Brain Functional Reorganization After Restoring The Bladder In The Spina Bifida Patient With Artificial Nerve Arc

Part oneTwo different pathway of brain control of void and void suppressionin human: an fMRI studyObjective: To observe two different pathways in brain structures control of void andvoid suppression in human.Methods: The different pathway was elucidated through comparing brain activation invoid and void suppression with fMRI.Results: The frontal cortex was activated in void and void suppression with similarintensity and coordinate. While the cingulate,insular,supplement motion cortex and postalcentral gyms were activated in void and void suppression with distinct intensity andcoordinate. The cerebellum had different part activated in void and void suppression. Thehypothalamus and L-region of pontine were only activated in void and the putamen wasonly activated in void suppression. The M region of pontine and PAG were not activatedperhaps because the intubation interrupted the synergetic contraction of bladder.Conclusions: The frontal cortex was the conjunct center of decision void or voidsuppression, and might be the most highest level center to deal with all kinds of bladderactions. The cingulate,insular,supplement motion cortex and postal central gyrus assistedin void decisions making, but different decisions making may required different parts of these cortexes. Different sub-cortex structures participated in either void or voidsuppression. The study suggested that there were tow different pathways in the braincontrol of void and void suppression. Part twoAn fMRI study of natural void procedure in humanObjective: We observed brain activation in natural void procedure fristly, whichoffered more precise and real functional brain mapping of void regulation than that insimulative bladder action. The result would benefit the understanding of urinaryincontinence result from brain diseaseMethods: The brain activation in natural void procedure was studed with fMRI.Results: The frontal cortex,postal central gyrus,supplemental motion area andcerebellum were activated in pre-void period. And cingulate,insular,supplemental motioncortex,postal central gyrus,hypothalamus,PAG,pontine and cerebellum were activatedin void period. The coordinates of active frontal cortex were similar in pre-void and voidperiod, and the coordinates of active cerebellum are different in pre-void and void period.Conclusions: The frontal cortex,postal central gyrus,supplemental motion areaallowed void and maintained void. The hypothalamus,supplement motion area,PAG,pontine and some parts of cerebellum only took part in void regulation. Some parts ofcerebellum only took responsibility for allow void in pre-void period. Part threeThe void center in spinal bifida patient with congenitalurinal incontinence: an fMRI studyObjective: To observe the function of micturition center in spina bifida patient withcongenital urinary incontinence.Methods: The fMRI was applied in this study to compare the brain activation innatural void in the normals with that in simulative natural void in the patients.Results: The frontal cortex,postal central gyrus,hippocamp and cerebllum wereactivated in simulative natural void procedure in the patient group, and besides the similaractive region of the cortexes found in patients, the active supplemental motion area,opercula and some sub-cortex structures were founded in natural void in the contrast group.Conclusions: In the spina bifida patients with congenital urinary incontinence, most of themicturition center were not activated in simulative natural void. The only active cortex offorntal cortex, postal central gyrus,hippocamp and cerebellum suggested that the voiddecisison making is unmatured. Part fourBrain functional reorganization after restoring the bladder in thespina bifida patient with artificial nerve arcObjective: To elucidate the brain functional reorganization after restoring bladderfunction with artificial nerve arc in the spina bifida patient with congential urinaryincontinence.Methods: The brain functional reorganization mechanism was elucidate wthcomparing the brain activation in void procedure pre- and post-operatively with fMRIResults: No active pontine was found in pre-operative group, strongly active pontinewas found post-operation group with coordinate different from that in the normals. Theactive suprapontine structures in pre-operative group only contained frontal cortex。postalcentral gyrus,hippocamp and cerebellum. The major active suprapontine structures inpost-operative group were similar as that in the normals.Conclusions: An new brain stem viod center formed in the post-operational patient,and Suprapontine strctures developed mature functional to serve as voluntary void control.No active sub-cortex except cerebellum were found in pre-operative group patient and littleactive cortexes were found, which meant a founctionally unmatured void decision makingsystem in the pre-operative group.