Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurg Focus. 2012 Aug;33(2):E10. doi: 10.3171/2012.6.FOCUS12110.
Although they provide excellent ventral and lateral exposure of the brainstem, petrosal approaches to brainstem cavernous malformations (CMs) are infrequently reported.
The authors reviewed their experience with petrosal approaches to brainstem CMs in combination with a comprehensive review of the literature to elucidate resection rates, complication rates, and outcomes.
Including their own results, the authors found 65 cases in 20 reports of brainstem CMs treated with petrosal approaches. The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 case (2%). For 50 cases in 16 reports with detailed outcome information, the overall complete resection rate was 90%, with early postoperative morbidity reported in 30% of cases and permanent morbidity in 14%. The rate of CSF leakage was 6%.
The versatile petrosal approaches to brainstem CMs are associated with good outcomes and an acceptable morbidity rate. More expansive lesions can be approached using a combination of the standard anterior and posterior petrosal approach, preserving hearing and avoiding the greater complication rates associated with extended posterior petrosal approaches.
岩骨入路可提供极佳的脑干腹侧和外侧显露，但用于脑干部位海绵状血管畸形（CM）的报道却很少。
作者结合文献综述，回顾了他们采用岩骨入路治疗脑干部位 CM 的经验，以阐明切除率、并发症发生率和结果。
包括作者自己的结果在内，作者在 20 篇关于采用岩骨入路治疗脑干部位 CM 的报道中发现了 65 例病例。具体的入路方式为：岩骨后入路 37 例（57%）、岩骨前入路 17 例（26%）、岩骨后扩展入路 10 例（15%）和联合岩骨入路 1 例（2%）。在 16 篇报道中有 50 例详细的预后信息，总的完全切除率为 90%，术后早期并发症发生率为 30%，永久性并发症发生率为 14%。CSF 漏发生率为 6%。
岩骨入路治疗脑干部位 CM 具有良好的预后和可接受的并发症发生率。对于更广泛的病变，可以采用标准的岩骨前入路和后入路联合入路，保留听力并避免与岩骨后扩展入路相关的更高并发症发生率。
