自发性脑干血肿的诊断和治疗

报告11例自发性脑干血肿,平均年龄33岁,临床缺少典型表现,好发桥脑。MR和CT是本病主要诊断方法,两者有相辅作用:急性期(出血1周内)CT诊断价值较大,亚急性和慢性期则MR优于CT,MR不仅可显示血肿的位置、大小和形态,而且可显示畸形血管,指导手术入路的选择。手术的10例中,9例康复,1例术时未发现畸形血管术后1年再出现,再手术仍未发现亦无改善,终死于肺炎。5例术时和/或病理发现畸形血管。8例随访,平均3年,生活自理2例,复工6例。1例未手术者2年中出血2次致病残。作者认为自发性脑干血肿应手术治疗,手术是安全的。

Spontaneous brainstem hematomas:their diagnosis and treatment.

Eleven patients (mean age 33 years) with spontaneous brainstem hematomas which are liable to be in the pons were reported.Lacking specific clinical manifestations,spontaneous brainstem hematomas were sometimes hard to differentiate from brainstem tumors or multiple sclerosis.MR and CT are essential diagnostic modalities and supplementary to each other for finding the lesions.Usually CT is better than MR for acute hematomas (within one week after hemorrhage),but MR is preferable to CT for subacute or chronic ones.MR has an ability not only to demonstrate the location,size and shape of the hematoma but also to reveal the abnormal vessels and to help the choice of proper surgical approaches.Of 10 patients undergoing surgery,9 patients made an uneventful recovery,one patient with a recurrent pontinc hematoma which was removed one year ago without positive pathological findings underwent the second surgical procedure still with negative pathological results.The patient did not come round from preoperative unconsciousness and died of pneumonia 2 months later.Vascular malformations were discovered surgically and/or pathologically in 5 patients.Of 8 patients having a long-term follow-up study (mean 3 years),6 resume their previous employment,two are in sef-care.One patient who refused surgery suffered from 2 episodes of hemorrhage during a period of 2 years,being disability.It was shown that surgical treatment is the rational choice and safe for spontaneous brainstm hematomas.