Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Neurosurg Rev. 2020 Aug;43(4):1179-1189. doi: 10.1007/s10143-019-01156-7. Epub 2019 Aug 6.
The aim of this study was to report our surgical experience on resection of the pontine cavernous malformations (CMs) via subtemporal transtentorial approach (STTA) and intradural anterior transpetrosal approach (ATPA). Clinical data were retrospectively reviewed in 61 patients with pontine CMs that were surgically treated by the STTA and the intradural ATPA. The surgical procedures, complications, and outcomes were analyzed. The study consists of 61 patients with a total of 61 pontine CMs. Other than 4 lesions located medially in the pons, all CMs were in the lateral pons with a left or right lateral epicenter (the left/right ratio was 22/35). Totally, 11 patients (18.0%) with lesions located in the upper pons were treated by the STTA, and 50 patients (82.0%) with lesions involving the lower pons were treated by the intradural ATPA. Postoperatively, the complete resection was achieved in 58 patients (95.1%) and incomplete resection in 3 patients (4.9%). Twenty-seven patients (44.3%) suffered from a new or worsened neurological deficit in the immediate postoperative period, and 8 patients (13.1%) encountered a non-neural complication, including rebleeding, cerebrospinal fluid leak, intracranial infection, and pulmonary infection, and 3 patients had contusion of temporal lobe. With a mean follow-up of 54.2 months, the patients' neurological condition had improved in 43 cases (71.6%), not changed in 10 cases (16.7%), and worsened in 7 cases (11.7%), respectively. The Karnofsky Performance Scale (KPS) score evaluated at the last time for per patient was significantly better than their baseline status (t = 6.677, p < 0.001). However, 21 patients (35.0%) suffered from a new or worsened persistent postoperative deficit. The lateral and anterolateral pons can be exposed well by the subtemporal transtentorial and intradural anterior transpetrosal approaches. Lesions of CMs located in the lateral pons, including ventrolateral and dorsolateral pons, could be totally removed by these two lateral approaches with an acceptable surgical morbidity.
本研究旨在报告我们通过颞下入路（STTA）和硬脑膜内前岩下入路（ATPA）切除脑桥海绵状血管畸形（CMs）的手术经验。回顾性分析了 61 例经 STTA 和硬脑膜内 ATPA 手术治疗的脑桥 CMs 患者的临床资料。分析了手术过程、并发症和结果。研究包括 61 例患者，共 61 个脑桥 CMs。除了 4 个位于脑桥内侧的病变外，所有 CMs 均位于脑桥外侧，左侧或右侧外侧为病变起源（左侧/右侧比为 22/35）。总共 11 例（18.0%）病变位于脑桥上段的患者采用 STTA 治疗，50 例（82.0%）病变累及脑桥下段的患者采用硬脑膜内 ATPA 治疗。术后，58 例（95.1%）患者达到完全切除，3 例（4.9%）患者达到不完全切除。27 例（44.3%）患者术后即刻出现新的或加重的神经功能缺损，8 例（13.1%）患者发生非神经并发症，包括再出血、脑脊液漏、颅内感染和肺部感染，3 例患者出现颞叶挫伤。平均随访 54.2 个月后，43 例（71.6%）患者神经功能改善，10 例（16.7%）患者无变化，7 例（11.7%）患者恶化。每位患者最后一次的卡氏功能状态（KPS）评分均明显优于基线状态（t=6.677，p<0.001）。然而，21 例（35.0%）患者出现新的或持续存在的术后神经功能缺损。颞下入路和硬脑膜内前岩下入路可良好暴露脑桥的外侧和前外侧。位于脑桥外侧的 CMs 病变，包括脑桥腹外侧和背外侧，可通过这两种外侧入路完全切除，手术并发症发生率可接受。
