亚甲蓝甘油合剂封闭治疗三叉神经痛108例

目的观察亚甲蓝甘油合剂封闭治疗三叉神经痛的临床疗效并探讨其治疗机制。方法按国际头面痛学会分类委员会确定的诊断标准,108例原发性三叉神经患者随机分为两组:A组为亚甲蓝甘油合剂组(n=54),B组为单纯甘油合剂组(n=54);采用徐贵印推荐的三维测角穿刺半月神经节进行封闭治疗,对治疗后1周、3个月和2年分别进行疗效评判和随访观察。结果两组治疗后1周、3个月优良率比较差异无统计学意义(P>0.05),两年后优良率比较差异有统计学意义(P<0.05);两组并发症没有明显差异,2例出现视力下降,3例因解剖变异未能穿刺成功,仅在卵圆孔周围进行了注射,外加眶下孔以及骸孔封闭。结论亚甲蓝甘油合剂用于治疗三叉神经痛远期疗效优于单纯甘油合剂,且亚甲蓝对神经未见明显损害(经2年随访)。     

Trigeminal amyloidoma: case report and review of the literature.

The authors present a case of amyloid infiltration involving the trigeminal nerve that mimicked a malignant cavernous sinus tumor with perineural tumor infiltration. A 64-year-old man presented with trigeminal nerve numbness. Imaging revealed a plaque-like enhancing lesion along the right lateral cavernous sinus extending anteriorly into Meckel's cave and involving the proximal V2 and V3 branches of the trigeminal nerve. The patient underwent an extradural frontotemporal craniotomy with middle fossa exposure of the cavernous sinus to diagnose and treat the presumed malignant cavernous sinus tumor. A reddish mass involving the lateral dural wall of the cavernous sinus was resected. The gasserian ganglion, V2, and V3, the latter of which was biopsied, were enlarged. Permanent histopathological studies showed microscopic eosinophilic, amorphous material, which stained positive for Congo red, and an absence of neoplastic cells. The final diagnosis was amyloidoma. Thus, amyloidomas can involve the trigeminal nerve or ganglia and should be considered in the differential diagnosis of a cavernous sinus lesion mimicking a tumor. Patients may have symptomatic improvement of trigeminal neuropathy with resection of the amyloidoma outside the nerve capsule that is compressing the nerve, while resection of the lesion from within the capsule may result in permanent trigeminal nerve dysfunction.     

应用卵圆孔定位仪治疗三叉神经痛

目的总结卵圆孔定位仪在选择性经皮温控射频热凝治疗三叉神经痛的应用方法和技巧。方法对三叉神经第Ⅱ、Ⅲ支疼痛者或第Ⅰ、Ⅱ、Ⅲ支同时疼痛者应用Hartel前入路半月神经节射频热凝治疗,其中260例患者应用三叉神经卵圆孔定位仪辅助定位,对39例患者术中应用X线或三维CT进行卵圆孔靶点验证。结果所有病例穿刺成功。术后即刻疗效:优良206例,良好42例,无疗效12例,总有效率95.4%,无严重并发症发生。结论卵圆孔定位仪可用于射频热凝治疗三叉神经痛的辅助定位,可以提高穿刺的成功率和安全性。     

原发性三叉神经痛的LEKSELL-C伽玛刀治疗

目的 探讨伽玛刀治疗原发性三叉神经痛的方法和效果.方法 对28例原发性三叉神经痛采用LEKSELL-C型伽玛刀治疗,均沿三叉神经走行在三叉神经根近桥脑处选择双靶点治疗.中心剂量75～85Gy,50%等剂量线限定靶点.结果 随访3～11个月,疼痛消失时间平均在术后3.5个月.按疼痛缓解评分,在随访时点,总有效率为96%.结论 LEKSELL-C型伽玛刀是治疗原发性三叉神经痛安全和有效的方法之一.     

微血管减压术治疗舌咽神经痛16例临床分析

目的　研究舌咽神经痛 (glossopharyngealneuralgia,GPN)手术治疗的最佳术式 ,评估微血管减压手术(microvasculardecompression ,MVD)的效果、并发症和随访结果 ,探讨可能的治疗机制。方法　 2 0 0 0年 12月到2 0 0 3年 10月间 ,16例GPN患者接受了MVD ,无一例行神经根切断术。患者全部进行了电话或信件随访。结果　15例患者术后疼痛消失 ,1例患者为不典型GPN ,术后疼痛减轻。 1例患者术后出现轻度声音嘶哑和吞咽困难 ,1例患者出现偶发干咳。本组患者平均随访时间为 14 .1± 6 .3月 ,随访期间无一例复发。结论　MVD是治疗舌咽神经痛的一种安全、有效的手术方式 ,尤其适用于典型的GPN患者。     

Timecourse of development of the wallaby trigeminal pathway. I. Periphery to brainstem

The development of the vibrissae and their innervation and the maturation of the brainstem trigeminal sensory nuclei have been studied in the wallaby, Macropus eugenii, from birth to adulthood. At birth, developing vibrissal follicles consist of solid epidermal pegs surrounded by dermal condensations. The developing follicles and adjacent skin are innervated by trigeminal afferents. Ten days after birth the follicle contains a dermal papilla and the deep vibrissal nerve can be recognised. A hair cone is present at postnatal day (P) 30 and hairs are apparent on the skin surface by P35. By P63 the deep vibrissal nerve can be seen innervating Merkel cells in the outer root sheath; in addition, the first signs of the blood sinus can be recognised. Innervation of the inner conical body and lanceolate and lamellated receptors supplying the mesenchymal sheath and waist region are not seen until P119, when the follicle resembles that seen in the adult. At birth, central processes of the trigeminal ganglion cells have entered the trigeminal tract and extend from the rostral pons to the upper cervical cord. Labelling with a carbocyanine dye at P0 shows afferents extending medially from the tract into the trigeminal subnuclei at all levels. At this stage the trigeminal nuclei appear as areas of increased cell density in the lateral brainstem. By P30–40 the four subnuclei can be distinguished on the basis of shape, cytoarchitecture, and succinic dehydrogenase reactivity. Adult morphology is not fully established until P210. In mature animals, nucleus principalis contains closely packed, polymorphic cells, frequently aligned parallel to thick fibre bundles that traverse the nucleus obliquely. Subnuclei oralis and interpolaris contain sparsely distributed, medium to large cells, randomly oriented, as well as prominent rostrocaudally directed fibre bundles. Subnucleus caudalis consists of the marginal layer, substantia gelatinosa, and magnocellular layers as described in other species. Patches of increased succinic dehydrogenase or cytochrome oxidase reactivity, presumably corresponding to the vibrissae, are present in subnuclei principalis, interpolaris, and caudalis in developing and adult animals, although the pattern is less clear than in rats. The brainstem patches are first seen at P40, approximately 6 weeks before the corresponding vibrissal-related pattern develops in the cortex. This suggests that the onset of patch formation may be regulated independently at different levels of the pathway. © 1994 Wiley-Liss, Inc.     

The influence of muscle-conditioned media on chick embryo brainstem neurons in culture

Brainstem pieces from the trigeminal region of the metencephalic basal plate of 10-day chick embryos were dissociated and cultured in control conditions or in the presence of muscle-conditioned medium (MCM). The MCM was derived from age-matched target tissue relevant to this neuronal region (jaw musculature), from relevant target tissue of an age at which innervation would initially be taking place (4 days), and from nonrelevant target tissue also of an early stage (4-day limb bud). Neuronal survival and differentiation was assessed daily, for 7 days. Survival and differentiation were significantly enhanced by the 4-day jaw MCM compared to both the controls and the cultures grown with 10-day jaw MCM and 4-day limb MCM. These measures in the presence of 10-day jaw MCM and 4-day limb MCM did not differ, but surpassed that seen in control cultures. The results are compared to the more specific responsiveness seen in earlier (2-day) neural tube cultures, and their relationship to in vivo regenerative nerve fiber outgrowth is considered.     

实验性单纯疱疹病毒Ⅰ型感染兔眼部扫描电镜观察研究

应用ＤＭＳＯ（Ｄｉｍｅｔｈｙｌｓｕｌｆｏｘｉｄｅ二甲基亚砜）冷冻割断制样扫描电镜技术首次动态观察了不同感染阶段（ｐｏｓｔＩｎｆｅｃｔｉｏｎ，ＰＩ）实验性单纯疱疹病毒性角膜炎（ＨＳＫ）兔的角膜、三叉神经节（ＴＧ）泪腺等组织的病变情况。初步报告并分析了各组织病变的扫描图像结果，并对冷冻割断法观察扫描电镜的原理及优缺点予以讨论，认为该技术应用于眼部单疱病毒感染的研究图像清晰、直观、简便可行，是一种有实用价值的方法。     

颈交感神经对血管源性头痛痛觉传导的影响

目的采用电刺激大鼠上矢状窦(SSS)区硬脑膜,观察颈上交感神经节(SCG)摘除术前后在延髓和上颈段三叉神经脊束核一氧化氮合酶(NOS)阳性神经元数目的变化,以探讨交感神经系统在血管源性头痛(如偏头痛)涉及的伤害觉信息传递中的作用。方法以雄性SD大鼠(体重为220～250g)为实验对象,行颈上交感神经节摘除术后再手术暴露其SSS,然后电刺激SSS区硬脑膜,应用免疫组织化学染色技术,观察延髓和上颈段三叉神经脊束核NOS表达的变化。结果NOS免疫反应阳性神经元主要分布在三叉神经脊束核和上颈段脊髓的第Ⅰ、Ⅱ板层,双侧对称。假手术对照组、SCG摘除组每张切片的NOS阳性神经元数分别为150.2±10.3、223.0±11.6,SCG摘除组NOS阳性神经元数目较假手术对照组明显增加(P<0.05)。结论颈交感神经系统参与了头部血管源性疼痛(如偏头痛)中伤害性感觉信息导致的疼痛的产生、传导及调节过程。