显微手术治疗脑干海绵状血管瘤的临床分析

Clinical analysis of microsurgery for brainstem cavernous malformations

目的 探讨脑干海绵状血管瘤的显微手术治疗方法及其疗效。方法 回顾性分析2011年10月至2015年9月显微手术治疗的19例脑干海绵状血管瘤的临床资料,其中桥脑12例,中脑4例,延髓2例,桥脑延髓交界区1例。经坐位枕下后正中小脑延髓裂入路12例,坐位乙状窦后入路4例,坐位后正中幕下小脑上入路2例,翼点入路1例。结果 病灶全切除17例,次全切除2例。术后症状改善16例,无明显变化3例,无手术死亡病例。术后随访14~58个月,次全切除2例均复发并行二次手术;术前KPS评分为（75±6）分,术后KPS评分为（84±8）分,随访1年KPS评分为（90±5）分。结论 应根据术前影像学检查以及术者经验及习惯选择手术方式,坐位可以作为大部分脑干海绵状血管瘤的常规手术体位;显微手术治疗脑干海绵状血管瘤应在保证安全的前提下做到全切除,使患者获得良好预后。

Objective To investigate the surgical method for brainstem cavernous malformations （BSCMs） and its curative effects. Methods The clinical data of 19 patients with BSCMs undergoing microsurgery from October, 2009 to September, 2015 were analyzed retrospectively. Of 19 BSCMs, 12 were in the pontes, 4 in the mesencephalons, 2 in the medullas oblongatae and 1 in the pontomedullary junction. Of 19 patients, 12 underwent microsurgery via suboccipital cerebellomedullary fissure, 4 via retrosigmoid approach, 2 via infratentorial-supracerebellar approach and 1 via pterional approach. CT and MRI examinations were performed before and after the operation in all the patients, in whom the pathological examination was performed after the operation. Results Total resection of BSCMs was achieved in 17 and subtotal in 2. The clinical symptoms were improved in 16 patients and unchanged i：a 3. Two patients, who received subtotal resection, recurred and received the second operation within 3 years after the first operation. No one died of the operation in all the patients. Conclusions The surgical approach should be chosen according to the imaging examination and the experiences of surgeons. Sitting position can be applied during the surgery in most of patients with BSCMs. Microsurgery is an effective method to treat BSCMs and good prognoses may be obtained by total resection of the tumors in the patients with BSCMs.