Sakai N, Sakai H, Gotoh Y, Nishimura Y, Andoh T, Yamada H
Department of Neurosurgery, Gifu University School of Medicine, Japan.
No To Shinkei. 1992 Nov;44(11):983-8.
The surgical indications for localized brain stem lesions were evaluated retrospectively through the clinical results of 14 patients: 5 cavernous angiomas and 9 gliomas. Cavernous angiomas were located in fourth ventricle floor (2 cases), in dorsal midbrain (1 case), in right cerebellar peduncle (1 case), and in medulla oblongata (1 case). Those cases had direct surgery because of relapse of clinical symptoms and enlargement of the lesions on follow-up MR imagings. Each lesion was extirpated totally. Consequently, the majority of neurological deficits before operation improved. Therefore, radical extirpation in brain stem cavernous angioma was strongly recommended. Also, total, subtotal resection was performed for gliomas localized in brain stem: 2 low grade astrocytomas, 3 malignant astrocytomas, 3 plexus papillomas, and 1 ependymoma. Most of cases improved without new neurological deficits after surgery. In addition, MR imaging was considered to be essential to accurate diagnosis and surgical strategies for brain stem lesions.
通过14例患者的临床结果对局限性脑干病变的手术指征进行了回顾性评估：5例海绵状血管瘤和9例胶质瘤。海绵状血管瘤位于第四脑室底部（2例）、中脑背侧（1例）、右侧小脑脚（1例）和延髓（1例）。这些病例因临床症状复发及随访磁共振成像显示病变增大而接受了直接手术。每个病变均被完全切除。因此，术前的大多数神经功能缺损得到改善。所以，强烈建议对脑干海绵状血管瘤进行根治性切除。此外，对局限于脑干的胶质瘤进行了全切除或次全切除：2例低级别星形细胞瘤、3例恶性星形细胞瘤、3例丛状乳头状瘤和1例室管膜瘤。大多数病例术后病情改善且未出现新的神经功能缺损。此外，磁共振成像被认为对于脑干病变的准确诊断和手术策略至关重要。
