Fahlbusch R, Strauss C
Neurochirurgische Klinik, Universität Erlangen-Nürnberg.
Zentralbl Neurochir. 1991;52(1):25-32.
Cavernous hemangiomas are identified as source of brainstem hemorrhage in increasing numbers by magnetic resonance imaging. The optimal treatment of this rare vascular malformation, indication for surgery and time of intervention is still under discussion as the experience so far is mainly based on case reports. We have investigated a series of 20 patients with cavernous hemangiomas of the brainstem between 1986 and 1990, 10 of them underwent surgical removal of the lesion. Based on these experiences we conclude: Surgical removal of cavernous hemangiomas should be attempted in patients with recurrent hemorrhage, persistent or progressive neurological deficit. In cases with additional venous malformation the cavenoma should be selectively removed. Surgery should be radical, as residual cavernoma can cause recurrent bleedings. Surgery should be performed during the subacute stage. Late surgery increases the risk for additional neurological deficit. Neurophysiologic monitoring can be helpful to minimize surgical risk.
磁共振成像显示，海绵状血管瘤越来越多地被确定为脑干出血的来源。由于目前的经验主要基于病例报告，这种罕见血管畸形的最佳治疗方法、手术指征和干预时机仍在讨论中。我们对1986年至1990年间的20例脑干海绵状血管瘤患者进行了研究，其中10例接受了病变的手术切除。基于这些经验，我们得出结论：对于复发性出血、持续性或进行性神经功能缺损的患者，应尝试手术切除海绵状血管瘤。对于合并静脉畸形的病例，应选择性地切除海绵状血管瘤。手术应彻底，因为残留的海绵状血管瘤可导致再次出血。手术应在亚急性期进行。晚期手术会增加出现额外神经功能缺损的风险。神经生理监测有助于将手术风险降至最低。
