Visocchi Massimiliano, Della Pepa Giuseppe Maria, Esposito Giuseppe, Tufo Tommaso, Zhang Wenchuan, Li Shiting, Zhong Jun
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
Stereotact Funct Neurosurg. 2011;89(5):263-74. doi: 10.1159/000329357. Epub 2011 Aug 19.
The effects of spinal cord stimulation (SCS) on cerebral blood flow (CBF) are well known based on experimental investigations, and its vasodilator effect on peripheral arteries is widely used in clinical settings in the treatment of peripheral vascular disease. Since Hosobuchi's [Appl Neurophysiol 1985;48:372-376] first observations on the effects of SCS on CBF were published 22 years ago, many advances have been made in understanding SCS-mediated effects on CBF. This paper reviews the main laboratory observations and analyzes the most significant neurophysiological theories on the SCS-mediated effect on CBF. Most significant experimental data have been discussed, with specific reference to possible mechanisms such as 'functional reversible sympathectomy', cerebral infarction and related ischemic edema, hemodynamic deterioration in experimental combined ischemic-traumatic brain injury and cerebral vasospasm. The authors revised the published experiences in humans with hypoperfusion syndromes and 'adjuvant' locoregional CBF increase in chemotherapy of brain tumors. SCS represents a new perspective in challenging neurosurgical clinical fields such as cerebral ischemia and vasospasm, and seems promising as a new trend of functional neurosurgery in cerebrovascular diseases.
基于实验研究，脊髓刺激（SCS）对脑血流量（CBF）的影响已为人熟知，其对外周动脉的血管舒张作用在临床治疗外周血管疾病中被广泛应用。自22年前细渊[《应用神经生理学》1985年；48：372 - 376]首次发表关于SCS对CBF影响的观察结果以来，在理解SCS介导的对CBF的影响方面已取得了许多进展。本文回顾了主要的实验室观察结果，并分析了关于SCS介导的对CBF影响的最重要的神经生理学理论。讨论了最重要的实验数据，并特别提及了诸如“功能性可逆性交感神经切除术”、脑梗死及相关缺血性水肿、实验性合并缺血 - 创伤性脑损伤中的血流动力学恶化以及脑血管痉挛等可能机制。作者回顾了人类低灌注综合征的已发表经验以及脑肿瘤化疗中“辅助性”局部脑血流量增加的情况。SCS为诸如脑缺血和血管痉挛等具有挑战性的神经外科临床领域提供了一个新视角，并且作为脑血管疾病功能性神经外科的一种新趋势似乎很有前景。
