Ding Dale, Starke Robert M, Crowley R Webster, Liu Kenneth C
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Department of Neurological Surgery, University of Miami, Miami, FL, USA.
J Cerebrovasc Endovasc Neurosurg. 2017 Mar;19(1):19-35. doi: 10.7461/jcen.2017.19.1.19. Epub 2017 Mar 31.
Surgical resection of thalamic and brainstem cerebral cavernous malformations (CCMs) is associated with significant operative morbidity, but it may be outweighed, in some cases, by the neurological damage from recurrent hemorrhage in these eloquent areas. The goals of this retrospective cohort study are to describe the technical nuances of surgical approaches and determine the postoperative outcomes for CCMs of the thalamus and brainstem.
We reviewed an institutional database of patients harboring thalamic or brainstem CCMs, who underwent surgical resection from 2010 to 2014. The baseline and follow-up neuroimaging and clinical findings of each patient and the operative details of each case were evaluated.
A total of eight patients, including two with thalamic and six with brainstem CCMs, were included in the study cohort. All patients had progressive neurological deterioration from recurrent CCM hemorrhage, and the median modified Rankin Scale (mRS) at presentation was 3. The median CCM maximum diameter and volume were 1.7 cm and 1.8 cm, respectively. The thalamic CCMs were resected using the anterior transcallosal transchoroidal and supracerebellar infratentorial approaches each in one case (13%). The brainstem CCMs were resected using the retrosigmoid and suboccipital trans-cerebellomedullary fissure approaches each in three cases (38%). After a median follow-up of 11.5 months, all patients were neurologically stable or improved, with a median mRS of 2. The rate of functional independence (mRS 0-2) was 63%.
Microneurosurgical techniques and approaches can be safely and effectively employed for the management of thalamic and brainstem CCMs in appropriately selected patients.
丘脑和脑干脑海绵状血管畸形（CCM）的手术切除与显著的手术并发症相关，但在某些情况下，这些功能区反复出血导致的神经损伤可能比手术并发症更为严重。这项回顾性队列研究的目的是描述手术入路的技术细节，并确定丘脑和脑干CCM的术后结果。
我们回顾了2010年至2014年期间接受手术切除的丘脑或脑干CCM患者的机构数据库。评估了每位患者的基线和随访神经影像学及临床结果，以及每个病例的手术细节。
研究队列共纳入8例患者，其中2例为丘脑CCM，6例为脑干CCM。所有患者均因CCM反复出血出现进行性神经功能恶化，就诊时改良Rankin量表（mRS）中位数为3。CCM最大直径和体积的中位数分别为1.7 cm和1.8 cm。丘脑CCM各有1例（13%）采用经胼胝体前脉络膜入路和小脑上幕下入路切除。脑干CCM各有3例（38%）采用乙状窦后入路和枕下经小脑延髓裂入路切除。中位随访11.5个月后，所有患者神经功能稳定或改善，mRS中位数为2。功能独立率（mRS 0 - 2）为63%。
对于经过适当选择的患者，显微神经外科技术和入路可安全有效地用于治疗丘脑和脑干CCM。
