Bouillot P, Dufour H, Roche P H, Lena G, Graziani N, Grisoli F
Service de Neurochirurgie (Pr Grisoli), CHU La Timone, Marseille.
Neurochirurgie. 1996;42(4-5):189-200; discussion 200-1.
Due to the current use of magnetic resonance imaging (MRI), angiographic occult vascular malformations (AOVM) located in the brain stem are frequently reported in the last ten years. The term AOVM is ambiguous and controvers. For, most of these lesions presented with MRI pattern of a cavernous angioma, but only few cases received pathological confirmation. In this location, the operative treatment while worthwhile could be hazardous indeed, so a conservative management is more commonly discussed first. However, the potential risk of rebleeding or poor clinical condition sometimes encourage a more aggressive decision. We report our experience in 25 patients (4 children and 21 adults) admitted between 1982 and 1994 with an AOVM located in the brain stem. In 17 patients, the cryptic vascular lesion was removed surgically. A cavernous angioma was strictly confirmed in only 8 cases. Conversely, 8 patients were managed conservatively. In the surgically treated group of patients, 10 improved their neurological deficit postoperatively, 2 patients remained unchanged, 3 patients worsened, and 2 patients died. The final outcome in 14 patients was evaluated after 51 months of mean follow-up (17 to 70 months). In 5 cases (35.7%) the result was excellent (no symptoms), 5 cases had a good result (normal activity with minimal residual disability), and 4 cases (28.5%) remained with severe permanent disability. In the non-surgically treated group of patients, the final outcome was evaluated after a mean follow-up period of 67 months (from 1 to 120 months). One patient experienced a rebleeding and remained severely disabled. Another patient had two bleeding episodes leaving only a minor facial numbness. Four patients were symptom-free, and the last case was lost for follow-up.
由于目前磁共振成像（MRI）的应用，位于脑干的血管造影隐匿性血管畸形（AOVM）在过去十年中屡有报道。术语AOVM含混不清且存在争议。因为，这些病变大多呈现出海绵状血管瘤的MRI表现，但仅有少数病例得到病理证实。在此部位，手术治疗虽有价值但确实具有危险性，所以通常首先会讨论保守治疗。然而，再出血的潜在风险或不佳的临床状况有时会促使做出更积极的决策。我们报告了1982年至1994年间收治的25例（4例儿童和21例成人）位于脑干的AOVM患者的治疗经验。17例患者的隐匿性血管病变接受了手术切除。仅8例严格证实为海绵状血管瘤。相反，8例患者接受了保守治疗。在手术治疗组患者中，10例术后神经功能缺损有所改善，2例患者病情未变，3例患者病情恶化，2例患者死亡。对14例患者在平均随访51个月（17至70个月）后评估最终结果。5例（35.7%）结果极佳（无症状），5例结果良好（活动正常，仅有轻微残留残疾），4例（28.5%）仍有严重永久性残疾。在非手术治疗组患者中，在平均随访67个月（1至120个月）后评估最终结果。1例患者发生再出血，仍严重残疾。另1例患者有两次出血发作，仅遗留轻微面部麻木。4例患者无症状，最后1例失访。
