Burkhardt Jan-Karl, Bozinov Oliver, Nürnberg Johannes, Shin Benjamin, Woernle Christoph M, Ulrich Nils H, Bertalanffy Helmut
Department of Neurosurgery, University Hospital, University of Zurich, Zurich, Switzerland.
Clin Neurol Neurosurg. 2012 Oct;114(8):1172-6. doi: 10.1016/j.clineuro.2012.02.040. Epub 2012 Mar 16.
Cerebral cavernous malformations (CCMs) and especially cavernous malformations (CMs) in highly eloquent brain areas such as brainstem CMs are rare but possible events during pregnancy. Due to the few published cases in literature clear recommendations regarding the management are rare. In this study we evaluate the proceeding decision in pregnant patients with highly eloquent brainstem CMs.
In our series 43 patients with CMs in highly eloquent brain areas, including 39 patients with brainstem CMs, were surgically treated by the senior author between July 2007 and July 2010. Out of these, 29 patients were female and three of them presented with a symptomatic brainstem CMs during pregnancy and were included in this study. According to our experiences and to the available literature we analyzed demographic and clinical variables to provide recommendations for the management of pregnant patients with highly eloquent brainstem CMs.
Only one patient was operated during pregnancy the other two patients were surgically treated after delivery, respectively. A thorough review of the literature revealed 12 patients with brainstem cavernomas during pregnancy there of only two patients were operated during pregnancy.
Surgical treatment during pregnancy is rarely required, but needs to be performed right away in life-threatening and rapidly progressive clinical situations. Pregnant women with CMs in highly eloquent brain areas such as brainstem CMs need to be treated in specialized centers to assess the best point of time for surgery. Our study offers a useful tool to support the proceeding decision in this rare but important situation.
脑海绵状血管畸形（CCM），尤其是位于脑干等脑功能区的海绵状血管畸形（CM）在孕期较为罕见，但确有可能发生。由于文献中已发表的病例较少，关于其治疗的明确建议也很罕见。在本研究中，我们评估了患有脑功能区脑干CM的孕妇的治疗决策过程。
在我们的病例系列中，43例脑功能区CM患者，包括39例脑干CM患者，于2007年7月至2010年7月间由资深作者进行了手术治疗。其中，29例为女性，她们中有3例在孕期出现有症状的脑干CM，并被纳入本研究。根据我们的经验和现有文献，我们分析了人口统计学和临床变量，以为患有脑功能区脑干CM的孕妇的治疗提供建议。
仅1例患者在孕期接受了手术，另外2例患者分别在产后接受了手术治疗。对文献的全面回顾显示，有12例孕妇患有脑干海绵状血管瘤，其中仅2例在孕期接受了手术。
孕期很少需要进行手术治疗，但在危及生命和病情快速进展的临床情况下需要立即进行手术。患有脑功能区CM（如脑干CM）的孕妇需要在专业中心接受治疗，以评估最佳手术时机。我们的研究提供了一个有用的工具，以支持在这种罕见但重要的情况下的治疗决策。
