显微手术治疗脑干实体性血管母细胞瘤的疗效分析

Efficacy analysis of microsurgery for brain stem solid hemangioblastomas

目的探讨脑干实体性血管母细胞瘤在神经电生理监测及临时阻断供血动脉技术辅助下的显微手术治疗的疗效。方法回顾性分析四川大学华西医院神经外科2005年1月至2014年12月收治的56例脑干实体性血管母细胞瘤患者的显微手术治疗效果。56例患者中，46例行枕下后正中入路，10例行扩大远外侧入路显微手术治疗。所有患者术中均在脑干体感诱发电位及运动诱发电位监测下临时阻断可疑供血动脉辅助肿瘤切除。结果56例患者中，肿瘤全切除54例，近全切除2例。2例肿瘤未能全切的患者均因术中分离肿瘤时神经电生理监测出现明显变化，并伴有明显的心率下降而停止手术。56例患者平均随访25个月，随访期内45例术前神经功能障碍明显好转，9例较术前无明显好转，2例出现新的神经功能损伤。随访期内共2例肿瘤复发，其中1例为肿瘤近全切除的患者，1例为肿瘤全切除的患者。后者经基因检测明确为VonHippel Lindau（VHL）患者。结论神经电生理监测及临时阻断供血动脉技术能减小显微手术切除脑干实体性血管母细胞瘤的风险，提高肿瘤全切率并明显改善患者的预后。

Objective To investigate the efficacy of microsurgery of brain stem solid hemangioblastomas under the techniques of nerve electrophysiological monitoring and temporary occlusion of feeding artery. Methods The treatment effect of microsurgery in 56 patients with brain stem solid hemangioblastoma treated at the Department of Neurosurgery, West China Hospital, Sichuan University from January 2005 to December 2014 were analyzed retrospectively. Of the 56 patients, 46 were treated via posterior median suboccipital approach, and 10 were treated with microsurgical treatment via extended far-lateral approach. All patients performed temporary occlusion of suspected blood supply artery for assisted tumor resection under the brainstem somatosensory evoked potential and motor evoked potential monitoring. Results In 56 patients, the postoperative magnetic resonance examination confirmed that the tumors of 54 patients were resected totally, and 2 were resected neartotally. Two patients who were not resected totally stopped their operation because of electrophysiological monitoring showed significant changes, and accompanied by a significant decrease in heart rate during the introperative separation of tumors. The 56 patients were followed up for a mean of 25 months. During the follow-up period, preoperative neurological dysfunction of 45 patients was improved significantly, 9 patients did not have any improvement compared with before procedure, and 2 developed new neurological deficits. Two patients had tumor recurrence during the follow-up period. One of them the tumor was resected neartotally. The gene detection of the latter was identified as Lindau VonHippel （VHL） disease. Conclusion Nerve dectrophysiological monitoring and temporary occlusion of blood supply artery may reduce the risk of microsurgical resection of brainstem solid hemangioblastoma, improve the total tumor resection rate, and significantly improve the prognosis of patients.