脑干海绵状血管瘤的手术入路选择  

Choice of surgical approaches for brainstem cavernous malformations

作　　者：陈立华[1] 徐如祥[1] 魏群[1] 李运军[1] 李文德[1] 赵浩[1] 高进宝[1] 于斌[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2013年第9期900-904,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨脑干海绵状血管瘤的手术适应证和手术入路选择。方法回顾性分析51例显微手术治疗脑干海绵状血管瘤的临床资料。中脑海绵状血管瘤9例，间脑-中脑交界处1例，中脑-桥脑交界处2例，桥脑海绵状血管瘤33例，延髓海绵状血管瘤4例，桥脑-延髓交界处2例。49例亚急性手术，2例慢性期手术。结果术中均采用神经电生理监测引导手术，11例采用神经导航定位。根据肿瘤的部位选择手术入路。肿瘤全切49例，2例次全切，肿瘤全切除率为96．1％。术中19例伴有明显的静脉畸形，予以保护。神经功能障碍改善23例，无明显变化25例，术后症状改善和稳定率为94．1％（48／51）。无手术死亡。结论正确选择手术适应证和个体化选择手术入路，术中神经电生理监测和神经导航辅助手术，有助于提高肿瘤全切除率。Objective To explore the microsurgical indication and surgical approaches of brain stem cavernous malformations （BCMs）. Methods A retrospective review of 51 patients diagnosed as having BCM, admitted to and underwent microsurgical resection in our hospital from June 2004 to May 2013, was performed; their clinical manifestations, surgical indications, and surgical methods and approaches were analyzed. Among them, 9 lesions were situated in the mesencephalon, 1 in diencephalon-mesencephalic junction, 2 in pontomesencephalic jtmction, 33 in pons, 4 in medulla oblongata and 2 in pontomedullary junction. The surgical approaches were selected according to tumor location for all cases; 49 were operated at the subacute stage and 2 at the chronic stage. Results The lesions were removed by the guide of monitoring of neuroelectrophysiology and neuro-navigation in 11 cases. Of the 51 BCMs, total resection and subtotal resection were achieved in 49 and 2, respectively, with a total resection rate reaching 96.1%. Nineteen patients were associated with venous anomaly. At the discharge, neurological deficits were improved in 23 patients and kept the same level in 25 cases. A total of 94.1% （48/51） patients achieved stable outcomes. No operative mortality was noted. Conclusion The correct candidates and individual microsurgical approaches, intraoperative neuroelectrophysiological monitoring and neuronavigation are the important prerequisite for BCMs, and benefit to improve total resetion rate.

关 键 词：脑干 海绵状血管瘤 手术指征 手术入路 

分 类 号：R651.1[医药卫生—外科学]