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小脑脑桥角的相关文献在1992年到2022年内共计73篇,主要集中在肿瘤学、外科学、神经病学与精神病学 等领域,其中期刊论文73篇、专利文献77932篇;相关期刊43种,包括法医学杂志、中国微侵袭神经外科杂志、中国现代神经疾病杂志等; 小脑脑桥角的相关文献由296位作者贡献,包括汪照炎、吴皓、李劲松等。

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小脑脑桥角

-研究学者

  • 汪照炎
  • 吴皓
  • 李劲松
  • 杨洁
  • 柴永川
  • 乔慧
  • 凌苗
  • 刘开东
  • 孙杰
  • 尹连虎
  • 期刊论文
  • 专利文献

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    • 方军超; 杨晋生; 范波
    • 摘要: 目的统计分析中国近20年来听神经瘤外科治疗临床文献,为合理选择治疗策略提供依据。方法应用万方数据库等4个国内权威数据库,检索从2000年1月至2019年12月国内听神经瘤手术文献。纳入包含听神经瘤具体治疗方式的期刊文献。排除手术方式交代不清、同一单位或时间重复文献。统计分析内容:文献来源的区域分布;文献期刊源分布、引用频次及其排行;手术例数及手术入路方式;手术并发症及死亡率。结果共检索到文献1067篇,符合纳入标准258篇,发表文献排名前三地区为北京、江苏、广东,期刊为《中国临床神经外科杂志》《中华神经外科杂志》《中国微侵袭神经外科杂志》,被引用频次前三的文献为“听神经瘤切除面神经保留技术探讨”“大型听神经瘤的手术治疗”“大型听神经瘤的显微手术治疗与面神经保护”。文献病例总数10469例:2000年1月至2009年12月病例数3674例,手术方式主要为乙状窦后入路;2010年1月至2019年12月病例数6795例,主要术式为乙状窦后入路、颅中窝入路、迷路入路等手术方式。10469例手术患者中,死亡患者152例(1.45%);并发症依次为后组脑神经麻痹、颅内感染、颅内血肿、脑脊液漏、肺部感染、皮下积液、无菌性脑膜炎等。结论近20年来,我国在听神经瘤领域的研究有所创新,发表的文献在国际上占有一定地位,治疗策略也随着技术进步和对疾病认识程度的加深不断发生变化。
    • 丁威; 龚旋; 杨魁; 李春涛; 冯松山; 黄正; 周鸿书; 刘志雄; 李臻琰
    • 摘要: 目的 总结内镜下经颅脑桥小脑角区肿瘤切除术的手术要点.方法 纳入2019年1月至2020年12月中南大学湘雅医院诊断与治疗的28例脑桥小脑角区肿瘤患者,均行内镜下经颅入路手术切除脑桥小脑角区肿瘤.结果 28例患者均顺利完成内镜下经颅脑桥小脑角区肿瘤切除术,并全切除肿瘤.术后经病理证实听神经瘤9例,脑膜瘤8例,胆脂瘤9例,血管母细胞瘤1例,三叉神经鞘瘤1例.术后面神经功能Ⅲ级3例,Ⅱ级6例,Ⅰ级19例.术后1例听力障碍缓解不明显;2例出现头晕、眩晕、恶心症状;无一例出现脑脊液漏、脑膜炎、切口感染等并发症,无死亡病例.随访3个月时复查MRI均未见肿瘤复发,亦未出现新的神经系统症状.结论 内镜下经颅脑桥小脑角区肿瘤切除术具有诸多优点,亦存在一定不足,具有较好的发展前景.
    • 张晶; 杨智君; 张顺; 陈震; 赵赤; 吴涛; 王博; 刘丕楠; 赵赋
    • 摘要: 目的 探讨小脑脑桥角区(CPA)恶性周围神经鞘瘤(MPNST)患者的临床、影像学及病理学特征.方法 回顾性纳入首都医科大学附属北京天坛医院神经外科2013年3月至2018年3月收治的经病理学确诊的CPA区MPNST患者,共8例(占同期CPA病变的0.2%,3/3 500);另外纳入38例散发神经鞘瘤患者为对照组.分别比较两组患者的临床、影像学及病理学特征.结果 8例MPNST患者中,男1例,女7例;诊断年龄为26~60(42.1±13.4)岁;病程为1~18个月(中位数为6个月),与对照组的3 ~ 120个月(中位数为24个月)比较,差异有统计学意义(P=0.009).与对照组比较,MPNST组患者术前更容易出现颅高压症状[分别为4/8、4/38(10.5%),P =0.022]、听力丧失[分别为8/8、14 /38 (36.8%),P=0.001]及面神经功能丧失[分别为3/8、1/38(2.6%),P=0.013];肿瘤全切除比例[分别为4/8、37/38(97.4%),P=0.002]及术后面神经保留比例[分别为4/8、38/38(100.0%),P<0.001]均低于对照组.两组患者肿瘤体积、囊变等影像学特征比较差异均无统计学意义.组织病理学比较,MPNST组有坏死区域(分别为2/8、0/38,P=0.027),核分裂象[分别为(38.0±4.2)个/10 HPF、(1.9±1.0)个/10 HPF、Ki-67[分别为(14.2±8.7)%、(1.9±1.0)%]和p53阳性表达(分别为4/8、0/38)均高于对照组,差异均有统计学意义(均P<0.001);两组患者S100、Vimentin表达均为阳性.在3例MPNST样本中,均未检测到NF2基因突变;而30例神经鞘瘤样本中共检测出18例(60.0%)存在NF2基因突变.8例MPNST患者随访时间为12 ~ 41个月,平均(22.4±7.4)个月.复发4例,平均复发时间为(11.8±3.7)个月;2例死亡.结论 CPA区的MPNST极为罕见,影像学很难与神经鞘瘤区别,该肿瘤具有高度恶性的临床及组织病理学特征,组织病理学为主要的确诊方法.%Objective To analyze the clinical and pathological features of malignant peripheral nerve sheath tumors (MPNSTs) located in cerebellopontine angle (CPA).Methods Eight patients of MPNSTs in CPA region admitted to Department of Neurosurgery of Beijing Tiantan Hospital,Capital Medical University between March 2013 and March 2018 were retrospectively included,and 38 patients with sporadic schwannoma (VS) were enrolled as control.T test and Fisher test were used to compare the differences in clinical factors,imaging findings and pathologic characteristics between MPNST group and control.Results This study invlved 8 cases of CPA MPNST (1 male and 7 female).The age of patients with MPNST at diagnosis was 26-60 years (42.1 ± 13.4 years) old.The disease duration with MPNST was 1-18 months (median:6 months),compared with 3-120 months (median:24 months) in the control,and the difference was statistically significant (P =0.009).The incidence rates of preoperative hearing loss (8/8vs.14 /38,P =0.001),facial nerve dysfunction (3/8 vs.1/38,P =0.013),cranial hypertension symptoms (4/8 vs.4/38,P =0.022),the proportion of total tumor resection (4/8 vs.37/38,P =0.002)and the proportion of facial nerve preservation after surgery (4/8 vs.38/38,P < 0.001) were higher in MPNST patients than in those with sporadic VS,respectively.MPNSTs displayed higher mitotic activity [(38.0 ± 4.2)/10 HPF vs.(1.9 ± 1.0)/10HPF] and Ki-67 index [(14.2± 8.7) % vs.(1.9 ±1.0%)] than VS,respectively (both P <0.001).Nuclear positivity of p53 was also higher in MPNST than in VS (4/8 vs.0/38,P<0.001).In addition,NF2 gene mutation was found in 18 of 30 (60.0%) cases of VS,while none of 3 cases of MPNST was detected with NF2 mutation.All of the MPNST patients were followed up for 12-41 months (22.4 ± 7.4 months),recurrence occurred in 4 patients (average recurrence time:11.8 ± 3.7 months) and 2 cases of MPNST patients died.Conclusions MPNSTs in CPA are extremely rare and imaging is difficult to distinguish it from VS.MPNSTs show highly malignant clinical and pathohistological features and histopathology is the main method of diagnosis.
    • 凌苗; 乔慧; 贾旺; 贾桂军; 杨晓翠; 陶晓蓉; 李萍; 刘洋
    • 摘要: Objective To investigate the predictive value of preoperative and intraoperative electrophysiological parameters in facial nerve (FN) function after cerebellopontine angel (CPA) tumor surgery.Methods A total of 58 patients with CPA tumor underwent operations from August 2016 to March 2017 at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University and were enrolled into this retrospective study.Preoperative blink reflex (BR) and FN F wave response were tested in all patients.The R1 component latency and mean F wave latency were determined.Intraoperative facial motor evoked potentials (FMEP) was applied to monitor the FN function and the amplitude ratio of FMEP was documented.According to the House-Brackmann (H-B) grading system,the functional classification of FN was determined preoperatively,at 1 week,3 months and 6 months postoperatively.Multiple logistic regression analysis was applied to explore the predictor of postoperative FN function.Results A total of 58 cases of CPA tumor underwent microsurgical excisions by retrosigmoid approach.Total and subtotal resections were performed in 55 (94.8%) and 3 cases,respectively.Single factor Logistic regression analysis showed that the results of blink reflex in patients with good FN outcome were better than those in the group with poor outcome at 3 follow-up time points (P < 0.05).The results of F wave response in patients with good FN outcome were better than those in poor outcome group at 6 months post operation (P < 0.05).At 3 and 6 months post surgery,the maximal tumor diameters in the good outcome group were (31.9 ± 10.2) mm and (31.9 ± 9.3) mm,respectively,which were smaller than those in the poor outcome group [(37.8 ±9.7) mm and (40.0 ± 10.0) mm,respectively] (both P <0.05).At 1 week,3 and 6 months post surgery,the FMEP amplitude ratios in the good outcome group were (84.6 ±21.3)%,(83.0 ± 19.0)% and (81.0 ± 19.1)%,respectively,which were higher than those in the poor outcome group [(66.2 ± 27.0) %,(63.4 ± 29.0) % and (59.6 ± 31,2) %] (all P < 0.05).Multivariate Logistic regression analysis showed that FMEP amplitude ratio was the independent predictor of FN outcome at 1 week,3 and 6 months post operation (P < 0.05).The maximal tumor diameter was the independent predictor of FN outcome at 3 and 6 months post operation (P < 0.05).BR classification was the independent predictor of FN outcome at 6 months after operation (P < 0.05).ROC (receiver operating characteristic) curve analysis showed that the FMEP amplitude ratio cut-off values of 89.2% [AUC (area under the curve) =0.709],58.2% (AUC =0.706) and 58.2% (AUC =0.713) predicted good FN function at 1 week,3 and 6 months after surgery,respectively.Conclusions BR and maximal tumor diameter have certain predictive values for postoperative FN function.The FMEP amplitude ratio is a valuable predictor for postoperative FN function and its value of at least 60% is predictive of favorable long-term postoperative FN function.%目的 探讨术前及术中神经电生理检测指标对小脑脑桥角(CPA)区肿瘤术后面神经功能的预测价值.方法 回顾性分析2016年8月至2017年3月首都医科大学附属北京天坛医院神经外科收治的58例CPA区肿瘤患者的临床资料.患者术前均行瞬目反射及面神经F波检测,对瞬目反射的R1波潜伏期及F波的平均潜伏期结果进行分级.术中均采用面肌运动诱发电位(FMEP)保护面神经功能,记录FMEP波幅的比值.依据House-Brackmann(H-B)评分标准分别于术前1d、术后1周、3个月及6个月评估面神经功能.采用多因素Lotistic回归分析术后面神经功能的影响因素.结果 58例CPA区肿瘤患者均经乙状窦后入路切除肿瘤,其中55例获得肿瘤全切除(94.8%),3例肿瘤行次全切除.单因素Logistic回归分析显示,术后1周、3个月及6个月面神经功能结局良好组患者的瞬目反射结果优于结局不良组(均P<0.05).术后6个月面神经功能结局良好组的F波反应检测结果优于结局不良组(P<0.05).术后3个月及6个月面神经功能结局良好组的肿瘤最大径小于结局不良组[(31.9±10.2)mm、(31.9±9.3)mm对比(37.8±9.7)mm、(40.0±10.0)mm](均P<0.05).术后1周、3个月及6个月面神经功能结局良好组的FMEP波幅比值高于结局不良组[(84.6±21.3)%、(83.0±19.0)%、(81.0±19.1)%对比(66.2±27.0)%、(63.4±29.0)%、(59.6±31.2)%](均P<0.05).多因素Logistic回归分析显示,FMEP波幅比值为预测术后1周、3个月及6个月面神经功能结局的独立预测因素,差异有统计学意义(P<0.05).肿瘤最大径为3个月及6个月面神经功能的独立预测因素(P<0.05);瞬目反射结果分级是术后6个月面神经功能的独立预测因素(P<0.05).ROC曲线分析,FMEP波幅比值预测术后1周、3个月及6个月面神经功能良好的截点值分别为89.2%、58.2%、58.2%;曲线下面积分别为0.709、0.706、0.713.结论 瞬目反射及肿瘤最大径对术后远期面神经功能有一定的预测价值.FMEP波幅比值对术后面神经功能有良好的预测价值,波幅比值>60%预测术后远期面神经功能结局良好.
    • 王彬彬; 李德志; 乔慧; 王世炜; 苏迪娅; 李萍; 凌苗; 刘松; 万虹
    • 摘要: 目的 探讨预变性自体腓肠神经移植桥接舌下神经-面神经“侧”-侧吻合术治疗小脑脑桥角(CPA)区肿瘤切除术后面神经损伤所致周围性面瘫的疗效.方法 回顾性分析2013年6月至2016年2月首都医科大学附属北京天坛医院神经外科收治的48例CPA区肿瘤切除术后面瘫患者的临床资料.48例(试验组)均行预变性腓肠神经桥接舌下神经-面神经“侧”-侧吻合术治疗.同期纳入CPA区肿瘤术后行非手术治疗的8例患者(对照组).术后两组均行康复锻炼治疗.采集两组患者的静态和动态面容图像,并进行面神经电生理检查(包括肌电图、运动神经传导以及F波情况).采用House-Brackmann面神经功能分级方法(简称H-B分级)评估面神经的功能.随访时间为2~36个月,平均(12.1±13.4)个月.结果 与吻合术前相比,试验组术后H-B分级明显改善24例,改善21例,无改善3例;对照组术后H-B分级明显改善1例,改善2例,无改善5例.两组H-B分级改善程度的差异有统计学意义(P<0.01).面瘫6个月内行腓肠神经预变性桥接舌下神经-面神经“侧”-侧吻合术,患者面神经功能改善效果最明显.结论 预变性自体神经移植桥接舌下神经-面神经“侧”-侧吻合术可有效治疗CPA区肿瘤切除术后的周围性面瘫,面瘫6个月内实施吻合术效果较佳.%Objective To evaluate the treatment effects of hypoglossal-facial ‘side’-to-side neurorrhaphy using a predegenerated sural nerve autograft for facial paralysis following tumor resection in cerebellopontine angle (CPA) area.Methods We followed up 48 patients who developed facial paralysis as a result of CPA tumor removal and underwent hypoglossal-facial ‘ side’-to-side neurorrhaphy using a predegenerated sural nerve autograft between June 2013 to February 2016 at Neurosurgery Department of Beijing Tiantian Hospital,Capital Medical University.Eight other patients who served as controls did not receive any repair treatment.Patients in both groups received rehabilitation exercises and their static and dynamic facial images were collected.Electrophysiological tests of the facial nerve were conducted including electromyography,motor nerve conduction and F wave.The patients' facial nerve functions were assessed according to House-Brackmann grading scale (H-B scale).The follow-up lasted 2-36 months with an average of (12.1 ± 13.4) months.Results In the surgical treatment group,24/48 patients were found postoperatively to have significant facial function improvement on H-B scale,21/48 patients to have improvement,and 3/48 remained unchanged.In the control group,1/8 patient was found to have significant facial function improvement on H-B scale,2/8 had improvement and 5/8 remained unchanged associated with marked atrophy of paralyzed facial muscles.Significant difference was identified in the facial function improvement on H-B scale between the surgical treatment and control groups (P < 0.01).The improvement of facial nerve function was most evident if the surgical repair treatment was performed within the 6 months after the onset of facial paralysis.Conclusions Hypoglossal-facial ‘ side’-to-side neurorrhaphy may effectively treat facial paralysis resulting from CPA tumor resection.Better recovery of facial nerve function could be achieved when the surgical treatment is performed within the 6 months after the onset of the facial paralysis.
    • 汪照炎; 贾欢; 杨洁; 谭皓月; 吴皓
    • 摘要: 目的探讨显微镜、内镜联合技术在桥小脑角区手术中的应用。方法回顾性分析2006年1月至2015年1月采用显微镜内镜联合技术进行手术治疗的72例侧颅底疾病患者的临床资料,其中男35例,女37例,年龄36~73岁。疾病种类:听神经瘤22例,颅神经疾病45例(包括三叉神经痛21例、梅尼埃病17例,面肌痉挛5例,舌咽神经痛2例),桥小脑角胆脂瘤5例;手术进路:乙状窦后进路37例(其中听神经瘤20例、颅神经疾病15例、桥小脑角胆脂瘤2例),迷路后进路35例(其中听神经瘤2例,颅神经疾病30例,桥小脑角胆脂瘤3例)。手术在显微镜和不同角度内镜配合下完成,使用时将内镜图像与显微镜图像融合。所有病例术后均随访1~5年,对手术效果进行分析。结果所有病例手术均成功。45例颅神经病变患者术后症状均消失,无一例出现面神经麻痹或非责任神经并发症,所有病例听力与术前相比均无下降。22例听神经瘤患者肿瘤均全切除,术后无一例出现面神经麻痹或其他颅脑并发症,术后实用听力保留率72.7%(16/22);随访1~5年,无复发。5例桥小脑角胆脂瘤患者胆脂瘤均彻底切除,术后无一例出现面神经麻痹或其他颅脑并发症,术后2例患者出现听力丧失,3例保存实用听力;随访1~5年,无复发。结论显微镜联合内镜在处理桥小脑角区域病变时能结合二者的优势,避免各自的不利之处,具有较好的应用前景,尤其适用于乙状窦后进路和迷路后进路的颅神经手术、听神经瘤手术以及桥小脑角胆脂瘤手术。%Objective To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle ( CPA) surgery.Methods A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively .The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas , 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma .Twenty cases of vestibular swannnomas , 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach , while other cases undergone the surgery via retrolabyrinthine approach .Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion.The surgical results were evaluated according to subjective and objective criteria , and all patients were followed up for 15 years.Results The symptoms was disappeared in the cranial neuropathy patients , without facial paralysis , complication of other nerves or hearing loss .Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits ; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma , which gained completely surgical removal;useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up.Conclusions A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques .It can provide better exposure with minimal invasion in CPA surgery , and is especially applicable in surgery for cranial neuropathy , vestibular schwannoma and CPA cholesteatoma , which should be performed through retrosigmoid approach and retrolabyrinthine approach .
    • 杨洁; 朱伟栋; 柴永川; 贾欢; 汪照炎; 吴皓
    • 摘要: 目的探讨迷路后入路在桥小脑角区手术中的应用方法和临床价值。方法回顾分析上海交通大学医学院耳科学研究所2011-01-01~2016-01-01收治的42例桥小脑角区疾病患者,均采用迷路后入路暴露手术区域,术中应用显微镜-内镜双镜联合技术。结果所有病例均成功手术。听神经瘤及胆脂瘤病例均完全切除,术后可测听力保留率(AAO-HNS听力评级A、B、C级)为66.7%(6/9),术后面神经功能良好(HB分级I-II级),无1例患者出现脑脊液漏等颅脑并发症,随访中未见复发。颅神经疾病术后症状均消失,术后均保留可测听力,面神经功能良好,术后无后组颅神经等非责任神经并发症。结论迷路后入路创伤较小,听觉及面神经功能保留率高,在内镜辅助下特别适合功能性颅神经手术及位于内耳道口且直径<15 mm的桥小脑角听神经瘤及胆脂瘤的治疗。
    • 朱伟栋; 柴永川; 杨洁; 张治华; 汪照炎; 吴皓
    • 摘要: 目的探讨内耳道及桥小脑角非听神经瘤病变的诊断以及影像学检查在鉴别诊断中的作用。方法回顾分析上海交通大学医学院耳科学研究所2001年1月~2016年12月185例内耳道及桥小脑角非听神经瘤的病例资料,其中后组颅神经鞘瘤65例,面神经瘤55例,脑膜瘤25例,胆脂瘤9例,恶性肿瘤9例,三叉神经鞘瘤8例,海绵状血管瘤6例,蛛网膜囊肿5例,脂肪瘤3例。所有病例均接受手术治疗,术前诊断和手术入路根据术前临床表现、颞骨高分辨率CT和MRI检查结果确定,术后均病理确诊。结果 185例患者中男96例,女89例,年龄11~77岁,平均(46.4±25.6)岁,术后平均随访(5.1±3.2)年,病变均全切除,术后并发症脑脊液漏4例(2.2%),术后随访过程中死亡4例(均为桥小脑角恶性肿瘤),1例胆脂瘤复发。各类内耳道及桥小脑角非听神经瘤病变有特征性影像学表现,根据术前临床表现、颞骨高分辨率CT和MRI检查结果诊断准确率为93.5%(173/185)。结论准确的术前诊断对制定内耳道及桥小脑角病变的治疗策略具有重要意义;术前结合临床表现、颞骨高分辨率CT和MRI检查结果可明显提高诊断准确率。
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