Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurgery. 2011 Feb;68(2):403-14; discussion 414-5. doi: 10.1227/NEU.0b013e3181ff9cde.
Brainstem cavernous malformations (BSCMs) are relatively uncommon, low-flow vascular lesions. Because of their relative rarity, relatively little data on their natural history and on the efficacy and durability of their treatment.
To evaluate the long-term durability of surgical treatment of BSCMs and to document patient outcomes and clinical complications.
The charts of all patients undergoing surgical treatment of BSCM between 1985 and 2009 were reviewed retrospectively. The study population consisted of 300 patients who had surgery for BSCM. Forty patients were under 19 years of age at surgery; pediatric BSCMs have been reported separately. Patient demographics, lesion characteristics, surgical approaches, and patient outcomes were examined.
The study population consisted of 260 adult patients with a female-to-male ratio of 1.5 and mean age of 41.8 years. Of the 260 patients, 252 presented with a clinical or radiographic history of hemorrhage. The mean follow-up in 240 patients was 51 months. The mean Glasgow Outcome Scale on admission, at discharge, and at last follow-up was 4.4, 4.2, and 4.6. Postoperatively, 137 patients (53%) developed new or worsening neurological symptoms. Permanent new deficits remained in 93 patients 3(36%). There were perioperative complications in 74 patients (28%); tracheostomy, feeding tube placement, and cerebrospinal fluid leakage were most common. Eighteen patients (6.9%) experienced 20 rehemorrhages. Twelve patients required reoperation for residual/recurrent BSCM. The overall annual risk of postoperative rehemorrhage was 2%/patient.
Although BSCM surgery has significant associated risks, including perioperative complications, new neurological deficits, and death, most patients have favorable outcomes. Overall, surgery markedly improved the risk of rehemorrhage and related symptoms and should be considered in patients with accessible lesions.
脑干海绵状血管畸形（BSCM）是相对少见的低流量血管病变。由于其相对罕见，关于其自然史以及治疗的疗效和持久性的数据相对较少。
评估 BSCM 手术治疗的长期持久性，并记录患者的结果和临床并发症。
回顾性地审查了 1985 年至 2009 年间接受 BSCM 手术治疗的所有患者的图表。该研究人群包括 300 名因 BSCM 而行手术的患者。40 名患者在手术时未满 19 岁；儿科 BSCM 已单独报告。检查了患者的人口统计学、病变特征、手术方法和患者结果。
该研究人群包括 260 名成年患者，女性与男性的比例为 1.5，平均年龄为 41.8 岁。在 260 名患者中，有 252 名有出血的临床或影像学病史。240 名患者的平均随访时间为 51 个月。入院时、出院时和最后随访时的平均格拉斯哥结果量表（GOS）分别为 4.4、4.2 和 4.6。术后，137 名患者（53%）出现新的或恶化的神经症状。93 名患者（36%）永久性出现新的缺陷。74 名患者（28%）发生围手术期并发症；气管切开术、置管喂养和脑脊液漏是最常见的并发症。18 名患者（6.9%）经历了 20 次再出血。12 名患者因残余/复发性 BSCM 而需要再次手术。术后再出血的总体年风险为 2%/患者。
尽管 BSCM 手术存在显著的相关风险，包括围手术期并发症、新的神经功能缺损和死亡，但大多数患者都有良好的结果。总体而言，手术显著改善了再出血和相关症状的风险，对于可接近病变的患者应考虑手术治疗。
