桥脑海绵状血管瘤的显微手术治疗

目的 探讨桥脑海绵状血管瘤（CA）的手术治疗及其疗效。方法 2009年1月至2016年1月显微手术切除桥脑CA 9例，其中桥脑上端腹内侧1例采用颞下切开小脑幕入路，桥脑腹外侧3例采用同侧乙状窦后入路，桥脑桥臂2例采用乙状窦后经三叉神经根部周围安全区入路，第四脑室2例均采用枕下后正中入路，左侧桥脑与延髓交界区1例采用远外侧入路。结果 病灶全切8例，次全切1例；全切率为88.9%。术后7例神经功能改善，1例无变化，1例外展受限和面瘫加重；无死亡病例。术后平均随访26.3个月，次全切1例术后5年内发生再出血。结论 桥脑CA展神经功能受损和面瘫恢复较差，面部、躯体感觉障碍以及共济失调术后恢复较好；桥脑出血较少遗留明显肢体运动障碍，仅表现为下肢肌力减退；乙状窦后经三叉神经根部周围安全区入路，对同时凸向第四脑室底部和脑桥侧方的病灶其效果优于经第四脑室底入路。

Microsurgery for pontile cavernous malformations

Objective To explore the clinical manifestations, the surgical techniques of pontile cavernous malformations (PCMs) and curative effects of surgery on them. Methods The clinical data of 9 patients with PCMs, who underwent microsurgical resection from January, 2009 to January, 2016, were analyzed retrospectively. Of 9 patients with PCMs aged from 26 to 71 years, 3 were male and 6 female. The surgical approaches included suboccipital, retrosigmoid, subtemporal-transtentorial and far lateral approaches. Results Of 9 patients with PCMs, 8 received total resection of PCMs and 1 subtotal. Neurological functions were improved in 7 patients and unchanged in 1, and the symptoms of prosopoplegia and abducens paralysis became worse in 1 after the surgery. No patients died from the surgery. All the patients were followed up from 5.5 to 72 months (mean, 26.3 month). There was cerebral hemorrhage again in 1 patient 5 years after the surgery. Conclusions The symptoms of prosopoplegia and abducens paralysis are hard recovered, and the ataxia, facial sensory disturbances and hemi-sensory disturbances may be recovered well in the patients with PCMs after the surgery. The therapeutic effect of microsurgery through suboccipital retrosigmoid transtrigeminal root approach on PCMs located in the pons arms and closed to the fourth ventricles are better than those of microsurgery through sub-occipital midline approach.