脑干海绵状血管瘤的显微手术治疗

目的 分析和评价脑干海绵状血管瘤手术治疗的有效性和愈后。方法 手术切除123例颅内海绵状血管瘤，其中7例为脑干海绵状血管瘤，女6例，男1例，共8个病灶，6个病灶位于桥脑，1个位于延髓，1个位于中脑，桥脑和延髓部肿瘤采用经四脑室底入路，中脑部肿瘤采用幕下小脑上入路，并采用神经导航系统进行病灶精确定位。结果 病灶均作全切除，无手术死亡，4例术后神经功能障碍改善，2例神经功能缺失加重，但在术后4个月和3年随访时，神经功能已恢复至术前状态，中脑病变患者术后病情加重，病理检查提示该患者除海绵状血管瘤外，还伴有少枝胶质瘤1级，经平均42个月随访，均未见肿瘤复发。结论 采用微侵袭技术，手术治疗预后良好。

Microsurgery of brainstem cavernous malformation

Objective To evaluate the effectiveness and benefits of surgical treatment of cavernous malformations (CMs) in brainstem. Methods From 1992 to 1999, 7 cases of brainstem cavernous malformations (six females and one male, aged 44 on average) with 6 lesions in pons, one in mesencephalon, and one in medulla oblongata, were operated on with microsurgery. In the recent three years neuronavigation system has been applied. Results All of the eight lesions were removed without death toll. The functional disorders of nervous system were improved after operation in four cases. The neurological deficits worsened in two cases, however, their neurological functions improved gradually to the preoperative level in four months or three years. The neurological function in the case with lesion in mesencephalon worsened after operation. Pathology revealed a grade one oligodendroglioma in addition to the CM lesion. Neuronavigation helped facilitate the accurate location of the lesions and minimize the surgical injury. Conclusion Microsurgery is effective in treating brainstem cavernous malformations with appropriate indications and minimal invasive technique.