CHRU de Tours, Service de Neurochirurgie, Université François Rabelais, Tours, France.
Acta Neurochir (Wien). 2010 Aug;152(8):1321-9; discussion 1329. doi: 10.1007/s00701-010-0667-9. Epub 2010 May 4.
Pontine cavernomas are benign vascular lesions whose surgical treatment is challenging due to their localization. We report our experience in the surgical management of these lesions exclusively using a lateral, subtemporal transtentorial approach in high pontine lesions and an anterior petrosal approach in low pontine lesions.
We performed a retrospective study on a series of patients who were operated on for a pontine cavernoma in our neurosurgery department between 1987 and 2007. In the study, we detail the patients' clinical and preoperative radiological data and compare the two surgical techniques we used. Finally, we analyze the postoperative follow-up, the morbidity encountered according to the surgical approach used, and the long-term outcomes.
We enrolled nine patients into the study. Six patients were operated on using an anterior petrosal approach. None of the patients died. Five patients were able to resume their former professional activity after surgery and were clearly improved following surgery. One patient was worse after surgery (hemiplegia and deafness). We used a subtemporal transtentorial approach in three of the patients. None of the patients died. Two of the patients were able to resume their prior professional activities without any sequels, and the third patient's condition worsened following surgery (temporal hematoma).
The lateral surgical approach for pontine cavernomas constitutes a reasonable surgical alternative to the transventricular, suboccipital, retromastoid, or transclival approaches. Patient morbidity in both approaches is acceptable, and the long-term outcome is satisfactory with respect to sequels and the resumption of prior professional activity.
桥脑海绵状血管畸形是良性血管病变，由于其位置特殊，手术治疗具有挑战性。我们报告了仅使用外侧经颞下入路（对于高位桥脑病变）和前岩下入路（对于低位桥脑病变）治疗这些病变的经验。
我们对 1987 年至 2007 年间在我们神经外科治疗的一组桥脑海绵状血管畸形患者进行了回顾性研究。在研究中，我们详细介绍了患者的临床和术前影像学资料，并比较了我们使用的两种手术技术。最后，我们分析了术后随访、根据手术入路出现的发病率以及长期结果。
我们纳入了 9 名患者进行研究。6 名患者接受了前岩下入路手术。没有患者死亡。5 名患者在手术后能够恢复以前的职业活动，并且在手术后明显改善。1 名患者在手术后更差（偏瘫和耳聋）。我们对 3 名患者使用了经颞下入路。没有患者死亡。2 名患者在手术后能够恢复以前的职业活动，没有任何后遗症，第 3 名患者的病情在手术后恶化（颞部血肿）。
对于桥脑海绵状血管畸形，外侧手术入路是一种合理的替代经脑室、枕下入路、乳突后或经蝶入路的手术方法。两种入路的患者发病率都可以接受，并且在后遗症和恢复以前的职业活动方面，长期结果是令人满意的。
