摘要
目的总结脑干海绵状血管瘤(BSC)的临床特点、手术入路选择、显微外科切除技术要点,评价手术治疗BSCH的疗效。方法对海军总医院神经外科2003年1月-2011年4月行显微手术切除的41例BSC患者的临床资料以及手术治疗情况进行回顾性分析。男23例,女18例,年龄8～62岁。主要临床表现包括头痛、头晕,脑神经功能障碍、肢体麻木、肌力减退等长束征以及共济失调等。根据病灶所在部位,遵循"最短距离"的原则选择手术入路,术中行短潜伏期体感诱发电位(SSEP)和听觉诱发电位(AEP)监测。结果 41例患者中35例获BSC全切除,6例巨大病变有少部分残留。无手术死亡病例。术后27例神经功能障碍得到改善,14例出现新的神经功能缺失或原有神经障碍加重,其中2例呼吸功能受影响,人工辅助呼吸1周后恢复自主呼吸。平均随访38个月,有神经功能缺失的患者多数得到恢复,1例残余肿瘤再次出血,其余患者未见复发。结论根据病变部位和病灶突向的方式,选择个体化的手术入路,遵循"最短距离"原则,手术切除BSC能获得良好的预后,术中导航和脑干电生理学监测有助于减少手术损伤及降低并发症。
Objective To summarize the clinical features and the surgical approach and techniques for microsurgical removal ofbrainstem cavernoma, and to evaluate the efficacy of surgical treatment ofbrainstem cavernoma. Methods The clinical data of 41 brainstem cavernoma patients treated by microsurgical resection from January 2003 to April 2011 were retrospectively analyzed, and they were 23 males and 18 females, aged 8 to 62 years. The clinical presentations included signs and symptoms of increased intracranial pressure, such as headache and dizziness, long-tract signs such as cranial nerve dysfunction, numbness and decrease in muscle strength, and ataxia. According to the site of the lesions, surgical approaches were selected following the principle of ＂the shortest distance between the incision and the lesion＂. Intraoperative short-latency somatosensory evoked potential （SSEP） and auditory evoked potential （AEP） were monitored. Results Total resection of cavernoma was achieved in 35 patients, small residual tumor was left in 6 with giant lesions. No death occurred. Twenty-seven patients showed improvement in nerve function. Aggravation of preexisting neurological disorders or appearance of new neurological disorders was found in 14 patients, including 2 with respiratory dysfunction who regained spontaneous breathing after assisted respiration for one week. Follow-up was carried out for 38 months in average. Neurological deficits have been restored in most patients, and no recurrence was found except for 1 case of re-bleeding from residual tumor. Conclusions According to the lesion site and protruding direction, individualized surgical approach can be selected following the ＂shortest distance＂ principle for the resection ofbrainstem cavernoma. The application of intraoperative navigation and electrophysiological monitoring of the brainstem is helpful in reducing surgical injury and decreasing the complications.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2012年第8期800-804,共5页
Medical Journal of Chinese People's Liberation Army
