耳前颞下经小脑幕入路切除脑干海绵状血管畸形的疗效及可行性探讨

Feasibility analysis and clinical efficacy of preauricular subtemporal transtentorial approach for removal of brainstem cavernous malformation

目的探讨耳前颞下经小脑幕入路切除脑干海绵状血管畸形（cavernous malformations,CM）的疗效。方法回顾性分析30例位于中脑及脑桥上、中部的脑干CM的临床资料,均采用耳前颞下经小脑幕入路,显微外科技术切除病变。术中运用神经电生理监测,部分病例采用神经导航技术定位病灶。结果术后MRI显示病灶均全切除,无手术死亡。术后平均随访时间11.7个月（6~18个月）,随访期内MRI复查均未见病灶复发。结论耳前颞下经小脑幕入路能够充分显露并切除位于中脑至脑桥上、中部的CM,且术后脑神经功能障碍、意识障碍、肢体偏瘫等致残性并发症发生率低。但不适用于病变主体位于脑桥下部及延髓的病灶。

Objective To explore therapeutic efficacy of microsurgical resection for brainstem cavernous malformation（CM） via preauricular subtemporal transtentorial approach. Methods The clinical data of 30 patients with midbrain and mid- to upper pons CM were analyzed retrospectively. The patients were treated by microsurgery via preauricular subtemporal transtenorial approach.The intraoperative electrophysiological monitoring was performed; intraoperative neuronavigation was employed to locate the deep brainstem CM. Results Total resection was achieved in all the patients. No patient died. The mean duration of the follow-up period was 11.7 months（range 6-18 months）, during follow-up, no recurrence was revealed in postoperative MRI images. Conclusions Preauricular subtemporal transtenorial approach can provide adequate exposure for the surgical removal of CM in midbrain and mid- to upper pons. The rates of cranial nerve dysfunction, consciousness disorder and hemiparalysis are low. However, this approach is not applicable for CM in the lower pons and medulla oblongata.