延髓海绵状血管瘤的显微外科手术治疗

Micro-surgical Treatment of Medulla Oblongata Cavernomas

目的探讨延髓海绵状血管瘤的显微外科手术治疗体会。方法回顾性分析显微外科手术治疗的21例延髓海绵状血管瘤患者的临床资料,其中男13例,女8例,年龄22~63岁,术前KPS评分76.5±10.2。主要临床表现包括肢体活动及感觉障碍、饮水呛咳、吞咽困难、共济失调、颈肩部疼痛、呼吸困难等。根据病灶所在部位,15例采用后正中经脉络膜裂入路,6例采用远外侧入路。术中均辅助行电生理监测及神经系统导航,并通过KPS评分对患者手术前后的生活质量进行评价,观察临床疗效及预后。结果 21例延髓海绵状血管瘤均全部切除,无手术死亡病例。17例患者原发神经功能障碍有不同程度缓解或消失,4例原有症状加重,8例出现新的临床表现,主要包括对侧肢体肌力下降、顽固性呃逆、进行性吞咽困难伴声音嘶哑、呼吸功能下降、严重呼吸功能减弱、急性脑积水及昏迷。术后随访8~97个月(平均47.6个月),所有患者均能够生活自理,进行简单或正常的学习和工作,未见复发,无再次出血,术后KPS评分83.7±15.5。结论延髓海绵状血管瘤出血或症状进行性加重者应行积极的手术治疗,反复出血更是手术的绝对适应证。手术技巧和术中电生理监测及神经系统导航都有助于减少颅神经的损伤,保护脑干功能。

Objective To investigate the efficacy of micro-surgery for the treatment of medulla oblongata cavemomas. Methods A retrospective analysis was conducted on the clinical data of 21 patients with cavernous hemangioma who received micro-surgical treatment. Of the 21 patients, 13 were men and 8 women, aged 22 to 63 years. The preoperative Karnofsky performance status （KPS） score was 76.5 ±10.2. The main clinical manifestations included sensory disorder and difficulty swallowing etc. According to the location of the lesions, the posterior transchoreidal fissure approach was employed for 16 patients ; far-lateral approach, 5 patients. Electrophysiological monitoring and nervous system navigation were supplementarily adopted in both types of surgery. Further, KPS scoring was conducted to evaluate the patients＇ quality of life. Results The medulla cavernous hemangioma was excised in all cases. For 17 patients with primary neurological disorders, their symptoms were alleviated or resolved ; 4 patients had severe symptoms and 8 presented with new clinical symptoms. A follow-up visit was conducted 8 to 97 months post-surgery （average 47.6 months）. All patients were found capable of caring for themselves in daily life and performing simple or normal learning and working activities without recurrence or bleeding. The mean postoperative K/X3 score was 83.7 ±15.5. Conclusion Patients with medulla cavernous hemangioma bleeding or severe symptoms should actively seek surgical treatment. Repeated bleeding is the absolute indication for surgery. Surgical skills, elec- trophysiological monitoring, and nervous system navigation can reduce nervous system damage and protect the bralnstem. The patient＇ s quality of life is expected to significantly improve after surgery.