目的 探讨脑干听觉诱发电位(BAEPs)联合耳蜗电图(ECochG)监测在桥小脑角胆脂瘤切除术中对听觉功能监测的价值.方法 回顾性分析中日友好医院神经外科自2018年1月—2020年12月行乙状窦后入路肿瘤切除术治疗的68例桥小脑角胆脂瘤患者的临床资料.根据术中所采取听神经功能监测方法的不同,将患者分成BAEPs监测组(24例)、ECochG监测组(23例)和BAEPs+ECochG监测组(21例).比较三种监测方法所记录的波形引出率、平均引出时间,术中预警效果,以及术后患者即刻与随访期间听力情况.结果 (1)波形的引出率:ECochG监测组(95.7％)＞BAEPs监测组(87.5％);平均引出时间:ECochG监测组(9.6 s±3.9)s＜BAEPs监测组(58.7 s±28.1)s,差异均有统计学意义(P＜0.05);ECochG监测组中CAP波幅明显高于BAEPs监测组中V波波幅,且CAP波潜伏期明显短于V波潜伏期,差异均有统计学意义(P＜0.05).(2)术中预警出现的频率:BAEPs+ECochG 监测组(95.2％)＞ECochG 监测组(69.6％)＞BAEPs监测组(62.5％),P=0.031.(3)3组患者术后即刻听力及随访期间听力美国耳鼻咽喉头颈外科学会(AAO-HNS)分级,差异均有统计学意义(H=7.156,P=0.028;H=9.042,P=0.011),平均秩次提示BAEPs+ECochG监测组患者听力均优于其他两组.结论 桥小脑角胆脂瘤切除术中,ECochG与BAEPs联合监测可以更加全面、准确、及时地为术者提供听觉传导通路的功能情况,进而对患者听觉功能的保护具有重要意义.

目的 探讨国产睿米手术机器人(神经外科定位导航系统)在颅骨或脑内微小病灶及功能区病灶精准切除手术中的效果及安全性.方法 中日友好医院神经外科自2021年10月至2022年3月在国产睿米手术机器人辅助下导航、定位并切除颅骨和脑内微小病灶及功能区病灶12例,术中均采用头皮Markers进行光学注册,记录注册误差,根据病灶的颅骨映射,由机械臂激光导航描记、设计头皮切口及骨瓣边界;术后行头颅CT和MRI扫描观察颅内出血、病灶切除情况;将术后影像与术前手术计划相融合,计算计划骨瓣中心与实际骨瓣中心的偏移误差.结果 12例患者的注册误差为(0.90±0.12)mm(范围为0.6～1.5 mm),机械臂注册误差为0.09～0.12 mm.计划骨瓣中心与实际骨瓣中心的偏移误差为(1.9±1.1)mm(范围为1.4～4.5 mm).所有患者均在手术机器人机械臂导航下一次性精准找到病灶边界,对皮层及病灶周围组织破坏性小;术后复查头颅CT或MRI提示所有病灶均完整切除,均无严重并发症发生.结论 国产睿米手术机器人可为颅骨或脑内微小病灶及功能区病灶切除术提供精准的定位和导航功能,提高了手术效率,保障了手术安全.

Objective:To investigate the clinical application value of frameless stereotactic electroencephalography (SEEG) electrode implantation assisted by domestic Remebot robot in patients with drug-refractory epilepsy.Methods:Ten patients with medically-refractory epilepsy, admitted to and accepted SEEG electrode implantation assisted by domestic Remebot robot in our hospital from October 2021 to March 2022, were chosen in our study. Epileptogenic focuses of these patients were determined. Bone Fiducial Markers were used for registration during surgery, and the registration error and implantation time of each electrode were recorded in detail. Thin-layer CT scan was performed immediately after surgery to observe the occurrence of complications. Three-dimensional reconstruction of all implanted electrodes was performed postoperatively, which was fused with the preoperative surgical planning paths and targets, and the electrode entry point error and target error were calculated.Results:SEEG electrodes were implanted in all 10 patients with the assistance of frameless surgical robot, and the resection areas were accurately determined according to the results of SEEG records. The registered error of these 10 patients was (0.24±0.03) mm. A total of 97 SEEG electrodes were implanted, and the average effective implantation time of each electrode was (6.3±1.2) min. After the fusion of three-dimensional electrode reconstruction with preoperative surgical plan, the mean entry point error of 97 electrodes was (1.9±1.2) mm, and the mean target error was (2.1±1.2) mm. Immediate postoperative head CT showed that none of the 10 patients had surgical complications such as intracranial hemorrhage or severe pneumoencephalos.Conclusion:The SEEG electrode implantation assisted by Remebot frameless robot is safe, accurate, and effective, which can meet the clinical needs.

Objective:To investigate the relationship between basal ganglia calcification (BGC) and segmental craniocervical dystonia (SCCD) and to explore the clinical characteristics of SCCD patients with BGC.Methods:The clinical data of 90 SCCD patients (experimental group) admitted to Neurosurgery Department of China-Japan Friendship Hospital from March 2015 to September 2018 were retrospectively analyzed, and the outpatient patients with neurological diseases (including 30 patients with cerebrovascular disease, 18 patients with dementia, 22 patients with cerebral hemorrhage) and 20 healthy subjects were taken as the controls. Chi-square test was used to compare the incidence of BGC between the two groups, and the clinical characteristics of SCCD patients with BGC were analyzed.Results:The incidence of BGC in the experimental group was 38.9% (35/90), which was higher than that in the control group (18.9%, 17/90). The difference between the two groups was statistically significant ( χ2=8.762, P=0.003). The proportion of female SCCD patients with BGC (31/35) was higher than that of SCCD patients without BGC (30/55), and the difference was statistically significant ( χ2=11.353, P=0.001). The ratios of BGC in SCCD patients with various clinical manifestations was: 30.3% (10/33) in patients with blepharospasm mainly, 33.3% (13/39) in patients with blepharospasm combined with oral and mandibular dystonia, and 12/18 in patients with neck symptoms in addition to the manifestations as above. The difference between the three groups was statistically significant ( P<0.05). At the same time, comparative imaging results showed that BGC in patients with blepharospasm mainly was relatively mild, while that in patients with blepharospasm, oral and mandibular dystonia, and neck symptoms were more serious. The degree of BGC in patients with blepharospasm combined with oral and mandibular dystonia was between the above-mentioned two other types. Conclusions:BGC may be related to the onset of SCCD. Female patients account for the majority of SCCD patients with BGC. SCCD patients with more involved sites and more complex clinical manifestations have higher positive rate of BGC and more serious calcification.

每年的6月28日为"国际癫痫关爱日".这一天同时也是"中国癫痫日". 既然是关爱日,那怎么样才能更好地关爱癫痫患者们呢?关于癫痫的科普知识,各媒体都讲了不少了.那我的关爱不妨谈一谈,癫痫患者怎么能更有效地就诊.这里,给各位患者支一招,那就是——记日记.

帕金森病是怎么回事? 帕金森病是一种常见的神经系统变性疾病,老年人多见,平均发病年龄为60岁左右,40岁以下起病的青年帕金森病较少见.我国65岁以上人群帕金森病的患病率大约是1.7％.帕金森病与遗传因素、环境因素、年龄老化等有关,但确切的病因目前仍不清楚. 帕金森病有哪些症状? 嗅觉减退嗅觉减退是帕金森病非常重要的一种非运动症状,可以出现在疾病的不同时期.轻度嗅觉减退表现为对一些刺鼻的气味不敏感.

Objective:To investigate the clinical efficacy of deep brain stimulation (DBS) in the treatment of different types of segmental craniocervical dystonia (SCCD).Methods:Clinical data of 80 patients with SCCD admitted to Department of Neurosurgery of China-Japan Friendship Hospital from March 2015 to September 2018 were retrospectively analyzed. There were 33 cases (41.2%) with blepharospasm as the main manifestation. There were 35 cases (43.8%) of blepharospasm with oromandibular dystonia. In addition, there were 12 cases (15.0%) with cervical symptoms and other symptoms, including 8 cases with the comorbidity of spasmodic torticollis and 4 cases with the comorbidity of dysarthria. All patients underwent bilateral GPi (globus pallidus interna)-DBS. During the clinical follow-up, Burke- Fahn-Marsden Dystonia Rating Scale (movement part) (BFMDRS-M) was used for preoperative and postoperative comparison to analyze the surgical efficacy of GPi-DBS for SCCD with different manifestations.Results:Out the 80 patients, 30 were lost to follow-up and 50 were followed up for 24.5±12.2 months (4-47 months). The total effective rate of GPi-DBS for SCCD was 68.0% (34/50) at the latest follow-up. In this series, the effective rate in patients with blepharospasm as the main manifestation was 65.0% (13/20) and 68.0% (17/25) in those with blepharospasm combined with oromandibular dystonia. In addition, the effective rate of patients with the comorbidity of cervical symptoms or other symptoms was 4/5. The BFMDRS-M scores of 50 patients before and after surgery showed statistically significant differences (6.3±2.2 point and 4.9±2.5 point, respectively, P<0.001), and the preoperative and postoperative BFMDRS-M scores of patients with different manifestations showed statistically significant differences (all P<0.05). During the follow-up, except for 1 case with implant rejection and skin erosion, the remaining 49 patients had no surgical or hardware-related complications. Conclusion:GPi-DBS, with few complications, is an effective treatment for various clinical manifestations of SCCD.

帕金森病又称“震颤麻痹”,是一种中老年人常见的运动障碍疾病.患病后,患者生活质量会受到严重的影响.目前此病已经成为影响我国老年人安度晚年的疾病之一. 在帕金森病的治疗中,药物治疗是首选也是最为有效的治疗方式之一.帕金森病的药物治疗中,多巴胺替代疗法是最为有效也是较常使用的方式,但是由于帕金森病病因的特殊性和药物的特异性,患者在服用药物期间有着明显的禁忌,总结来说就是“七个不要”.

Objective To investigate the value of subtraction ictal SPECT co-registered to MRI (SISCOM) on localizing epileptogenic focus.Methods Two representative patients were enrolled.One suffered from refractory seizure due to diffuse encephalomalacia on left parietal lobe,while another showed MRI negative with frequency uncontrolled seizure,of which the origin from the medial temporal lobe or the temporal lobe needed to be identified.As the conventional approaches including semiological analysis,MRI and scalp electroencephalogram failed to describe the epileptogenic zone exactly,interictal and ictal 99mTcethyl cysteinate dimer (ECD) SPECT was further performed,followed by SISCOM processing,including linear coregister,voxel normalization and subtraction with ictal and interictal 99mTc-ECD SPECT.Three standard deviation of focal area hyperperfusion above the interictal period was considered as statistical significance.Results Definitely,significant hyperperfusion changes were observed on both patients.Although the lesions of 1 patient were diffuse,significant hyperperfusion appeared on limited areas surrounding the lesions;meanwhile,typical pattern of medial temporal lobe was observed in the other patient.The epileptogenic zones were located in the brains of both patients,without attack after surgical treatment.Conclusion SISCOM is of great help in localizing epileptogenic zone in presurgical evaluation in intractable epilepsy,especially in complex patients.