皮质运动区海绵状血管瘤的显微外科治疗

The microsurgical treatment of the cavernous angioma located mostly in cortical motor area

目的探讨皮质运动区海绵状血管瘤的显微外科操作技巧。方法回顾性分析25例海绵状血管瘤主体部分位于皮质运动区患者的术前主要临床资料,包括肢体肌力、癫痫发作、影像学检查结果、术中操作要点、术后肢体瘫痪及癫痫发作情况等。结果全切除23例（92.0%）,次全切除2例（8.0%）。无手术死亡病例。与术前相比术后出现肢体瘫痪或瘫痪加重11例（44.0%）,肢体肌力减退无变化4例（16.0%）,肌力正常10例（40.0%）。经保守治疗并随访5月~4年,其中肢体肌力减退得到随访者14例,恢复正常12例,轻瘫2例;术前癫痫发作者得到随访18例,完全消失16例,发作明显减少2例。其它临床症状均基本恢复正常。结论在神经电生理监测下采取合理的脑沟入路、精细的显微外科操作技巧及皮层低功率电凝热灼术可获得满意疗效。

Objective To investigate the microsurgical techniques of treatment for the pa- tients with the cavernous angioma mostly located in cortical motor area. Methods The clinical materials including limbs＂ myodynamia, seizures, imaging findings, intraoperationgal techniques, postoperational hemiplegia and seizures etc in 25 cases were retrospectively analyzed. Results Total resection of cavernous angioma was achieved in 23 cases （92.0%）, sub--total resection in 4 cases （8.0%）. The hemiplegia were acquired or aggravated after microsurgery in 11 cases （44. 0 %）, the limbs＇ myodynamic attenuation had nol change in 4 cases （16.0 %）, normal myodynamia in 10 cases （40. 00%）. 14 cases with postoperatiohnal hemiplegia and 18cases with seizures were followed--up from 5 months to 4 years, there were normal myodynamia in 12 cases （85.7%）, hemiparesis in 2 cases （14. 3%）, sezures completely free in 16 cases （88. 9%） and seizures de- creased in 2 cases （11.1%）. Conclusion Careful manipulations were especially emphasized during microsurgical procedure,the sulcus approach was the first choice in cortical approaches, arteries and veins in surgical area should been possibly reserved. The monitoring of neruoelectrophysiolo- gy during surgical procedure and low electric power thermo--coagulation of cortex could aid in improvement of outcomes for the patients with cavernous angioma located mostly in cortical mo- tor area.