Department of Neurosurgery, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy.
Department of Neurology, Azienda Ospedaliero Univer-sitaria S. Maria della Misericordia, Udine, Italy.
Oper Neurosurg (Hagerstown). 2018 Nov 1;15(5):483-497. doi: 10.1093/ons/opx281.
Cavernous malformations (CMs) are congenital malformations and may be located anywhere in the brain. We present a series of CMs located close to or inside of the motor-sensory cortex or corticospinal tract (CST) with clinical onset due to hemorrhage or mass effect. In such cases, surgery becomes an acceptable option.
To evaluate the role of diffusion tensor imaging (DTI), functional-magnetic-resonance imaging (fMRI), intraoperative neurophysiological monitoring, neuronavigation, and brain-mapping and the clinical results of surgical treatment of CMs in this critical location.
The study included 54 patients harboring 22 cortical and 32 deep locations. This series was distinct because in group I, where the DTI was not obtained, and in the group II, where this evaluation was performed.
The postoperative permanent morbidity rate was 4% in the historical group for the deeper CMs, and there was no morbidity in the second group. DTI and fMRI permitted us to estimate the distance between the CMs and both the cortical activation cluster and the pyramidal tract. These data, in addition to intraoperative mapping and monitoring, made it necessary for us to perform a partial resection in 2 cases in the second series.
CMs are congenital lesions and CST fibers can run directly on their surface. Integration of fMRI and DTI data with intraoperative functional monitoring and direct cortical and subcortical mapping are mandatory to accomplish an optimal resection, tailoring the best surgical approach to the acceptable morbidity. A subtotal resection could be considered an option for deep locations.
海绵状畸形（CMs）是先天性畸形，可能位于大脑的任何部位。我们报告了一系列因出血或占位效应而导致临床发作的靠近运动感觉皮层或皮质脊髓束（CST）的 CMs。在这种情况下，手术成为一个可接受的选择。
评估弥散张量成像（DTI）、功能磁共振成像（fMRI）、术中神经生理监测、神经导航、脑图谱以及在这一关键部位手术治疗 CMs 的临床结果的作用。
该研究纳入了 54 例患者，其中 22 例位于皮质，32 例位于深部。本系列的特点是在 I 组中未获得 DTI，而在 II 组中进行了该评估。
深部 CMs 的历史组术后永久性发病率为 4%，而第二组则没有发病率。DTI 和 fMRI 使我们能够估计 CMs 与皮层激活簇和锥体束之间的距离。这些数据，加上术中的定位和监测，使得我们在第二组的 2 例中需要进行部分切除。
CMs 是先天性病变，CST 纤维可以直接在其表面运行。将 fMRI 和 DTI 数据与术中功能监测以及直接皮层和皮层下定位相结合，对于实现最佳切除至关重要，从而为可接受的发病率制定最佳手术方法。对于深部病变，次全切除可以被认为是一种选择。
