显微外科手术与伽玛刀治疗脑干海绵状血管畸形的疗效比较  

Efficacy of microsurgical management and gamma knife radiosurgery on brain stem cavernous malformations

作　　者：谢兵[1] 梁军潮[1] 白红民[1] 王伟民[1] 王国良[1] 伍犹梁[1] 杜汉强[1] 

机构地区：[1]广州军区广州总医院神经外科,广州510010

出　　处：《中华神经医学杂志》2013年第6期609-612,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨显微外科手术与伽玛刀治疗脑干海绵状血管畸形的疗效差异。方法回顾性分析广州军区广州总医院神经外科自2002年1月至2011年12月收治的有完整随访资料的脑干海绵状血管畸形显微外科手术治疗15例患者与伽玛刀治疗22例患者的临床资料．对比2组患者治疗后临床症状改善情况、格拉斯哥预后评分、远期生活质量评估及美国国立卫生研究院卒中量表（NIHSS）评分。结果显微外科手术组：1例桥脑病灶术后有残余．未见再出血及死亡病例，2例出现不可逆性神经功能障碍加重。临床症状改善11例（73．3％）。术后格拉斯哥预后评分、远期生活质量评估较术前分别提高0．20分和6．66分，NIHSS评分降低1．20分。伽玛刀组：2例因再出血而病灶增大、3例出现灶周脑水肿并经治疗后好转，未见死亡病例。I临床症状改善9例（40．9％1。术后格拉斯哥预后评分及远期生活质量评估较术前分别提高0．05分和1．82分．NIHSS评分降低0．82分。结论显微外科手术较伽玛刀治疗脑干海绵状血管畸形更有效，若患者无手术条件或拒绝手术者亦可选择伽玛刀治疗，但需谨慎。Objective To explore tlae emcacy ot mlcrosu,a brainstem cavernous malformations. Methods Retrospective analysis was performed on the clinical data of 15 patients with brainstem cavernous malformations treated by microsurgery and 22 patients by gamma knife in our hospital from January 2002 to December 2011. The clinical symptom improvement, scores of Glasgow Outcome Scale, scores of Karnofsky Performance Scale and scores of National Institutes of Health Stroke Scale before and after treatment were observed and compared between the two groups. Results Patients in the micro-surgery group enjoyed the following results： one patient with pontine lesion had residual postoperation; no re-bleeding or death was noted; two had irreversible neurological dysfunction; clinical symptoms improved in 11 patients （73.3%）; the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.20 and 6.6 as compared with the preoperative ones; The postoperative scores of National Institutes of Health Stroke Scale decreased 1.20 as compared with the preoperative ones. Patients in Gamma Knife group enjoyed the following results： the lesions of two patients increased due to re-bleeding; three had perifocal brain edema; no death was noted; the clinical symptoms improved in 9 patients （40.9%）; the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.05 and 1.82 as compared with the preoperative ones; the postoperative scores of National Institutes of Health Stroke Scale decreased 0.82 as compared with the preoperative ones. Conclusion Micro-surgery may be more effective than Gamma Knife in treating brainstem cavernous malformations; however, patients with non-surgical conditions or refusing surgery could choose Gamma Knife treatment; gamma knife treatment should be cautiously chosen.

关 键 词：脑干 海绵状血管畸形 显微外科手术 伽玛刀 

分 类 号：R743.4[医药卫生—神经病学与精神病学]