Gui Songbai, Meng Guolu, Xiao Xinru, Wu Zhen, Zhang Junting
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2019 Feb;122:e1162-e1171. doi: 10.1016/j.wneu.2018.11.008. Epub 2018 Nov 14.
Brainstem cavernous malformations (CMs) are benign lesions, often show an acute onset, and result in a high rate of morbidity. Surgical resection could inhibit the progressive deterioration of neurologic function caused by repetitive hemorrhage. This study aimed to summarize timing, approaches, and techniques of surgery and to evaluate outcomes of treatment.
Between March 2011 and May 2013, 67 patients (32 male, 35 female; average age 40 years; range, 14-68 years) with brainstem CMs received surgical treatment. Clinical presentation, surgical approaches, and results of follow-up were retrospectively analyzed.
Seven surgical approaches were used: orbitozygomatic approach (1 case), suboccipital transtentorial approach (Poppen approach; 3 cases), subtemporal transtentorial approach (32 cases), subtemporal transtentorial/anterior petrosectomy approach (9 cases), suboccipital retrosigmoid approach (3 cases), midline suboccipital approach (16 cases), and far lateral approach (3 cases). Total resection of the brainstem CM was achieved in all cases (100%). No operative mortality was encountered. Nine patients had new symptoms after surgery: 3 had diplopia, 3 had facial numbness, 1 had numbness of contralateral limbs, 1 had transient aphasia, and 1 had reduced muscle strength of contralateral limbs. Symptoms significantly improved in 23 patients (34.3%), symptoms were unchanged in 36 patients (53.7%), and new postoperative symptoms occurred in 9 patients (13.4%).
Choosing a proper surgical approach and using appropriate techniques are fundamental for favorable outcomes of patients with brainstem CMs.
脑干海绵状血管畸形（CMs）是良性病变，常急性起病，且致残率高。手术切除可抑制因反复出血导致的神经功能进行性恶化。本研究旨在总结手术时机、入路和技术，并评估治疗效果。
2011年3月至2013年5月，67例脑干CMs患者（男32例，女35例；平均年龄40岁；范围14 - 68岁）接受了手术治疗。对临床表现、手术入路及随访结果进行回顾性分析。
采用了7种手术入路：眶颧入路（1例）、枕下经小脑幕入路（Poppen入路；3例）、颞下经小脑幕入路（32例）、颞下经小脑幕/岩前入路（9例）、枕下乙状窦后入路（3例）、枕下中线入路（16例）和远外侧入路（3例）。所有病例（100%）均实现了脑干CM的全切。未发生手术死亡。9例患者术后出现新症状：3例出现复视，3例出现面部麻木，1例出现对侧肢体麻木，1例出现短暂性失语，1例出现对侧肢体肌力减弱。23例患者（34.3%）症状明显改善，36例患者（53.7%）症状无变化，9例患者（13.4%）出现新的术后症状。
选择合适的手术入路并采用恰当的技术是脑干CMs患者获得良好预后的基础。
