延髓海绵状血管畸形出血致呼吸障碍的手术治疗

Surgical management of cavernous malformation in medulla oblongata with dyspnea

目的探讨延髓海绵状血管畸形出血导致严重自主呼吸障碍患者的手术适应证及显微外科治疗。方法回顾性分析4例延髓海绵状血管畸形出血导致严重自主呼吸障碍的临床资料，术前KPS评分平均17．5分，均行枕下后正中入路病灶切除。结果4例延髓海绵状血管畸形均手术全切，自主呼吸均改善，肢体麻木和行走困难无显著改善，术后KPS评分平均60分，生活质量改善2例，稳定2例。平均随访15．0个月，无症状加重，随访KPS评分平均70分。结论手术治疗延髓海绵状血管畸形出血伴自主呼吸障碍可取得良好预后。

Objective To discuss the surgical management of cavernous malformation （CM） in medulla oblongata with dyspnea after hemorrhage. Methods The clinical data of four patients with CM in medulla oblongata with dyspnea after hemorrhage were analyzed retrospectively. The mean preoperative Karnofsky Performance Scale （KPS） was 17. 5. All of the patients underwent operation through posterior midline suboccipital approach. Results Complete resection was achieved in four patients. The main clinical symptoms of dyspnea, facial paralysis and pain were totally improved. But there was no change of motor deficits or sensory disturbance. The mean postoperative KPS was 60. Two patients were improved and others were stabilized. The mean follow - up duration was 15.0 months without recurrent hemorrhage. The recent mean KPS was 70. Conclusions Patients with CM in medulla oblongata suffering from dyspnea could obtain favorable prognosis through surgical treatment.