脑干海绵状血管瘤的显微外科治疗(附10例报告)

目的分析脑干海绵状血管瘤的显微外科治疗方法和预后。方法显微手术切除脑干海绵状血管瘤10例,病灶位于桥脑8例,延髓2例。6例桥脑、延髓背侧的海绵状血管瘤,采用枕下正中经四脑室底入路切除; 4例桥脑外侧和腹外侧的海绵状血管瘤,采用枕下乙状窦后入路切除。结果病灶均镜下全切除,病理证实为海绵状血管瘤。4例患者术后症状明显改善,5例患者出现不同程度并发症,在1周至3个月内恢复,1例患者术后因肺内感染死亡。患者术后随访3-58个月,复查MRI均未发现病灶复发,无其他并发症出现。结论在正确选择适应证的前提下,脑干海绵状血管瘤的显微外科治疗效果良好。

Microsurgical management of brainstem cavernous malformations: report of 10 cases

Objective To investigate the microsurgical management of brainstem cavernous malformations and evaluate the surgical outcomes. Methods Ten patients with brainstem cavernous malformations were treated microsurgically including eight in the pons and two in the medulla. Six cases of cavernous malformations in the dorsal of pons and medulla underwent operations via through the base of the fourth ventricle approach. And the others which were in lateral and ventral lateral pons, were treated via suboccipito - retrosigmoid approach. Results All of the lesions were totally resected. Pathologic diagnosis was cavernous malformations. The functional disorders were improved after operation in four cases. But the symptoms appeared in five cases, which improved between one week and three months. One patient died because of infection of lung after operation. During three months to fifty - eight months after operation the brainstem cavernous malformations didn't recrudesce through MRI diagnosis, and the patients hadn't appear the new symptoms. Conclusions With the correct choice of operational indication, the microsurgical management of brainstem cavernoma improves the prognosis.