脑干海绵状血管畸形的显微外科治疗

Strategy of microsurgery for brainstem cavernous malformations

目的探讨脑干海绵状血管畸形的手术入路、手术技巧及预后。方法回顾性分析2004年1月至2017年1月手术治疗的24例脑干海绵状血管畸形的临床资料。结果畸形全切除22例,部分切除2例。术后随访6个月~10年,2例发生肺炎,3例发生脑膜炎,经抗生素治疗后痊愈;5例发生永久性神经功能障碍,1例遗留轻微面瘫和吞咽困难,1例昏迷后自动出院。术后KPS评分[(75.83±21.04)分]明显高于术前[(64.58±10.62)分;P<0.05]。结论对于脑干海绵状血管畸形,应严格掌握手术指征和时机,术中根据位置选择不同的手术入路,利用神经导航及电生理监测,采取两点定位法,对神经功能的保护至关重要。

Objective To evaluate the approach,skill and outcomes of surgery for brainstem cavernous malformations(BSCM).Methods The clinical data of 24 patients with BSCM,who was treated microsurgically in our hospital from January,2004 to January,2017,was analyzed retrospectively.All the patients were followed up for 0.5 to 10 years.Results The total resection of BSCM was achieved in 22 patients and partial resection in 2.The pneumonia occurred in 2 patients,meningitis occurred in 3,permanent neurological disfunction occurred in 5 after the surgery.The discharge from hospital against advice occurred in 1 patient with coma after the surgery.The postoperation Karnofsky performance scores were significantly improved compared with the preoperation(P<0.05).Conclusions The patients with BSCM accompanied with progressive nerve dysfunction,especially those near the surface of brainstem should be treated by microsurgery.The neuronavigation and the appropriate surgical approach according to two-point location method are very important to protecting the neurologic function intraoperatively in the patients with BSCM.