Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurg Focus. 2010 Sep;29(3):E8. doi: 10.3171/2010.6.FOCUS10128.
Brainstem cavernous malformations (CMs) are low-flow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages that appear to occur more frequently than hemorrhage from supratentorial cavernomas. Brainstem CMs can be removed using 1 of the 5 standard skull-base approaches: retrosigmoid, suboccipital (with or without telovelar approach), supracerebellar infratentorial, orbitozygomatic, and far lateral. Patients being referred to a tertiary institution often have lesions that are aggressive with respect to bleeding rates. Nonetheless, the indications for surgery, in the authors' opinion, are the same for all lesions: those that are symptomatic, those that cause mass effect, or those that abut a pial surface. Patients often have relapsing and remitting courses of symptoms, with each hemorrhage causing a progressive and stepwise decline. Many patients experience new postoperative deficits, most of which are transient and resolve fully. Despite the risks associated with operating in this highly eloquent tissue, most patients have had favorable outcomes in the authors' experience. Surgical treatment of brainstem CMs protects patients from the potentially devastating effects of rehemorrhage, and the authors believe that the benefits of intervention outweigh the risks in patients with the appropriate indications.
脑干海绵状血管畸形（CM）是位于功能区的低流量血管病变。其表现常伴有症状性出血，似乎比幕上海绵状血管畸形出血更为频繁。脑干 CMs 可以通过以下 5 种标准颅底入路中的 1 种进行切除：乙状窦后、枕下（伴有或不伴有经小脑幕中入路）、小脑上蚓部下、眶颧和远外侧。被转诊到三级医疗机构的患者通常具有较高出血风险的病变。然而，作者认为，所有病变的手术指征是相同的：有症状的、引起占位效应的或与软脑膜表面相邻的病变。患者的症状常常反复发作和缓解，每次出血都会导致进行性和逐步恶化。许多患者在术后出现新的缺陷，其中大多数是短暂的，并完全恢复。尽管在这个高度功能区的组织中操作存在风险，但作者的经验表明，对于有适当适应证的患者，手术治疗的效果是有利的。手术治疗脑干 CMs 可以保护患者免受再次出血的潜在破坏性影响，作者认为，对于有适当适应证的患者，干预的益处大于风险。
