颞下经小脑幕入路切除脑桥海绵状血管畸形

Removed of cavernous malformation in the pons via subtemporal transtentorial approach

目的总结颞下经小脑幕入路切除脑桥海绵状血管畸形的治疗经验。方法回顾性分析23例脑桥海绵状血管畸形病人的临床资料,采用颞下经小脑幕入路手术切除病灶。采用常规马蹄形切口15例,耳前弧形切口8例。结果全切除21例,近全切除2例,无手术死亡。术前面瘫、眼肌协同性运动障碍完全恢复,无新出现的面瘫,术后出现一过性语言障碍5例。GOS评分:恢复良好21例,重度病残2例。结论颞下经小脑幕入路能够充分显露并切除脑桥海绵状血管畸形,同时可避免出现面瘫等严重并发症。

Objective To summarize the treatment experiences of cavernous malformation（CM） in the pons via subtemporal transtentorial approach.Methods Clinical data of 23 patients with CM in the pons were analyzed retrospectively and the lesions were resected via subtemporal transtentorial approach.The horseshoe-shaped skin incision was made in 15 patients and preauricular arc-shaped skin incision in 8.Results Total removal of lesion was achieved in 21 cases and subtotal removal in 2.No patient died.All the patients with preoperative facial nerve paralysis and ocular coordinated movement disorder recovered.No new facial nerve paralysis occurred after the operation.Five patients experienced a transient language disorder after the operation.Glasgow outcome scale（GOS） revealed that 21 patients recovered well and 2 severely disabled.Conclusions Subtemporal transtentorial approach can provide adequate exposure for the surgical removal of CM in the pons and avoid the severe complications such as facial nerve paralysis.