascular diseases, and the investigative outcomes have been gradually applied in clinical practice, and satisfactory results have been obtained. However, the application of BNP in diagnosing and treating central nervous system diseases is still at the experimental phase without –outstanding outcomes, thus the preclinical and clinical studies should be enhanced. CONCLUSION: As a kind of central medium or modulator, BNP plays a certain role in the occurrence, development and termination of central nervous system diseases, the BNP level in serum has certain changing law in SAH, brain edema, epilepsy, etc., but the specific mechanisms are unclear.     

Biological characteristics of brain natriuretic peptide and its association with central nervous system diseases

OBJECTIVE： To explain the mechanisms of tuhe synthesis, secretion and regulation of brain natriuretic peptide （BNP）, and analyze its role in central nervous system diseases. DATA SOURCES： An online search of Pubmed was undertaken to identify articles related to BNP published in English from January 1990 to February 2007 by using the key words of ＂brain natriuretic pepfide （BNP）, central nervous system, subarachnoid hemorrhage （SAH）, brain edema, epilepsy＂. Other articles were searched in China Hospital Knowledge Database （CHKD） by concrete name of journals and title of articles. STUDY SELECTION： The collected articles were primarily screened, those about BNP and its association with central nervous system diseases were selected, whereas the obviously irrelative ones excluded, and the full-texts of the other literatures were searched manually. DATA EXTRACTION： Totally 96 articles were collected, 40 of them were enrolled, and the other 56 were excluded due to repetitive studies or reviews. DATA SYNTHESIS： At present, there are penetrating studies on BNP in the preclinical medicine and clinical medicine of cerebrovascular and cardiovascular diseases, and the investigative outcomes have been gradually applied in clinical practice, and satisfactory results have been obtained. However, the application of BNP in diagnosing and treating central nervous system diseases is still at the experimental phase without - outstanding outcomes, thus the preclinical and clinical studies should be enhanced. CONCLUSION： As a kind of central medium or modulator, BNP plays a certain role in the occurrence, development and termination of central nervous system diseases, the BNP level in serum has certain changing law in SAH, brain edema, epilepsy, etc., but the specific mechanisms are unclear.     

组蛋白脱乙酰酶6在中枢神经系统疾病中作用的研究进展

近年来越来越多的证据表明,组蛋白脱乙酰酶6（histone deacetylase 6,HDAC6）在中枢神经系统疾病中发挥了重要作用。HDAC6属于组蛋白脱乙酰酶（histone deacetylase,HDAC）家族的Ⅱb类,是HDAC家族中分子量最大的酶。HDAC6主要定位于细胞质中,是唯一具有两个串联催化结构域的HDAC亚型,另外HDAC6还包含1个SE14基序（含Glu-Ser的四肽重复结构域）、1个朝向其羧基端的泛素结合锌指结构域,以及其氨基端区域的2个保守的核输出信号结构域。HDAC6功能复杂,具有脱乙酰化作用、调控错误蛋白降解、细胞内物质运输、调节细胞功能等多种作用,可通过多种信号通路发挥功能。在阿尔茨海默病、帕金森病、癫痫、亨廷顿病、急性缺血性脑卒中、多发性硬化等多种中枢神经系统疾病中发挥了重要作用,但由于HDAC6功能复杂,其在中枢神经系统疾病中的作用尚不完全明确。该文就目前已知的HDAC6与中枢神经系统疾病的研究进展进行综述,为研究和治疗中枢神经系统疾病提供新的思路和靶点。 [国际神经病学神经外科学杂志, 2023, 50(3): 84-90]     

肠道微生物与常见中枢神经系统疾病相关性的研究进展

肠道微生物不仅局限作用于胃肠道,可以通过脑肠轴对大脑功能产生重要影响.肠道微生物结构与功能的改变与阿茨海默病、帕金森病、多发性硬化、脑卒中等一系列常见中枢神经系统疾病密切相关,通过改善肠道微生物的微生态疗法有望成为预防和治疗中枢神经系统疾病的有效途径.现对近年来肠道微生物与常见中枢神经系统疾病的相关研究进展进行综述.     

肠道微生物在神经系统自身免疫性疾病中的研究进展

肠道微生物是人体最直接的外环境,对维持健康具有重要作用.肠道微生物可维持人体免疫系统稳态,与宿主共生可影响人体营养、代谢和免疫功能.肠道微生物通过免疫系统和内分泌系统与神经系统产生双向联系,即微生物-肠-脑轴.肠道微生物失调引起神经系统及外周异常免疫反应,参与自身免疫性疾病的发病机制.本文综述肠道微生物在多发性硬化、视...