外侧裂-岛叶入路手术治疗8例侵袭性丘脑海绵状血管瘤报道

Surgery via sylvian fissure-insular approach for 8 patients with invasive thalamus cavernous malformations

目的探讨侵袭性丘脑海绵状血管瘤(CMs)的外科治疗效果及体会。方法中国人民解放军联勤保障部队第九〇〇医院神经外科自2007年7月至2020年6月共收治8例侵袭性丘脑CMs患者,患者均在第2次破裂出血后经外侧裂-岛叶入路微创手术切除病变,术后随访8个月~10年,回顾性分析该8例患者的临床及随访资料。结果8例患者的病变均靠近丘脑外侧部,术中均全切病变;术后24 h内1例下肢肌力提升至2级、2例下肢肌力提升至1级;术后6个月随访时改良Rankin量表评分1~3分5例,4分3例;随访(49.7±37.8)个月内均无复发。结论对于再次破裂出血的侵袭性丘脑外侧部CMs,经外侧裂-岛叶入路手术安全有效。

Objective To investigate the surgical treatment efficacy and experience of invasive thalamus cavernous malformations(CMs).Methods A retrospective analysis was performed.The clinical and follow-up data of 8 patients with invasive thalamus CMs,admitted to our hospital from July 2007 to June 2020,were chosen.These patients accepted minimally invasive resection via sylvian fissure-insular approach after the second rapture hemorrhage;follow up was performed for 8 months-10 years.Results The lesions of these 8 patients were near the lateral thalamus,and the lesions were completely removed during the surgery.Within 24 h of surgery,the lower limb muscle strength of one patient was improved to grading 2,and that of 2 patients was improved to grading 1.Follow up results 6 months after treatment showed that the modified Rankin scale scores were 1-3 in 5 patients and 4 in 3 patients;and there were no recurrence during the follow-up of(49.7±37.8)months.Conclusion The resection via sylvian fissure-insular approach is safe and effective for patients with invasive thalamus CMs after the second rapture hemorrhage.