脑干海绵状血管瘤的手术指征和方法

Brain-stem cavernous hemangioma:surgical indications and approaches

目的 评价手术治疗脑干海绵状血管瘤 (CH)的疗效和愈后。方法 对近 8年手术切除的 14例脑干海绵状血管瘤 (15个病灶 )的手术情况进行回顾性分析。结果 15个病灶均全切除 ,患者无手术死亡。 10例术后神经功能障碍改善 ;2例神经功能缺失加重 ,但在术后随访时 ,神经功能已恢复至术前状态 ;1例术后症状无改善 ;1例中脑CH术后症状加重。经平均 42个月随访 ,均未见病变复发。 结论 掌握适当手术指征和微侵袭技术 ,脑干海绵状血管瘤可通过手术切除 。

Objective To evaluate the surgical indications and prognosis for cavernous hemangiomas (CHs) in the brain stem. Methods From 1992 to 2000, 163 patients with intracranial CHs were operated on in our department. Among them, 14 patients (8 women and 6 men; mean age 42 years) had 15 CHs in the pons (12), mesencephalon (1) and medulla oblongata (1). Surgical indications for CHs are: progressive focal neurological deficits; hemorrhage; near the surface of the brainstem. Transvemian approach with midline suboccipital craniotomy was used for the lesions in the pons and medulla, near the floor of the Ⅳ cerebral ventricle. Transpetrosal approach was used for the lesions in the anterior part of the pons, and infratentorial supracerebellar approach for those in the mesencephalic case. Results CHs were totally removed from all the 15 lesions. Neurological deficits were improved in 10 patients after operation. Two patients had transient worsening of neurological conditions, which returned to the preoperative status during follow up. The mesencephalic case, however had neurological condition deteriorated and was homebound after surgery. Pathologically, an oligodendroglioma was seen with CH in this case. Conclusions If surgically indicated, CHs involving the brain stem can be resected. Minimal invasiveness techniques and careful operative planning may contribate to the treatment of CHs involving the brain stem.