脑干血管畸形的外科治疗

目的探讨脑干血管畸形的外科治疗方法、手术入路和治疗效果.方法对10例脑干血管畸形患者进行回顾性分析,男8例,女2例;平均年龄34.4岁.所有患者均经CT和MRI检查确诊为脑干血管畸形.有6例患者行DSA检查,但无异常发现.病变位于桥脑者6例,桥脑中脑结合部者3例,桥脑延髓结合部者1例.结果10例患者平均在出血后第34 d行开颅手术,其中经后颅窝中线小脑下蚓部第四脑室入路5例,于枕下乙状窦后经小脑外侧入路4例,经颞下切开天幕入路1例.术后病理学检查报告毛细血管扩张症6例、海绵状血管瘤3例、动静脉畸形1例,无手术死亡病例.所有患者术后症状均获改善,有6例患者获得随访,最长随访时间6年,最短1年,无再出血.结论应用显微外科手术治疗脑干血管畸形患者安全有效,通过切除畸形的脑干血管可防止再次出血.

Surgical treatment of brain stem vascular mafformation

Objective The surgical treatment, approaches and result in ten patients with brain stem vascular malformation(BVM) was reported. Methods Ten cases of BVM (8 male and 2 female, average age 34.4 years)were diagnosed by CT and MRI showing the lesions in pons 6 cases, in pontomesencephalic junction 3 cases and in pontomedullary junction 1 case. Results The mean interval from the occurrence of hemorrhage to operation was 34 days. Surgical approaches were accessing via suboccipital midline transfourth ventrical 5 cases, suboccipital retrosigmoid 4 cases and subtemporal transtentorial 1 case. The pathological examination demonstrated that there were capillary telangiectasia 6 cases, cavernous angiomas 3 cases and AVM 1 case. All the patients had good outcome. Conclusion Microsurgical resection of BVM is safe and effective which can extirpate the lesion and prevent from rebleeding.