Department of Neurological Surgery, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2013 Jul-Aug;80(1-2):89-93. doi: 10.1016/j.wneu.2012.04.002. Epub 2012 Apr 5.
Although surgical resection of brainstem cavernous malformations (CM) has been reviewed, numerous large surgical series have been recently reported.
Eighteen new surgical series with 710 patients were found via a PubMed search, in addition to our previous meta-analysis. Complete excision, complications, and long-term outcome results were compiled across these series. They were then compared and subsequently combined with those of our previous report.
We combined results of 68 surgical series with 1390 patients, incorporating results from our previous meta-analysis. Across 61 series, 1178 of 1291 (91%) CMs were completely excised. Of 105 partially resected CMs with ample follow-up, 65 rebled (62%). Across 46 series providing information on early neurologic morbidity, the overall rate was 45%. Specifically, 12% of patients required tracheostomy and/or gastrostomy procedures. Overall long-term condition was improved in 62% of patients across 51 series. Across 60 series, overall long-term condition was improved or the same in 84% of patients, with worsening in the remaining 16%. The overall surgical and/or cavernoma related mortality rate for all 1390 patients was 1.5%. Notably, these results did not differ significantly between our initial review and the combined data from the subsequent 18 surgical series recently reported in the literature.
Surgical resection of brainstem CM continues to present a considerable challenge with resultant morbidity akin to another CM hemorrhage. We therefore prefer to offer surgery only to patients with at least one previous hemorrhage with CM pial representation. Appropriate patient counseling about expected early morbidity and the potential for long-term worsening is crucial.
尽管已经对脑干海绵状血管畸形（CM）的手术切除进行了综述，但最近仍有大量大型手术系列报道。
通过 PubMed 搜索发现了 18 个新的手术系列，共 710 例患者，此外还包括我们之前的荟萃分析。这些系列中汇编了完全切除、并发症和长期结果。然后将它们与我们之前的报告进行比较和合并。
我们将 68 个手术系列的结果与 1390 例患者合并，包括我们之前荟萃分析的结果。在 61 个系列中，1291 个 CM 中有 1178 个（91%）完全切除。105 个部分切除的 CM 中有 65 个（62%）再次出血。在提供早期神经功能发病率信息的 46 个系列中，总发生率为 45%。具体来说，有 12%的患者需要气管造口术和/或胃造口术。在 51 个系列中，有 62%的患者整体状况得到改善。在 60 个系列中，84%的患者整体状况得到改善或保持不变，16%的患者状况恶化。所有 1390 例患者的总手术和/或海绵状血管畸形相关死亡率为 1.5%。值得注意的是，这些结果在我们最初的综述和随后文献中报道的 18 个新手术系列的综合数据之间没有显著差异。
脑干 CM 的手术切除仍然是一个相当大的挑战，导致发病率类似于另一次 CM 出血。因此，我们只向至少有一次 CM 软脑膜表现的出血史的患者提供手术治疗。适当的患者咨询关于预期的早期发病率和长期恶化的可能性至关重要。
