经耳前弧形切口岩前入路切除脑桥海绵状血管畸形

Resection of pontine cavernous malformations using anterior transpetrosal approach with a preauricular arc incision

目的探讨经耳前弧形切口岩前入路切除脑桥海绵状血管畸形的手术方法及其治疗效果。方法回顾性分析2011年6月至2015年12月首都医科大学附属北京天坛医院神经外科手术治疗的48例脑桥海绵状血管畸形患者的临床资料，并对其治疗效果进行分析和总结。48例患者均采用经耳前弧形切口岩前入路手术切除病灶。结果48例脑桥海绵状血管畸形患者中，44例病灶全切除，4例近全切除，无手术死亡患者。其中有2例患者术后因再次出血而行第二次手术治疗。48例患者均得到随访，平均随访时间为（28．3±8．2）个月。术前面瘫、眼肌协同性运动障碍的患者术后均完全恢复，术后无新出现的面瘫。34例患者术后神经功能障碍得以改善，5例术后出现一过性语言障碍，11例术后症状无变化，3例神经功能缺失加重。结论经耳前弧形切口岩前入路能够充分显露并切除脑桥海绵状血管畸形。从侧前方切开脑干表面未造成严重的神经功能缺失，同时避免出现面瘫等严重并发症。

Objective To evaluate the surgical method and resection outcomes of cavernous malformations （CMs） using anterior transpetrosal approach with a preauricular arc incision. Methods From June 2011 to December 2015, 48 patients with pontine CMs underwent resection using anterior transpetrosal approach with a preauricular arc incision at Department of Neurosurgery, Beijing Tiantan Hospital ,Capital Medical University, The patients＇ clinical date and surgical outcomes were retrospectively analyzed. Results Among the 48 patients, gross total resection （GTR） was achieved in 44 cases and subtotal resection was performed in the remaining 4 cases. No death occurred in this series. Two patients were reoperated on due to postoperative rebleeding. 48 patients were followed up for a mean of 28.3±8.2 months. All patients with preoperative facial nerve palsy and ocular dyskinesia recovered post surgery, and no new cases of facial nerve palsy were reported. Neurological deficits were improved in 34 patients after operations. Five patients experienced transient aphasia postoperatively. The symptoms of 11 patients remained unchanged following surgery. Three patients＇neurological conditions deteriorated after surgery. Conclusions The anterior transpetrosal approach with a preauricular incision could provide adequate exposure for the surgical removal of pontine CMs. Resection through anterior lateral part of the brainstem might cause no serious neurological deficits and severe complications such as the facial nerve palsy could be avoided.