Brain & spine最新文献_第6页

Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis 框架导航引导下的经皮球囊压迫术治疗继发于多发性硬化症的顽固性三叉神经痛

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102798

Jose E. Valerio Pascua , Penelope Mantilla Farfan , Maria Paula Fernandez , Noe Santiago Rea , Matteo Borro , Andres M. Alvarez-Pinzon

Background

Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain.

Methods

A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). A precise reference frame was strapped firmly to the patient's forehead during the intraoperative procedure. Preliminary CT images were registered using the navigation system and the bony landmarks were set.

Case description

Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. Both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes.

Conclusion

Management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it presents unique challenges for neurosurgeons. Given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, microvascular decompression remains a debated approach for this patient population. While stereotactic radiosurgery may be a promising alternative.

背景多发性硬化症（MS）患者由于神经瘢痕和脱髓鞘斑块的形成，与普通人群相比更容易患三叉神经痛（TN）。尽管接受了治疗，但约有 10% 接受 TN 治疗的多发性硬化症患者症状复发，包括出现类似多发性硬化症的症状，如视神经炎和双侧面部疼痛。术中，一个精确的参考框架被牢牢地绑在患者的前额上。病例描述两名被诊断为多发性硬化症（MS）并伴有难治性三叉神经痛（TN）的患者接受了经皮球囊压迫术。最初的保守治疗和一次伽玛刀放射外科手术（GKR）使症状控制了几周。两名患者的疼痛均急性复发，因此对他们进行了经皮逆腰椎后球囊压迫术。在随访过程中，患者称术后疼痛减轻了 70%，枪击发作的复发率极低。经皮逆行性球囊压迫技术可为部分患者提供解决方案，但也给神经外科医生带来了独特的挑战。鉴于发病机制、目标识别的复杂性，以及潜在的神经血管冲突的缺失，微血管减压仍是该患者群体中一种备受争议的方法。虽然立体定向放射外科手术可能是一种很有前途的替代方法。

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引用次数: 0

Treatment-limiting decisions in patients with severe traumatic brain injury in the Netherlands 荷兰严重脑外伤患者的治疗限制性决定

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102746

Inge A.M. van Erp , T.A. van Essen , Erwin J.O. Kompanje , Mathieu van der Jagt , Wouter A. Moojen , Wilco C. Peul , Jeroen T.J.M. van Dijck

Introduction

Treatment-limiting decisions (TLDs) can be inevitable severe traumatic brain injury (s-TBI) patients, but data on their use remain scarce.

Research question

To investigate the prevalence, timing and considerations of TLDs in s-TBI patients.

Material and methods

s-TBI patients between 2008 and 2017 were analysed retrospecively. Patient data, timing, location, involvement of proxies, and reasons for TLDs were collected. Baseline characteristics and in-hospital outcomes were compared between s-TBI patients with and without TLDs.

Results

TLDs were reported in 117 of 270 s-TBI patients (43.3%) and 95.9% of deaths after s-TBI were preceded by a TLD. The majority of TLDs (68.4%) were categorized as withdrawal of therapy, of which withdrawal of organ-support in 64.1%. Neurosurgical intervention was withheld in 29.9%. The median time from admission to TLD was 2 days [IQR, 0–8] and 50.4% of TLDs were made within 3 days of admission. The main reason for a TLD was that the patients were perceived as unsalvageable (66.7%). Nearly all decisions were made multidisciplinary (99.1%) with proxies involvement (75.2%). The predicted mortality (CRASH-score) between patients with and without TLDs were 72.6 vs. 70.6%. The percentage of TLDs in s-TBI patients increased from 20.0% in 2008 to 42.9% in 2012 and 64.3% in 2017.

Discussion and conclusion

TLDs occurred in almost half of s-TBI patients and were instituted more frequently over time. Half of TLDs were made within 3 days of admission in spite of baseline prognosis between groups being similar. Future research should address whether prognostic nihilism contributes to self-fulfilling prophecies.

导言限制治疗决定（TLD）可能是严重创伤性脑损伤（s-TBI）患者不可避免的决定，但有关其使用情况的数据仍然很少。研究问题研究 s-TBI 患者中限制治疗决定的发生率、时间和考虑因素。收集了患者数据、时间、地点、代理人参与情况以及TLDs的原因。结果270例s-TBI患者中有117例（43.3%）报告了TLD，95.9%的s-TBI患者死亡前发生了TLD。大多数TLD（68.4%）被归类为撤消治疗，其中64.1%撤消了器官支持。29.9%的患者放弃了神经外科治疗。从入院到TLD的中位时间为2天[IQR，0-8]，50.4%的TLD在入院后3天内完成。终末期治疗的主要原因是患者被认为无法挽救（66.7%）。几乎所有决定都是在多学科（99.1%）和代理人参与（75.2%）的情况下做出的。有TLD和无TLD患者的预测死亡率（CRASH评分）分别为72.6%和70.6%。在 s-TBI 患者中，TLD 的比例从 2008 年的 20.0% 增加到 2012 年的 42.9% 和 2017 年的 64.3%。讨论与结论几乎一半的 s-TBI 患者都进行了 TLD，而且随着时间的推移，TLD 的使用频率越来越高。尽管各组间的基线预后相似，但有一半的TLD是在入院后3天内进行的。未来的研究应探讨预后虚无主义是否会导致自我实现的预言。

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引用次数: 0

Effect of the extent of posterior septectomy on surgical access during the endoscopic endonasal approach to the sella: A technical note 内窥镜鼻腔内入路椎弓根后部切除术的范围对手术入路的影响：技术说明

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102831

Reem Elwy , Abdel Rahman Younes , Amr K. Elsamman

Background

Using the bi-nostril 4-hand technique during the endoscopic endonasal approach (EEA) facilitates bimanual microsurgical techniques yet requires resection of the posterior nasal septum. The surgical exposure and degree of maneuverability gained proportionate to the extent of posterior septectomy in the sagittal plane was previously quantified.

Research question

We aim to describe our technique of posterior septectomy, and the effect of its extent in the axial plane on surgical access, and instrument maneuverability.

Material and methods

After fracturing the posterosuperior nasal septum, we disarticulate the vomer from the sphenoid rostrum and remove its upper part. The sphenoid rostrum is excised next exposing the clival recess where a suction tip without a side channel is anchored, allowing the assisting surgeon to use an additional instrument in their dominant hand. The vomer is removed down to the level of the floor of the sphenoid sinus.

Results

A wide exposure is achieved in the coronal plane bilaterally at the level of the sphenoid rostrum allowing unobstructed instrument manipulation in the craniocaudal and cross-court trajectories. Furthermore, the floor of the sella is reached through a straight rather than angled trajectory facilitating surgical access, manipulation, and instrument maneuverability. For lateral lesions requiring contralateral access, the assisting surgeon can assist in dissection from the contralateral nostril without changing the position of the endoscope.

Discussion and conclusion

Removing the upper vomer improves surgical access, and instrument maneuverability. Simultaneous dissection from both nostrils might be attempted. Caudally extending the posterior septectomy during the EEA allows better exposure and improves surgical access in all planes.

背景在鼻内镜鼻腔内入路（EEA）中使用双鼻孔四手操作技术有助于双臂显微外科技术，但需要切除后鼻中隔。研究问题我们旨在描述我们的后鼻中隔切除术技术，以及该技术在轴向平面上的范围对手术入路和器械可操作性的影响。接着切除蝶骨喙突，暴露出蝶骨凹陷，在蝶骨凹陷处固定一个没有侧通道的吸头，使辅助外科医生可以用他们的惯用手使用额外的器械。结果在双侧蝶骨水平的冠状面上实现了大范围的暴露，使得在颅尾和交叉轨迹上的器械操作畅通无阻。此外，通过笔直而非倾斜的轨迹到达蝶鞍底，有利于手术进入、操作和器械的可操作性。对于需要从对侧进入的外侧病变，辅助外科医生可以协助从对侧鼻孔进行解剖，而无需改变内窥镜的位置。可以尝试同时从两个鼻孔进行剥离。在 EEA 期间向尾部延伸后鼻孔隔切除术可以更好地暴露鼻孔，并改善所有平面的手术通路。

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引用次数: 0

Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury? 年龄或心血管合并症是预测老年脑外伤患者脑血管压力反应性降低的主要因素吗？

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102799

Floor Vanelderen, Dominike Bruyninckx, Bart Depreitere

Introduction

The Pressure Reactivity index (PRx) has been proposed as a surrogate measure for cerebrovascular autoregulation (CA) and it has been described that older age is associated with worse PRx. The etiology for this reduced capacity remains unknown.

Research question

To investigate the relation between age and PRx in a cohort of patients with traumatic brain injury (TBI) while correcting for cardiovascular comorbidities.

Material and methods

This is a retrospective analysis on prospectively collected data in 151 consecutive TBI patients between 2013 and 2023. PRx was averaged over 5 monitoring days and correlated with demographic, patient and injury data. A multiple regression analysis was performed with PRx as dependent variable and cardiovascular comorbidities, age, Glasgow motor score and pupillary reaction as independent variables. A similar model was constructed without age and compared.

Results

Age, sex, thromboembolic history, arterial hypertension, Glasgow motor score and pupillary reaction significantly correlated with PRx in univariate analysis. In multivariate analysis, age had a significant worsening effect on PRx (p = 0.01), while the cardiovascular risk factors and injury severity had no impact. The comparison of the models with and without age yielded a significant difference (p = 0.01), underpinning the independent effect of age.

Discussion and conclusion

In the present cohort study in TBI patients it was found that older age independently impaired cerebrovascular pressure reactivity regardless of cardiovascular comorbidity. Pathophysiology of TBI and physiology of ageing seem to line up to synergistically produce a negative effect on brain perfusion.

导言压力反应指数（PRx）被认为是衡量脑血管自动调节能力（CA）的替代指标，有研究表明年龄越大，压力反应指数越低。材料和方法这是对 2013 年至 2023 年间连续收集的 151 名创伤性脑损伤（TBI）患者的前瞻性数据进行的回顾性分析。PRx 是 5 个监测日的平均值，并与人口统计学、患者和损伤数据相关联。以 PRx 为因变量，心血管合并症、年龄、格拉斯哥运动评分和瞳孔反应为自变量，进行了多元回归分析。结果在单变量分析中，年龄、性别、血栓栓塞史、动脉高血压、格拉斯哥运动评分和瞳孔反应与 PRx 显著相关。在多变量分析中，年龄对 PRx 有明显的恶化影响（p = 0.01），而心血管风险因素和损伤严重程度则没有影响。讨论与结论在对创伤性脑损伤患者进行的这项队列研究中发现，无论是否患有心血管并发症，年龄越大，脑血管压力反应性越差。创伤性脑损伤的病理生理学和老化生理学似乎共同对脑灌注产生了负面影响。

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引用次数: 0

Neurotrauma from fall accidents in Ethiopia 埃塞俄比亚高处坠落事故造成的神经创伤

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102792

Tsegazeab Laeke , Abenezer Tirsit , Bente E. Moen , Morten Lund-Johansen , Terje Sundstrøm

Background

Ethiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury (SCI).

Methods

We prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome.

Results

We included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries.

Conclusion

Falls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.

背景埃塞俄比亚是一个快速增长的经济体，城市化进程迅速，职业安全措施薄弱。摔伤很常见，经常导致创伤性脑损伤（TBI）或脊髓损伤（SCI）。方法我们前瞻性地纳入了2017年在埃塞俄比亚亚的斯亚贝巴因神经创伤接受医院治疗或法医检查的摔伤者。我们登记了社会人口学因素、跌倒类型、损伤、治疗和结果。结果我们纳入了117名接受治疗的患者和51名死亡患者（中位年龄为27岁对40岁）。大多数患者在建筑工地受伤（39.9%），只有三分之一的患者使用了防护设备。创伤性脑损伤（64.7%）和损伤性脊髓损伤（27.5%）是死亡患者最常见的死因，其中大多数患者死于事故现场（90.2%）。许多患者的院前救治时间严重延误（中位数为 24 小时）。在接受治疗的患者中，SCI 比 TBI 更常见（50.4% 对 39.3%），10.3% 的患者同时患有 SCI 和 TBI。大多数 SCI 是完全性的（49.3%），而大多数 TBI 是轻微的（55.2%）。不到一半的创伤性脑损伤患者和不到五分之一的损伤性脑损伤患者接受过手术治疗。创伤性脑损伤患者的死亡人数是损伤性脑损伤患者的两倍。在中位数为 33 周的出院患者中，50% 的创伤性脑损伤患者恢复良好，而 35.5% 的 SCI 患者伤势完全恢复。这些结果支持埃塞俄比亚进一步制定预防战略和神经创伤护理。

{"title":"Neurotrauma from fall accidents in Ethiopia","authors":"Tsegazeab Laeke , Abenezer Tirsit , Bente E. Moen , Morten Lund-Johansen , Terje Sundstrøm","doi":"10.1016/j.bas.2024.102792","DOIUrl":"10.1016/j.bas.2024.102792","url":null,"abstract":"<div><h3>Background</h3><p>Ethiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury (SCI).</p></div><div><h3>Methods</h3><p>We prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome.</p></div><div><h3>Results</h3><p>We included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries.</p></div><div><h3>Conclusion</h3><p>Falls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000481/pdfft?md5=bc11123570b49fd13e19e4c57d031cb6&pid=1-s2.0-S2772529424000481-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of outcomes and recurrence rates in patients undergoing single or double burr hole surgery for the treatment of chronic subdural hematoma in Bosnia and Herzegovina 比较波斯尼亚和黑塞哥维那接受单孔或双孔毛细孔手术治疗慢性硬膜下血肿患者的疗效和复发率

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102863

Ibrahim Omerhodžić , Bekir Rovčanin , Ismar Ećo , Bakir Kudić , Salko Zahirović , Almir Džurlić , Adi Ahmetspahić , Mirza Pojskić

Introduction

Chronic subdural hematoma (CSDH) is a prevalent condition commonly seen in elderly individuals, often requiring neurosurgical intervention.

Research question

This study investigates patient characteristics and recurrence rates in CSDH patients treated with single or double burr hole surgery in Bosnia and Herzegovina. Methods: A retrospective study was conducted on patients treated for CSDH between January 2018 and December 2022. The diagnosis of CSDH was confirmed through preoperative CT or MRI of the brain. Patients underwent either single or double burr hole surgery based on the neurosurgeon's decision. Preoperative and postoperative brain CT scans, along with clinical outcomes, were analyzed.

Results

A total of 87 patients were included in the study, with 102 burr hole surgeries performed. Among these, 49 patients received single burr hole surgery, while 53 patients underwent double burr hole surgery. Recurrence of CSDH occurred in 8.8% of cases, with no significant difference observed between the groups. Notably, single burr hole surgery demonstrated comparable efficacy to double burr hole surgery in terms of subdural reduction and occurrence of pneumocephalus, while exhibiting fewer complications and shorter hospitalization.

Discussion and conclusions

burr hole surgery, whether performed as a single or double procedure, is an effective treatment option for CSDH, as it leads to positive outcomes in both radiological and clinical assessments of patients following surgery. The population of Bosnia and Herzegovina receives good neurosurgical care for CSDH.

导言：慢性硬膜下血肿（CSDH）是一种常见于老年人的多发病，通常需要神经外科介入治疗。研究问题：本研究调查了在波斯尼亚和黑塞哥维那接受单孔或双孔钻孔手术治疗的 CSDH 患者的特征和复发率。研究方法：对2018年1月至2022年12月期间接受CSDH治疗的患者进行回顾性研究。CSDH 的诊断是通过术前脑部 CT 或 MRI 确诊的。患者根据神经外科医生的决定接受单毛刺孔或双毛刺孔手术。研究对术前和术后脑部 CT 扫描结果以及临床疗效进行了分析。其中，49 名患者接受了单毛细孔手术，53 名患者接受了双毛细孔手术。8.8%的病例出现了CSDH复发，两组病例的复发率无明显差异。值得注意的是，单毛细孔手术在硬膜下缩小和气胸发生率方面的疗效与双毛细孔手术相当，同时并发症较少，住院时间较短。波斯尼亚和黑塞哥维那居民在 CSDH 方面得到了良好的神经外科治疗。

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引用次数: 0

Review of metastasis to meningiomas with case examples 脑膜瘤转移回顾（附病例

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102862

Magnus Sættem , Terje Sundstrøm , Anna.K.Myrmel Sæle , Rupavathana Mahesparan

Introduction

A tumor-to-tumor metastasis (TTM) is a rare metastatic process where a primary malignant tumor metastasizes to another tumor, most commonly a benign tumor such as a meningioma. Here, we present two recent cases of tumor-to-meningioma metastases (TMM) from our clinical practice and review of recent literature. The primary cancers were prostate and breast cancer, respectively.

Material and methods

We reviewed the electronic medical records of the two patients and conducted a literature review of TTM, focusing on biological mechanisms related to TMM.

Results

Our first patient, a man with a history of stable prostate cancer, underwent resection of two WHO grade 1 meningiomas, and the largest tumor was found to have TMM. Our second patient, a woman with progressive breast cancer, was operated for a WHO grade II meningioma, and the meningioma harbored breast cancer metastases. TMM is a rare occurrence, but breast cancer is a much more frequent cause than prostate cancer and we reviewed 50 cases. Only 15 of cases of TMM from prostate cancer have been described.

Discussion and conclusion

TMM is a rare phenomenon, but it is important to be aware of this as more and more patients live with cancer and meningiomas have a high prevalence, The possibility of TMM may impact not only both the surgical and oncological treatment but also surveillance of incidental meningiomas.

导读：肿瘤间转移（TTM）是一种罕见的转移过程，即原发恶性肿瘤转移到另一种肿瘤，最常见的是良性肿瘤，如脑膜瘤。在此，我们介绍两例近期临床实践中发生的肿瘤向脑膜瘤转移（TMM）病例，并对近期文献进行回顾。材料和方法我们查阅了这两名患者的电子病历，并对 TTM 进行了文献综述，重点关注与 TMM 相关的生物学机制。结果第一例患者是一名男性，有稳定的前列腺癌病史，接受了两个 WHO 1 级脑膜瘤的切除术，其中最大的肿瘤被发现有 TMM。第二例患者是一名患有进展期乳腺癌的女性，她因一个WHO二级脑膜瘤接受了手术，结果发现脑膜瘤藏有乳腺癌转移灶。TMM 虽然罕见，但乳腺癌的发病率却远高于前列腺癌。讨论与结论TMM是一种罕见的现象，但由于越来越多的患者患有癌症，而脑膜瘤的发病率又很高，因此我们必须意识到这一点，TMM的可能性不仅会影响手术和肿瘤治疗，还会影响对偶发脑膜瘤的监测。

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引用次数: 0

Intelligence overload: How AI is rewiring our approach to neurodegenerative diseases 智能超载：人工智能如何重塑我们应对神经退行性疾病的方法

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102868

引用次数: 0

Multi-Volume Rendering for Surgical Planning of Deformity Correction in Virtual Reality 虚拟现实中畸形矫正手术规划的多容积渲染技术

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102893

引用次数: 0

Transcranial magnetic stimulation brain mapping of the hand motor area: comparison between healthy subjects and patients with cervical myelopathy 手部运动区的经颅磁刺激脑图绘制：健康人与颈椎病患者的比较