Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China.
Neurosurgery. 2011 Mar;68(3):609-20; discussion 620-1. doi: 10.1227/NEU.0b013e3182077531.
Optimal therapy of brainstem cavernous malformations (BSCMs) remains controversial because their biological behavior is unpredictable and surgical removal is challenging.
To analyze our experience with BSCMs and to conduct a review of the literature to identify a rational approach to the management of these lesions.
Fifty-five patients harboring 57 BSCMs underwent surgery and 17 patients were treated conservatively during the 10-year period from 1999 to 2008. The operative strategy was to perform complete CM resection and to preserve any associated venous malformation with minimal functional brainstem tissue sacrificed. The National Institutes of Health Strength Scale (NIHSS) was used to assess neurological status.
The average hemorrhagic and rehemorrhagic rates were 4.7% and 32.7% per patient-year, respectively. Total lesional resection was achieved in all operated patients. Their mean NIHSS score was 4.6 after the first episode, 3.5 preoperatively, 3.2 at discharge, and 1.4 after a mean follow-up of 49 months. Complete recovery rates of motor deficits and sensory disturbances from the preoperative state were 70.4% and 51.7%, respectively. Complete recovery rates for cranial nerves III, V, VI, and VII and the lower group were 60%, 63.2%, 25%, 57.1%, and 80%, respectively. For the conservative patients, the mean NIHSS score was 5.9 after the first episode and 1.7 after a mean follow-up of 40 months.
NIHSS is optimal for evaluating the natural history and surgical effect of patients harboring BSCMs. Surgical resection remains the primary therapeutic option after careful patient screening and preoperative planning.
脑干海绵状血管畸形（BSCM）的最佳治疗方法仍存在争议，因为其生物学行为不可预测，且手术切除具有挑战性。
分析我们在 BSCM 方面的经验，并对文献进行回顾，以确定这些病变的合理治疗方法。
1999 年至 2008 年的 10 年间，55 例患者（57 个病灶）接受了手术治疗，17 例患者接受了保守治疗。手术策略是进行完全 CM 切除，并保留任何相关的静脉畸形，以最小化功能性脑干组织的牺牲。采用美国国立卫生研究院强度量表（NIHSS）评估神经功能状态。
平均每个患者每年出血和再出血率分别为 4.7%和 32.7%。所有接受手术的患者均达到了完全病变切除。他们首次发作后的 NIHSS 平均评分为 4.6，术前为 3.5，出院时为 3.2，平均随访 49 个月后为 1.4。运动功能障碍和感觉障碍从术前状态完全恢复的比例分别为 70.4%和 51.7%。颅神经 III、V、VI 和 VII 以及下组的完全恢复比例分别为 60%、63.2%、25%、57.1%和 80%。对于保守治疗的患者，首次发作后的 NIHSS 平均评分为 5.9，平均随访 40 个月后的 NIHSS 平均评分为 1.7。
NIHSS 是评估 BSCM 患者自然史和手术效果的最佳方法。在仔细筛选患者和术前规划后，手术切除仍然是主要的治疗选择。
