脑桥海绵状血管瘤的显微手术治疗
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摘要
目的探讨脑桥海绵状血管瘤的手术治疗。方法回顾性分析9例显微外科手术切除脑桥海绵状血管瘤病人的临床资料,术中均采用神经电生理监测,根据病变部位选择手术入路,采用颞下切开小脑幕入路3例,乙状窦后入路5例,枕下后正中经小脑延髓裂入路1例。结果病变达显微镜下全切除8例,部分切除1例。术后并发轻度脑干水肿2例,视物重影2例。随访6个月,MRI复查未见肿瘤复发及新发出血。术后3个月KPS评分90分7例,80分2例。结论对有明确手术指征的脑桥海绵状血管瘤,在出血后2～4周选择合适的手术入路,在神经电生理、神经导航辅助下切除血管瘤可取得良好手术效果。
Objective To explore the surgical treatment of pontine cavernous hemangioma(PCH). Methods Clinical data of 9 PCH patients undergoing microsurgery were analyzed retrospectively. All the patients received neurophysiological monitoring in the operation, and the operative approach was selected according to the tumor location, including subtemporal transtentorial approach in 3 patients, retrosigmoid approach in 5 and suboccipital posterior median transcerebellomedullary fissure approach in 1 patient. Results Total tumor resection was achieved in 8 patients and partial resection in 1. Brainstem edema occurred in 2 patients and double vision in 2 after the operation. During a follow-up period of 6 month, MRI reexamination showed no tumor recurred or new bleeding. The KPS score was 90 points in 7 patients and 80 in 2 at 3 months after the operation. Conclusions For PCH patients with clear surgical indications, good surgical results can be obtained by appropriate surgical approach in removing PCH with neurophysiological monitoring and neuronavigation during 2 to 4 weeks after bleeding.
Objective To explore the surgical treatment of pontine cavernous hemangioma(PCH). Methods Clinical data of 9 PCH patients undergoing microsurgery were analyzed retrospectively. All the patients received neurophysiological monitoring in the operation, and the operative approach was selected according to the tumor location, including subtemporal transtentorial approach in 3 patients, retrosigmoid approach in 5 and suboccipital posterior median transcerebellomedullary fissure approach in 1 patient. Results Total tumor resection was achieved in 8 patients and partial resection in 1. Brainstem edema occurred in 2 patients and double vision in 2 after the operation. During a follow-up period of 6 month, MRI reexamination showed no tumor recurred or new bleeding. The KPS score was 90 points in 7 patients and 80 in 2 at 3 months after the operation. Conclusions For PCH patients with clear surgical indications, good surgical results can be obtained by appropriate surgical approach in removing PCH with neurophysiological monitoring and neuronavigation during 2 to 4 weeks after bleeding.
引文
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[7]CONTI A,PONTORIERO A,FARAGO G,et al.Integration of three-dimensional rotational angiography in radiosurgical treatment planning of cerebral arteriovenous malformations[J].Int J Radiat Oncol Biol Phys,2011,81(3):e29-e37.
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[9]HU Y,SUN H,YUAN Y,et al.Acute bilateral massoccupying lesions in non-penetrating traumatic brain injury:a retrospective study[J].BMC Surg,2015,15(1):1471-1482.
[10]CHOTAI S,QI S,XU S.Prediction of outcomes for brainstem cavernous malformation[J].Clin Neurol Neurosur,2013,115(10):2117-2123.
[11]AKIYAMA O,MATSUSHIMA K,NUNEZ M,et al.Microsurgical anatomy and approaches around the lateral recess with special reference to entry into the pons[J].JNeurosurg,2018,129(3):740-751.
[12]陈立华,徐如祥,刘凤.脑干海绵状血管瘤的手术入路选择[J].中华神经医学杂志,2017,16(7):742-746.
[13]KIN T,NAKATOMI H,SHOJIMA M,et al.A new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images[J].J Neurosurg,2012,117(1):78-88.
[14]BOZKURT B,KALANI M Y S,YAGMURLU K,et al.Low retrosigmoid infratonsillar approach to lateral medullary lesions[J].World Neurosurgery,2018,111(3):311-316.
[15]毛颖.脑干海绵状血管畸形:个体化方案推荐[J].中华神经外科杂志,2015,31(5):433-435.
[2]洪健,杨树源,张赛.脑干海绵状血管畸形的外科治疗现状[J].中华神经医学杂志,2016,10(32):1067-1070.
[3]GARCIA R M,IVAN M E,LAETON M T.Brainstem cavernous malformations:surgical results in 104 patients and a proposed grading system to predict neurological outcomes[J].Neurosurgery,2015,76(3):265-278.
[4]LI D,HAO S Y,JIA G J,et al.Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations[J].Neurosurg,2014,121(1):32-41.
[5]CAMPBELL P G,JABBOUR P,YADLA S,et al.Emerging clinical imaging techniques for cerebral cavernous malformations:a systematic review[J].Neurosurg Focus,2010,29(3):E6.
[6]BULUT H T,SARICA M A,BAYKAN A H.The value of susceptibility weighted magnetic resonance imaging in evaluation of patients with familial cerebral cavernous angioma[J].Int J Clin Exp Med,2014,7(12):5296-5302.
[7]CONTI A,PONTORIERO A,FARAGO G,et al.Integration of three-dimensional rotational angiography in radiosurgical treatment planning of cerebral arteriovenous malformations[J].Int J Radiat Oncol Biol Phys,2011,81(3):e29-e37.
[8]FLORES B C,WHITTEMORE A R,SAMSON D S,et al.The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations[J].J Neurosurg,2015,122(3):653-662.
[9]HU Y,SUN H,YUAN Y,et al.Acute bilateral massoccupying lesions in non-penetrating traumatic brain injury:a retrospective study[J].BMC Surg,2015,15(1):1471-1482.
[10]CHOTAI S,QI S,XU S.Prediction of outcomes for brainstem cavernous malformation[J].Clin Neurol Neurosur,2013,115(10):2117-2123.
[11]AKIYAMA O,MATSUSHIMA K,NUNEZ M,et al.Microsurgical anatomy and approaches around the lateral recess with special reference to entry into the pons[J].JNeurosurg,2018,129(3):740-751.
[12]陈立华,徐如祥,刘凤.脑干海绵状血管瘤的手术入路选择[J].中华神经医学杂志,2017,16(7):742-746.
[13]KIN T,NAKATOMI H,SHOJIMA M,et al.A new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images[J].J Neurosurg,2012,117(1):78-88.
[14]BOZKURT B,KALANI M Y S,YAGMURLU K,et al.Low retrosigmoid infratonsillar approach to lateral medullary lesions[J].World Neurosurgery,2018,111(3):311-316.
[15]毛颖.脑干海绵状血管畸形:个体化方案推荐[J].中华神经外科杂志,2015,31(5):433-435.
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