Hypothalamus is the center of endocrine for human body, which is crucial to homeostasis and plays an irreplaceable role in regulating neuroendocrine function by secreting hypothalamic hormones. As the "initiator" of endocrine system, different functional areas of hypothalamus contain various neurosecretory cells responsible for the secretion of different hormones. Tumors of hypothalamic and adjacent tissue origin, including ganglion cell tumors, neuroblastomas, gliomas, malignant tumors and germ cell tumors, affect hormonal secretion in the hypothalamus or pituitary gland through occupying effects and abnormal secretion of hormones, resulting in a variety of complex clinical syndromes. In recent years there has been some research into tumors affecting hypothalamic hormone secretion, which is briefly reviewed here.

外科机械手俗称"手术机器人"，其研制和应用方兴未艾。采用通用型外科机械手经口入路垂体腺瘤切除术已进行了初步探索，目前仍存在诸多问题。经鼻蝶入路的刚性和柔性专用机械手尚处于研发阶段，代替手术助手扶持内镜的自动机械手在增加持镜稳定性、改善术中观察和照明等方面已经获得肯定的评价。未来的外科机械手将可能彻底改变垂体外科的工作方式。本文主要围绕"机器人"和"机械手"的概念辨识、外科机械手的类型及其在垂体腺瘤手术的初步实践情况和发展前景进行述评。

目的 探讨经胸锁乳突肌肌间入路(SMIA)行甲状腺切除的可行性及其在颈前区功能的保护作用.方法 回顾性分析2019年5-8月浙江大学医学院附属第一医院甲状腺疾病诊治中心收治的采取SMIA手术治疗的60例单侧甲状腺癌病人的临床资料(SMIA组),以同期采取低领弧形切口颈白线入路(LACA)手术治疗的60例单侧甲状腺癌病人作为对照(LACA组).比较两组间临床病理特征、手术相关结果及术后颈前区功能的差异.采用EQ-5D-5L量表评估颈前区功能的主观感受,采用Hollander伤口评估量表评定切口愈合的临床效果.结果 两组病人在年龄、性别、肿瘤大小、手术时间、术中出血、淋巴结清扫数目、术后甲状旁腺激素水平、引流量等方面差异均无统计学意义(P＞0.05).术后随访1个月,两组在保护颈前区功能和减少术后颈部不适感觉方面差异有统计学意义(P＜0.001),且SMIA组均优于LACA组;在切口愈合及临床效果方面,SMIA组Hollander伤口评估量表得分优于LACA组,差异有统计学意义(P＜0.05).结论 经SMIA行甲状腺切除不增加并发症的发生风险,且对甲状腺手术颈前区功能保护的作用优势明显,是安全可行的手术入路.

Objective:To study the beneficial effect of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on sleep disorder and other non-motor symptoms and their related influencing factors in patients with Parkinson's disease (PD).Methods:Thirty-six PD patients accepted bilateral STN-DBS in our hospital from January 2017 to April 2019 were chosen in our study. Two weeks before STN-DBS and one year after STN-DBS, Unified Parkinson's Disease Rating Scale part III (UPDRS III), Mini-Mental State Examination (MMSE), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), non-motion complications 30 questions questionnaire (NMS), 39 quality of life questionnaire for Parkinson's disease (PDQ39) and Parkinson's disease sleep rating scale (PDSS) were performed on these patients, and the levodopa equivalent dose (LED) of drugs and LED of levodopa receptor agonist were calculated. The improvement rate of each scale before and after STN-DBS were compared, and the correlations of improvement of sleep symptom with improvement rates of scores of each scale were analyzed.Results:The scores of UPDRS III ( "off"episodes), HAMA, HAMD, NMS, PDQ39 in patients one year after STN-DBS were significantly lower as compared with those before STN-DBS ( P<0.05). The total LED and LED of levodopa receptor agonist in patients one year after STN-DBS were significantly decreased as compared with those before STN-DBS ( P<0.05). The total scores of PDSS and sub-scale scores except for PDSS-6 and PDSS-15 scores one year after STN-DBS were significantly higher as compared with those before STN-DBS ( P<0.05). The improvement rates of PDSS total scores and sub-scale scores had correlations with improvement rates of UPDRSIII, HAMA and PDQ39 scores, and total LED deceased rate. Conclusion:Bilateral STN-DBS can obviously improve the night sleep quality of patients, which is partly benefited from improvement of exercise symptoms and anxiety relief.

中、重度颅脑损伤可以导致颅内出血、脑肿胀或外伤性脑梗死,引起急性颅内压增高.现代影像学除了观察中线结构和血肿体积这些较为宏观的因素,还能显示颅底蛛网膜下池等更为细微的结构,从而提供更为敏感和精确的诊断线索.对此类患者的头部CT等影像学检查,可见某些病例的脑沟和蛛网膜下池变窄,这是机体为维持相对稳定的颅内压而发生的代偿反应之一,即脑脊液吸收加速和生成下降.通过CT观察颅底脑池影像学改变,可以比临床症状和体征更早地发现颅内压增高的线索[1].传统的观察要点是血肿体积、中线结构移位、脑室系统受压等,但是,在影像学检查中对颅底蛛网膜下池的细致观察还可以发现是否存在或即将发生脑干受压的直接征象.在密切观察临床神经系统体征变化时,关注CT显示的颅底蛛网膜下池的形态变化,将有助于及早做出正确的临床预判和治疗决策.

目的：探讨重型颅脑损伤患者采用亚低温辅助治疗对其颅内压及生化指标的改善效果。方法回顾性分析本院2015年1月至2015年12月62例重型颅脑损伤患者临床治疗情况。其中以手术、脱水治疗、吸氧等基础治疗为对照组，31例；另31例则在对照组治疗基础上实施亚低温治疗，为观察组。采用颅内压监护仪动态监测患者入院时、治疗第1、3、5、7天颅内动态压变化；并于入院时、治疗第7天分别监测患者脑血流指标和脑氧代谢指标等临床生化指标变化，统计两组患者预后情况。结果两组患者颅内压随着时间的延长而不断下降，第1、3、5、7天颅内压与入院时比较，然观察组变化程度较对照组显著，P<0．05；两组患者治疗第7天时DR、Wv较治疗前显著下降，而 Qmean、Vmean较治疗前明显升高，观察组各指标下降或升高程度均较对照组显著，P<0．05；两组患者治疗第7天时CjvO2、SjvO2、CERO2较治疗前前显著升高，而CaO2较治疗前明显下降，观察组升高或下降程度较对照组显著，P<0．05。两组治疗第7天时外周血中神经元特异性烯醇化酶（NSE）、一氧化氮（NO）、C反应蛋白（CRP）水平较治疗前显著下降，而观察组下降程度优于对照组，P<0．05。观察组恢复良好率为51．6%明显高于对照组29．0%，而死亡率9．7%明显低于对照组32．3%，P<0．05。结论应用亚低温辅助治疗重型颅脑损伤有利于降低患者颅内压及临床各项生化指标的改善，从而改善其预后。

目的探讨微血管减压术在原发性三叉神经痛治疗中的效果。方法回顾性分析经微血管减压术治疗的36例原发性三叉神经痛患者的临床资料。结果 35例患者术后1周内疼痛明显缓解,1例疼痛轻度改善。术后分别电话或门诊随访3月至2年,32例疼痛完全消失;3例疼痛明显改善,但需结合小剂量药物控制;1例术后一个月左右复发。除1例怀疑有短暂性脑脊液鼻漏外无其它手术相关并发症。结论微血管减压术是原发性三叉神经痛的理想治疗手段,手术病例严格选择(有典型症状,且术前MRI颅底薄层增强扫描提示痛侧三叉神经根部有血管紧密接触),术中判定责任血管、解除压迫、充分且适当减压三叉神经是保证疗效的关键。

目的研究血性脑脊液刺激后的蛛网膜细胞能否发挥抗原提呈细胞(APC)功能激活T淋巴细胞。方法蛛网膜细胞培养和鉴定后,与血性脑脊液共同培养,免疫荧光染色观察其APC标志物人类白细胞抗原(HLA)-DR的表达改变。然后再与外周血单个核细胞(PBMC)共同培养,用ELISA法检测培养上清液中可溶性白细胞介素-2受体(slL-2r)的含量来代表T淋巴细胞被激活的程度。结果在血性脑脊液刺激下,蛛网膜细胞HLA-DR表达增强,再与PBMC共同培养后,slL-2r的含量增加,且HLA-DR表达和slL-2r含量变化的时间模式与临床上蛛网膜下腔出血后迟发性脑缺血发生的时间模式基本一致。结论蛛网膜细胞经血性脑脊液激活后,能够发挥抗原提呈功能,激活T淋巴细胞。

目的 研究单一依靠CT血管造影(CTA)资料,在超早期手术夹闭破裂颅内动脉瘤的可行性.方法 从2004年6月至2007年2月,共有125例自发性蛛网膜下腔出血病人行CTA检查.其中有78例在出血后72h内完成CTA检查,并对57例患者单一依靠CTA资料急诊行超早期动脉瘤夹闭术.结果 125例自发性蛛网膜下腔出血患者中,有78例在出血后72h内完成CTA检查,71例发现颅内动脉瘤,其中有57例行超早期开颅动脉瘤夹闭术.57例超早期开颅手术动脉瘤患者,多发动脉瘤4例,共61个动脉瘤,术中夹闭动脉瘤60个,动脉瘤包裹1个.CTA能很好地显示动脉瘤的大小、形态、同载瘤动脉及周边骨性结构的关系,为手术提供了足够的有用信息.结论 容积重建成像CTA是一种可靠、无创的快速诊断颅内动脉瘤的方法,能为破裂动脉瘤的超早期夹闭手术提供详实的影像学资料,满足在急诊状况下开颅夹闭手术所需。

目的 研究单一依靠CT血管造影(CTA)资料,在超早期手术夹闭破裂颅内动脉瘤的可行性.方法 从2004年6月至2007年2月,共有125例自发性蛛网膜下腔出血病人行CTA检查.其中有78例在出血后72h内完成CTA检查,并对57例患者单一依靠CTA资料急诊行超早期动脉瘤夹闭术.结果 125例自发性蛛网膜下腔出血患者中,有78例在出血后72h内完成CTA检查,71例发现颅内动脉瘤,其中有57例行超早期开颅动脉瘤夹闭术.57例超早期开颅手术动脉瘤患者,多发动脉瘤4例,共61个动脉瘤,术中夹闭动脉瘤60个,动脉瘤包裹1个.CTA能很好地显示动脉瘤的大小、形态、同载瘤动脉及周边骨性结构的关系,为手术提供了足够的有用信息.结论 容积重建成像CTA是一种可靠、无创的快速诊断颅内动脉瘤的方法,能为破裂动脉瘤的超早期夹闭手术提供详实的影像学资料,满足在急诊状况下开颅夹闭手术所需。

目的 研究蛛网膜细胞(Ar细胞)与血性脑脊液(CSF)共同培养后人类白细胞抗原-DR(HLA-DR)的表达变化.方法 (1)Ar细胞的培养、鉴定和HLA-DR基础表达的观察.(2)采用Ar细胞和血性CSF共同培养的方法,用流式细胞仪(FCM)和免疫荧光染色观察Ar细胞HLA-DR的表达改变. 结果 95%以上培养的Ar细胞均有HLA-DR的基础表达.在血性CSF刺激下,Ar细胞HLA-DR的表达明显增强,免疫荧光法和FCM检测出了一致的时间表达变化模式,在1-5d呈基础表达状态;6d左右表达开始升高;7d、8d表达显著增强,此时荧光颗粒数量和强度最高,阳性细胞数可达61.2%;第9天后表达逐渐降低,阳性细胞数减少,第10天时减低至12.5%,荧光数量和强度亦明显降低. 结论 在血性CSF刺激下,Ar细胞通过HLA-DR表达增高,可以发挥抗体提呈细胞(APC)的功能,提示其可能与SAH并发症尤其是迟发性脑缺血(DCI)的发生机制相关。

Objective: To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year, there were 10 patients diagnosed as having multiple intracranial a-neurysms by 3D-CTA and altogether 24 aneurysms were visualized, including 10 small aneurysms (≤ 5mm. Three-dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site, shape, size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick, reliable, and relatively noninvasive method for diagnosing multiple intracranial aneurysms. It delineates detailed aneurysmal morphology, and provides useful information for planning microsurgical approaches.

淀粉样脑血管病(cerebral amyloidangiopathy,CAA)在本世纪初被提出,但与脑出血的关系直到70年代才被重视.CAA好发于老年人群,其发病率随年龄增长而明显增加.65～74岁人群发生率约2%,75～84岁约8%,而85岁以上则高达12%.国内老年人中的发生率与国外报道相仿,但脑中分布范围较广[2].CAA相关性脑出血约占自发性脑出血的10%,是高龄老年人群自发性脑出血,尤其是复发性自发性脑出血的主要致病原因之一[3].

患者男,32岁.癫痫发作1年于1999年7月1日入院.自幼全身躯体和四肢有褐色色素沉着斑点, 12年前开始出现多处散在肿块,曾在当地医院行皮肤肿块切除,术后病理诊断为神经纤维瘤.

2001～2002年,我们将鼻内镜技术和手术显微镜结合应用,经鼻中隔-蝶窦径路行垂体腺瘤切除术11例,取得满意效果,报告如下.

Objective To study the clinical significance of 3 dimensional time of flight magnetic resonance angiography(3D-TOF-MRA) for the pathogenesis of hemifacial spasm (HFS) and trigeminal neuralgia(TN).Methods 48 patients with HFS and 46 patients without HFS and 42 patients with TN and 40 patients without TN were examined by MRI and 3D-TOF-MRA by the enhancement of DTPA. Diagnosis of the presence of compressions in the root exit zone(REZ) of facial nerves and trigeminal nerves were done by two radiologists on an independent console. Results (1)In the patients, compression of the REZ of the facial nerves and trigeminal nerves were detected on 45 spastic sides (93.8%,neurovascular on 44 sides and tumor on 1 side) and 36 spastic sides ( 85.7%,neurovascular on 32 sides and tumor on 4 sides ), 8 and 4 on the asymptomatic sides (16.7% and 9.5%, all neurovascular ). In the controls, 4 and 5 sides ( 4.4% and 6.3% ) were found in the compression of the REZ of the facial nerves and trigeminal nerves. ( 2 ) The offending vessels of compression of the REZ of the facial nerves were the anterior inferior cerebellar artery (AICA) in 17 cases ( 38.6% ), the posterior inferior cerebellar artery (PICA) in 12 cases (27.3%), the vertebral artery (VA) in 6 cases (13.6%). The offending vessels of compression of the REZ of the trigeminal nerves were the superior cerebellar artery ( SCA ) in 18 cases ( 56.3% ), the anterior inferior cerebellar artery in 5 cases (15.6%), the difficult identified vessels (DIV) in 4 cases (12.5%). (3)The relative risks of microvascular compressions which cause HFS and TN were 26.6 and 9.84. (4) The compressions of the REZ of the facial nerves and trigeminal nerves were proved in 4 cases (neurovascular 3 cases and tumor 1 case) and 10 cases (neurovascular 6 cases and tumor 4 casee) in the operation.Conclusion MRI and enhanced 3D-TOF-MRA appeare to be the best imaging technology for the pathogenesis of HFS and TN now. The major causes of HFS and TN may be different neurovascular compressions in the REZ of the facial nerves and trigeminal nerves, some cases are caused by tumor compression.

脑外科手术中脑肿瘤的压片或印片用于诊断由来已久.由于其方便、快捷、经济、准确等特点,术中压片诊断技术在国外医院应用较为广泛,我国尚无大宗的病例报道.在此我们回顾总结近年来所做的工作,结合文献复习,分析脑肿瘤术中压片诊断的准确性、意义及应用前景.

功能区肿瘤成功的手术切除,又不遗留有功能缺损,是神经外科手术的难题[1]之一.我院自2000年5月起使用瑞典Elekta surgiscope1.7神经导航系统对6例MRI呈T1、T2长信号,强化不明显的脑功能区肿瘤进行图像融合技术,得到了清楚的肿瘤解剖形态图像,手术效果满意,现报道如下.