Giunta F, Grasso G, Marini G, Zorzi F
Neurosurgical Department, University of Brescia, Italy.
Acta Neurochir Suppl (Wien). 1989;46:86-9. doi: 10.1007/978-3-7091-9029-6_21.
In most cases of brain stem expansive lesion a surgical approach is possible, but in each patient it must be evaluated if the surgical risk is proportional to the therapeutic result. Sometime surgery is limited to a biopsy sample, particularly in malignant lesions. We started stereotactic serial biopsy sampling in all CT or NMR intraaxial brain stem expansive lesions as a preliminary diagnostic procedure. The aim is to look for benign well delimited lesions that we consider for surgical removal or to drain haematomas and abscesses. 35 patients with brain stem expansive lesions were submitted to 47 surgical procedures: 35 stereotactic biopsies (one each patient) and, among them, 12 were major surgical procedures (with craniotomy) for microsurgical removal of the expansive lesions. 15 patients were in paediatric age. Suboccipital transcerebellar approach was performed in 25 mesencephalic, pontine, bulbar expansive lesions and frontal approach was limited to 10 thalamo-mesencephalic lesions. There was no mortality. Two patients were stereotactically drained and definitively cured.
在大多数脑干扩展性病变病例中，手术治疗是可行的，但对于每一位患者，都必须评估手术风险与治疗效果是否成正比。有时手术仅限于活检取样，尤其是在恶性病变中。我们对所有CT或核磁共振成像显示的脑内脑干扩展性病变患者开始进行立体定向连续活检取样，作为初步诊断程序。目的是寻找我们认为可进行手术切除的边界清晰的良性病变，或引流血肿及脓肿。35例脑干扩展性病变患者接受了47次手术：35例立体定向活检（每位患者1次），其中12例为扩大性病变显微手术切除的大型手术（开颅手术）。15例患者为儿童。25例中脑、脑桥、延髓扩展性病变采用枕下经小脑入路，额叶入路仅限于10例丘脑-中脑病变。无死亡病例。2例患者经立体定向引流后彻底治愈。
