Department of Neurosurgery, Military University Hospital, U Vojenske Nemocnice 1200, Prague, 169 02, Czech Republic,
Acta Neurochir (Wien). 2013 Nov;155(11):2079-83. doi: 10.1007/s00701-013-1842-6. Epub 2013 Aug 24.
Cavernomas are vascular hamartomas made up of thin-walled, grossly dilated blood vessels lined with endothelium. Between 4 and 35 % (mean 15 %) of cerebral cavernomas are located in the brainstem making resection of these lesions one of the most challenging tasks in neurosurgery.
Patients with cavernomas within the brainstem or deep supratentorial structures were chosen from our prospectively collected database of operated patients with brain cavernomas. The timespan of treatment was between January 1998 and June 2012. Primary outcome was defined as percentage of patients with favourable outcome (Glasgow Outcome Scale (GOS) 4 or 5) at 1 year. Secondary outcome was defined as operation-related morbidity and mortality (drop at least 1 point on GOS at 1 year).
A total of 37 patients underwent surgery. The mean age was 34.7 ± 11.7 years. The male to female ratio was 19:16. Thirty-two patients had a solitary lesion and 12 patients harboured multiple lesions. The Glasgow outcome score 4 or 5 was achieved after 34 operations (89.5 %). The mean follow-up was 39 months. We experienced two early post-operative deaths (5.3 %) and decrease in the Glasgow outcome scale postoperatively in 4 patients (10.5 %).
• Favourable outcome was achieved in 89.5 % of cases. • Although M&M appears to be relatively high, surgery is method of choice for surgically accessible lesion which has bled for the first time due to reported high rebleed rate and high probability of poor outcome after cavernoma rebleed. • Radiosurgery should be reserved for those lesions which are deemed unresectable and where surgical intervention is considered favourable to observation alone.
海绵状血管瘤是由薄壁、明显扩张的血管组成，内衬内皮。4%至 35%（平均 15%）的脑内海绵状血管瘤位于脑干，因此切除这些病变是神经外科最具挑战性的任务之一。
从我们的手术治疗脑海绵状血管瘤患者的前瞻性数据库中选择位于脑干或深部幕上结构的海绵状血管瘤患者。治疗时间范围为 1998 年 1 月至 2012 年 6 月。主要结果定义为 1 年后患者的良好结局（Glasgow 结局量表（GOS）4 或 5）的百分比。次要结果定义为与手术相关的发病率和死亡率（1 年内 GOS 下降至少 1 分）。
共 37 例患者接受手术。平均年龄为 34.7±11.7 岁。男女比例为 19:16。32 例患者有单发病变，12 例患者有多发病变。34 例手术获得格拉斯哥结局评分 4 或 5（89.5%）。平均随访时间为 39 个月。我们经历了两例术后早期死亡（5.3%）和 4 例患者术后格拉斯哥结局量表下降（10.5%）。
•89.5%的病例获得了良好的结果。•尽管 M&M 似乎相对较高，但由于报告的再出血率高且海绵状血管瘤再出血后预后不良的可能性高，手术是初次出血的可手术病变的首选治疗方法。•对于那些被认为不可切除的病变，以及手术干预被认为优于单独观察的病变，应保留放射外科治疗。
