神经导航辅助“锁眼”入路切除儿童幕上海绵状血管瘤33例分析

Microsurgery for the intracranial cavernous malformation in 33 pediatric patients through keyhole approach and neuronavigation

目的探讨神经导航下"锁眼"入路显微手术治疗儿童脑内海绵状血管瘤的可行性和临床应用价值。方法回顾分析2002年至2008年收治的33例通过导航引导并结合术中超声显微手术治疗儿童脑内海绵状血管瘤的临床资料,并对相关临床经验进行总结。结果 33例患儿均经"锁眼"入路暴露并全切除肿瘤;1例因位于左侧颞部,术后出现短暂的言语障碍,术后一周恢复正常;癫痫发作19例,16例术后癫痫药物治疗3年后逐渐停药未复发;1例发生1次癫痫大发作,2例发生部分性发作,均行药物控制;2例术前偏瘫术后得到改善,无术前神经系统症状加重或新的神经功能障碍出现。结论 "锁孔"入路中应用神经导航并结合术中超声显微手术治疗儿童脑内海绵状血管瘤具有暴露充分、微创、术后并发症少、恢复快等优点,可最大程度切除病灶,可减少癫痫和再次出血的风险,是治疗儿童幕上脑内海绵状血管瘤的一种有效治疗方案。

Objective To explore the application of the neuronavigation to microsurgery for the intracranial cavernous malformation in pediatric patients through keyhole approach. Methods 33 pediatric patients with intraeranial cavernous malformation were analyzed retrospectively by our institution between 2002 and 2008, and were carried out by keyhole incisions and neuronavigational system-assisted microneurosurgery. Results All the patients were operated through keyhole approach and were total resection.Surgical complications were limited to transient dysphasia in one patient, affected by a left temporal CM, which resolved 1 week after surgery. Among the 19 patients with seizures, 16 were now seizure- and drug-l^ee after we adopted the policy of maintaining the antiepileptic treatment for at least 3 years after the surgical treatment; in three patients, however, anti-epileptic medications were not discontinued, although these children did not present any epileptic seizures after the surgical removal of the CM. Generalized tonic clonic seizures were observed in 1 patient, and partial seizures were seen in 2 patients, and they were controlled with medication. Only two children（6.1%） had persistent presurgical neurological signs, although the treatment ameliorated them.And no pro-gression of the preoperative neurological signs or onset of new neurological deficits was seen in any of the patients. Conclusion The new approach has its own specific advantage of small skin incision which does not damage the patients looks and short hospitalization. In our patient group, the microsurgical removal of CMs resulted in the prevention of recurrent hemorrhage and the control of seizure disorders in all cases,and it is the first choice for paediatric cavernous malformation.