Maurer Adrian J, Bonney Phillip A, Strickland Allison E, Safavi-Abbasi Sam, Sughrue Michael E
Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Boulevard, Suite 4000, Oklahoma City, OK 73104, USA.
Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Boulevard, Suite 4000, Oklahoma City, OK 73104, USA.
J Clin Neurosci. 2015 May;22(5):865-71. doi: 10.1016/j.jocn.2014.10.028. Epub 2015 Feb 16.
Brainstem cavernous malformations can cause devastating neurologic disability when they hemorrhage, which occurs at a higher rate in the brainstem than in other locations. Traditional access to these lesions requires a large craniotomy with extensive exposure and manipulation of vital structures. We present a case series of patients who underwent surgical resection of brainstem cavernous malformations using minimally invasive approaches at our institution from January 2012 to August 2014, all of whom had experienced at least one hemorrhage prior to presentation. Approach choice was determined by location of the cavernous malformation in relation to the brainstem surface. Resection occurred through our described standardized method. Postoperatively, there were three instances of transient neurologic symptoms, all of which resolved at time of last follow-up. All eight patients experienced neurologic improvement after surgery, with four patients showing no deficits at last follow-up. Approach selection rationale and technical nuances are presented on a case-by-case basis. With carefully planned keyhole approaches to cavernous malformations presenting to the brainstem surface, excellent results may be achieved without the necessity of larger conventional craniotomies. We believe the nuances presented may be of use to others in the surgical treatment of these lesions.
脑干海绵状血管畸形出血时可导致严重的神经功能障碍，其在脑干的出血发生率高于其他部位。传统的治疗这些病变的方法需要进行大骨瓣开颅手术，广泛暴露并操作重要结构。我们报告了一组病例，这些患者于2012年1月至2014年8月在我院采用微创方法接受了脑干海绵状血管畸形的手术切除，所有患者在就诊前均至少经历过一次出血。手术入路的选择取决于海绵状血管畸形相对于脑干表面的位置。切除通过我们描述的标准化方法进行。术后出现了3例短暂性神经症状，所有症状在最后一次随访时均已缓解。所有8例患者术后神经功能均有改善，4例患者在最后一次随访时无神经功能缺损。手术入路的选择依据和技术细节将逐例介绍。对于向脑干表面显露的海绵状血管畸形，通过精心规划的锁孔入路，无需进行更大的传统开颅手术即可取得优异的效果。我们认为所介绍的这些细节可能对其他医生治疗这些病变有所帮助。
