显微手术切除脑干海绵状血管瘤  

Microsurgical removal of the cavernous malformations in the brainstem

作　　者：罗毅男[1] 葛鹏飞[1] 付双林[1] 孟繁凯[2] 孙利波[1] 王海峰[1] 李文臣[1] 于天浩[1] 

机构地区：[1]吉林大学第一医院神经外科,长春130021 [2]吉林省人民医院神经外科

出　　处：《中华神经外科杂志》2009年第5期436-439,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨显微手术切除脑干海绵状血管瘤的时机、方法和预后。方法回顾性分析显微手术切除及病理证实的10例脑干内海绵状血管瘤的临床资料。所有病例均行CT及MRI检查。海绵状血管瘤位于中脑1例、桥脑7例、延髓2例。采用颞下入路切除中脑海绵状血管瘤1例；乙状窦后入路切除桥脑海绵状血管瘤3例；枕下中线经第四脑室入路切除延髓海绵状血管瘤2例、桥脑海绵状血管瘤4冽。采用GOS分级对手术结果进行评估。结果显微镜下将肿瘤全切，无手术死亡。10例患者均获得随访，随访时间3—48个月（平均18．5个月）。术后3个月GOS分级：V级5例，Ⅳ级5例；术后1年GOS分级：V级8例，Ⅳ级2例。无再出血者。结论显微外科手术是治疗脑干内海绵状血管瘤的有效方法，远期效果满意。Objective To investigate the microsurgical time windows, techniques and prognosis of removing cavernous malformations in brain stem. Method The clinical materials of 10 cases of cavernous malformations of brain stem removed by mierosurgery and demonstrated by pathological examinations were studied retrospectively. All the cases were examined preoperatively by CT and MRI. One lesion located in midbrain ,7 lesions in pons and 2 lesions in medulla. The lesion in midbrain was removed by subtemporal approach,lesions in medulla and part of the lesion in pons were removed by suboceiptal middle approach, and the other part of the lesions in pons were removed by retrosigmoid approach. GOS system was used to evaluate the prognosis. Results All the lesions were removed radically under microscope and no death arose. Pathological examination demonstrated all the lesions were cavernous malformations. All the cases were followed up from 3 months to 48 months with the average time 18.5 months. 10 patients were evaluated by GOS system at 3 months after operation. There were 5 cases of GOS grade V and 5 cases of grade IV. 10 patients were evaluated by GOS system at 1 year after operation. There were 8 cases of GOS grade V and 2 cases of grade Ⅳ. There was no bleeding after operations. Conclusions Microsurgery is an effective way to cure cavernous malfoimations in brainstem, and the long-term prognosis is satisfying.

关 键 词：血管瘤 海绵状 中枢神经系统 脑干 显微外科手术 

分 类 号：R686[医药卫生—骨科学]