脑干海绵状血管畸形的手术治疗

Surgical management of brain stem cavernous malformation

目的明确脑干海绵状血管畸形（CM）的解剖位置，探讨相应的手术入路和手术技巧。方法回顾性分析53例脑干CM的病例资料。其中主体位于中脑10例（中脑腹侧1例，中脑背侧2例，中脑侧方7例）；主体位于脑桥32例（脑桥侧方28例，脑桥背侧4例）；主体位于延髓11例（延髓侧方2例，延髓背侧9例）。病变均行手术切除。共使用7种手术入路：额眶颧入路1例、枕下-经小脑幕入路（Poppen入路）2例、颞下-经小脑幕入路27例、颞下-岩前经小脑幕入路6例、枕下-乙状窦后入路2例、枕下后正中入路13例、远外侧入路2例。结果病变全切除53例（100％）。术后随访：症状明显改善18例（34％），症状无变化28例（53％），新增症状7例（13％）。结论对于脑干CM，选择适合的手术入路和精湛的手术技巧，术中配合使用辅助技术，是减少手术损伤、获得良好手术质量及预后的关键。

Objective The aims of this study were to determine how to choose the appropriate surgical approach based on the anatomical character of the Brain Stem cavernous malformation and to investigate the corresponding surgical skill. Methods The records of 53 adults who presented with Brain Stem cavernous malformation between 20011.3 and 2012. 9 were retrospectively reviewed. These lesions were classified according to their anatomical location as follows ： ventral midbrain （ 1 case）, lateral midbrain （7 cases）, dorsal midbrain （2 cases）, lateral pons （28 cases）, dorsal pans （4 cases）, lateral medulla （2 cases） and dorsal medulla （9 case）. All the patients underwent surgical removal of Brain Stem cavernous malformations. The surgical approaches used were orbitozygomatic （ I case）, poppen approach （2 cases）, subtemporal - transtentorial （ 27 cases ）, subtemporal/anterior petrosectomy （6 cases）, suboccipital - retrosigmoid （2 cases）, midline suboccipital （13 eases） and far- lateral （2 cases）. Results Total resection of the Brain Stern cavernous malformation was achieved in all eases （100%）. Postoperative improvement was achieved in 18 eases （34%）, unchange in 28 （53%）. New postoperative deficits were observed in 7 patients （13%）. Conclusions The correct surgical approach, skill and assistive technology are the key points to gain good results for the patients with brain stem cavernous malformations.