脑内海绵状血管瘤的临床特点与微侵袭手术治疗

Clinical features and minimally invasive surgery of cerebral cavernous angiomas

目的总结脑内海绵状血管瘤(CA)的临床特点及手术治疗经验。方法回顾性分析21例脑内型CA的临床资料和手术方法。首发症状为癫痫者16例,偏瘫或偏身感觉障碍者4例,无症状1例。采用神经导航辅助显微手术,其中4例同时做了颞叶部分切除,10例切除了胶质疤痕和含铁血黄素沉积带,2例在皮层脑电图监测下切除病灶和癫痫灶,余5例以含铁血黄素沉积带为界面切除病灶。结果病灶均全切。21例患者随访0.5～4年恢复良好或无变化。结论脑内型CA应积极手术治疗。合理采用微侵袭神经外科技术并遵循个体化原则有利于提高手术疗效。

Objective To summarize the clinical features and surgical experiences of cerebral cavernous angiomas （CA）. Methods The clinical data and surgical methods of 21 patients with cerebral CA were analyzed retrospectively. The early symptom was epilepsy in 16 cases and neurological deficit in 4 and free of symptom in 1. Neuronavigation-assisted microsurgery was performed in all cases,4 received temporal partial resection, glial scar and deposit belt of ferriheme were resected in 10, lesions and epileptogenic foci were resected under monitoring with cortical EEG in 2 and lesions of 5 were resected on the margin of deposit belt of ferriheme. Results Total removal was achieved in all cases. 21 cases were recovered well or on change during the follow-up of 0.5 to 4 years. Conclusions The surgery should be carried out actively for the patients with cerebral CA. The using of minimally invasive neurosurgical technique combined with individualizied therapy can improve the surgical effectiveness.