脑干海绵状血管畸形的手术治疗及预后研究  

Surgical management and outcomes of brainstem cavernous malformation

作　　者：杨阳[1] 李达[1] 郝淑煜[1] 汤劼[1] 孟国路[1] 肖新如[1] 吴震[1] 张力伟[1] 张俊廷[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2014年第8期769-773,共5页Chinese Journal of Neurosurgery

摘　　要：目的 评估脑干海绵状血管畸形（CMs）的术后出血风险、疗效及相关因素.方法 回顾性分析1999年至2010年手术治疗的242例脑干CMs的临床资料.结果 男女比为1.3：1.0,平均年龄32.6岁.入院、出院、目前随访的改良兰金评分（mRS）分别为2.2分、2.6分和1.5分.术前年均出血率和年均再出血率分别为5.0％和60.9％.病变全切率为95.0％（230/242）.平均随访（89.4 ±42.8）个月,147例（60.7％）改善,70例（28.9％）平稳,25例（10.3％）恶化.术后年均再出血率为0.4％.术后永久并发症率为26.9％.术后出血的危险因素包括发育性静脉畸形及非全切除.不良预后的危险因素为年长患者（P =0.025）、多次出血（P=0.017）、腹侧病变（P=0.048）及较重的术前神经功能症状（P =0.001）.结论 精确的手术可获得脑干CMs良好的长期预后,并显著降低术后的年出血率.在保证最小神经损伤的同时应尽量全切病变;术后并发症可在术后逐渐好转.Objective To evaluate the risk of rehemorrage after surgical evacuation,neurological outcome,and prognostic factors of surgically treated brainstem cavernous malformations （CMs） with longterm follow-up.Methods Clinical data from 242 surgically treated patients with CMs between 1999 and 2010 were reviewed retrospectively.Results The study consisted of 242 patients with a male-to-female ratio of 1.3 and mean age of 32.6 years.The mean modified Rankin scales on admission,at discharge,and at recent evaluation were 2.2,2.6 and 1.5,respectively.The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0％ and 60.9％,respectively.Complete resection rate was 95.0％.After a mean follow-up of （89.4 ± 42.8） months,147 patients （60.7％） improved,70 （28.9％） were unchanged,and 25 （10.3％） worsened.A total of 8 rehemorrhages occurred in 6 patients,and the postoperative annual rehemorrhage rate was 0.4％.Permanent neurological deficits remained in 65 patients （26.9％）.Postoperative rehemorrhage risk factors were developmental venous anomaly and incomplete resection.The independent factors for poor long-term outcome were increased age （P =0.025）,multiple hemorrhages （P =0.017）,ventral-seated lesions （P =0.048）,and poor preoperative status （P =0.001）.Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates can be achieved by appropriate surgical evacuation of brainstem CMs in patients.Total resection should be pursued with minimal injury to neurological function; however.The postoperative deficits can restore during the follow up course.

关 键 词：脑干 海绵状血管畸形 显微外科手术 预后 

分 类 号：R651.1[医药卫生—外科学]