脑干占位病变

Space-occuping Lesions of brainstem

本文总结了8例脑干内非囊性占位病变显微手术治疗的成功经验。 其中2例为星形细胞瘤;2例为血管网织细胞瘤,及4例桥脑出血,分析了所有病人术前的临床表现及神经影像检查。除1例死于并发症外,其它病人有较好的神经功能恢复,并术后的 MRI显示脑干形态明显改善。文中对脑干占位病变的诊断、治疗等作了系统的讨论。

Eight cases with space-occuping lesions ofbrainstem are presented. Of the 8 cases. twowere intrinsic nonexophytic pontine astrocytoma.two were the medullopontine hemangioblastoma.and four were hematomas of the pons. Allof the patients were studied by CT. MRI andDSA combined with clinical manifestationbefore the operation. and performed the mi-crosurgical operation successfully. Despite onepatient died of complication. there have beenan excellent neurological recovery and signifi-cant improvement in the appearance of brain-stem on the MRI postoperatively. Our ex-periences pointed to 1) the brain-stem tumors.even intrinsic non-exophytic brain-stem gliomasare possible to be operated. According to thetypes of tumor. different operative techniqueshould be adopted; 2) MRI should be usedas the imaging investigation of first choicein assesssment of the brainstem's condition.The multiplanar facility can provide a betterevaluation of whether a lesion is intra orextraaxial and of surface anatomy surroundingbrain-stem 3) 'cryptic' cerebrovascular malfor-mation should be considered in any case of'primary' hematoma of the brianstem. espe-cially in young patients with the normotensive.Angiography was noncontributory in those cases.Surgical managment carries the better prognosisand none suffered recurrence of the symptomsat more than 3 years follow-up.