神经导航及神经电生理辅助下显微手术治疗脑干海绵状血 管瘤

目的 探讨脑干海绵状血管瘤的手术适应证、手术时机、手术入路及手术技巧。方法 回顾性分析2013年3月至2018年12月神经导航及术中电生理监测辅助下显微手术治疗的60例脑干海绵状血管瘤的临床资料。结果 肿瘤全切除57例；次全切除3例，术后辅助伽玛刀治疗。出院时神经功能障碍改善34例，无变化21例，加重8例。无手术死亡病例，无颅内感染及脑脊液漏。术后随访3~60个月，平均（27.1±13.5）个月，术后症状加重8例中，2例好转，3例恢复至术前，3例无明显变化。肿瘤全切除病例未见肿瘤复发。伽玛刀治疗3例中，1例再出血。结论 脑干海绵状血管瘤手术需严格掌握适应证，选择合理手术时机，根据病灶位置采取个体化入路，联合神经导航及电生理监测等辅助技术，可以完整切除肿瘤、减少并发症，改善病人预后。

Microsurgery assited-with neuronavigation and electrophysiological monitoring for brainstem cavernous malformation

Objective To explore the indications, timing, approach and technique of microsurgery for brainstem cavernous malformations (BCM). Methods The clinical data of 60 patients with BCM who underwnent microsurgery assited-with neuronavigation and intraoperative electrophysiological monitoring between March 2013 and December 2018 were analyzed retrospectively. Results Total resection was achieved in 57 patientss and subtotal in 3 who received gamma knife radiosurgery after the operation. The neurological dysfunction was improved in 32 patients, unchanged in 20 and worsened in 8. No patients died from the surgery. There was no intracranial infection and cerebral spinal fluid leakage after the operation. The follow-up ranged from 3 to 60 months, with an average of (27.1±13.5) months. Of 8 patients with worsened symptoms after the operation, 2 patients were improved, 3 recovered to preoperative stage, and 3 no improvement. Conclusions For surgical treatment of BCM, it is necessary to control the indications strictly, choose the reasonable timing, and select the individual approach according to the location of lesions. Using neuronavigation and electrophysiological monitoring is helpful to the complete removal of tumor, reduce in complications and improvement of patients’ prognoses.