42例脑干占位性病变的诊断及显微手术治疗

Diagnosis and microsurgical treatment for 42 cases of space-occupying lesions in brain stem

目的探讨脑干占位性病变的临床表现、影像学检查、病理类型、显微手术治疗及术后并发症的防治。方法对我院2002年1月至2010年1月显微手术治疗的42例脑干占位性病变的临床表现、影像学特点及手术治疗进行回顾性分析。42例脑干占位性病变均行显微手术,采取颞下入路8例,枕下幕上入路8例,乙状窦后入路11例,后正中入路15例。全切除28例,次全切除10例,部分切除4例。结果术后症状明显改善者27例,变化不明显者9例,加重5例,1例桥-延髓血管网状细胞瘤患者术后呼吸衰竭,自动出院后死亡。结论应用显微神经外科技术治疗脑干占位性病变,手术适应症选择正确,采取不同的手术入路,术后积极预防和治疗并发症,可以取得良好的治疗效果。

Objective To explore the clinical manifestation,radiological modalities,pathology,microsurgical techniques and post-operative complications of space-occupying lesions in brain stem.Methods A total of 42 cases of space-occupying lesion in brain stem from January 2002 to January 2010 were reviewed and analyzed retrospectively.Results All patients received microneurosurgical treatment;8 cases via the subtemporal transtentorial approach,8 cases via the Poppen approach,11 cases via the retrosigmoid approach,and 15 cases via the post-meso approach.Total resection was achieved in 28 of 42 patients,subtotal resection in 10 patients,and partial resection in 4 patients.Obvious improvement of symptoms was obtained in 27 cases,mild improvement in 9 cases,deterioration in 5 cases and 1 patient with angioreticuloma in the pons-medulla died after discharge.Conclusion Microneurosurgery is an effective treatment for space-occupying lesions in brain stem.Proper choices of indications,microsurgical approach,prevention and treatment of post-operative complications are important for the good therapeutic effect.