脑干内血管畸形的诊断及治疗——附100例病例报告

Diagnosis and Surgical Treatment of Brain-stem Vascular Malformations

目的 总结脑干内血管畸形的诊断、治疗经验教训,为提高临床诊疗水平提供借鉴。方法 回顾性地总结本所1987～1997年间经显微手术治疗的脑干血管畸形100例(105个病灶)病历资料,对脑干内血管畸形的发生、发展、病理学分类、临床及影像学表现、手术时机及手术方法等进行分析、总结。结果 脑干内的血管畸形多为海绵状血管瘤,有的同时合并毛细血管扩张症或静脉畸形。本组67%的病例经历1次以上的出血发作,女性患者的平均出血次数有高于男性的趋势。本组100例无手术死亡,多数手术效果良好。92%的病例得到6个月～11年的随访,出血复发率为4%。结论 对于症状性出血的脑干内血管畸形,应积极、稳妥地采取显微外科手术治疗。反复出血会加重症状,使病灶变硬,增大手术难度。对无症状者或影像学上无占位效应的病灶,暂时无需手术,但应保持临床及影像学的随诊。

To study the various aspects of the brain stem vascular malformations, including the histopathology, clinical presentation, neuroimaging, techniques of surgical operation. Methods A retrospective analysis of 100 patients with 105 brain stem vascular malformations had underwent microsurgery from 1987 to 1997 in the institute. Results Most brain stem vascular malformations are cavernoma, some of them are not easily differentiated from telangiectasis. Meanwhile, they could also associate with venous malformation. In our group, 67% patients suffered from hemorrhage more than one time. The average number of bleeding in female is higher than in male's. There was no operative mortality. The outcome was improved and stable in 65% patients. Ninety two patients have followed up half a year to 11 years. Rebleeding after operation occurred in 4% cases. Conclusions Active microsurgery should be adopted carefully for the patients with symptomatic brain stem vascular malformations, while those with asymptomatic lesions need long term clinical observations and neuroimaging follow up.