Zamorano L, Matter A, Saenz A, Buciuc R, Diaz F
Neurological Surgery Department, Wayne State University, Detroit, Michigan 48201, USA. zamorano@neurosurg
Comput Aided Surg. 1997;2(6):327-32. doi: 10.1002/(SICI)1097-0150(1997)2:6<327::AID-IGS2>3.0.CO;2-1.
Between July 1992, and February 1997, 15 patients with cavernous malformations underwent interactive image-guided resection of their lesions. There were eight women and seven men in the group, ranging in age from 6 years to 62 years (mean 34 years). Clinical presentations included seizures (n = 7), headache (n = 4), and hemorrhage (n = 4). Prior conventional subtotal resection had been performed in one patient, and a history of prior hemorrhage was found for two patients. Diagnosis was made using magnetic resonance imaging and digital substraction angiography. Locations of the lesions were temporal (n = 9), frontal (n = 3), thalamus (n = 1), basal ganglia (n = 1), and pons (n = 1). Size ranged from 9 to 20 mm (mean 12 mm). For those lesions located near or within eloquent areas (n = 7), an awake craniotomy with functional cortical and subcortical mapping was performed. An infrared system was used intraoperatively to confirm the location and the extent of the resection of these lesions in real time. In 1996 we started using a robotic microscope to aid in localization and resection. Clinical follow-up ranged from 2 to 54 months (mean 27 months). In all 15 patients, complete surgical resection was achieved as demonstrated by postoperative magnetic resonance imaging studies. Two patients had postoperative transient neurological deficits (13.3%) that cleared over a 6-month period. One of them had a lesion in the pons, with multiple cranial nerve deficits postoperatively that gradually improved. There was no associated mortality. Histological diagnosis was consistent with cavernous angioma in all cases. Clinical follow-up revealed that 13 patients experienced complete recovery from preoperative symptoms and two patients with seizures showed marked improvement. We conclude that interactive image-guided surgery for deep-seated cavernous malformations represents a very accurate and safe approach.
1992年7月至1997年2月期间，15例海绵状血管畸形患者接受了交互式图像引导下的病变切除术。该组中有8名女性和7名男性，年龄从6岁至62岁不等（平均34岁）。临床表现包括癫痫发作（n = 7）、头痛（n = 4）和出血（n = 4）。1例患者曾接受过传统的次全切除术，2例患者有既往出血史。诊断采用磁共振成像和数字减影血管造影。病变部位为颞叶（n = 9）、额叶（n = 3）、丘脑（n = 1）、基底节（n = 1）和脑桥（n = 1）。大小范围为9至20毫米（平均12毫米）。对于那些位于功能区附近或内部的病变（n = 7），进行了清醒开颅手术并进行功能皮质和皮质下图谱绘制。术中使用红外系统实时确认这些病变的位置和切除范围。1996年，我们开始使用机器人显微镜辅助定位和切除。临床随访时间为2至54个月（平均27个月）。术后磁共振成像研究显示，所有15例患者均实现了完全手术切除。2例患者术后出现短暂性神经功能缺损（13.3%），在6个月内恢复。其中1例患者脑桥有病变，术后出现多条颅神经缺损，逐渐改善。无相关死亡病例。所有病例的组织学诊断均与海绵状血管瘤一致。临床随访显示，13例患者术前症状完全恢复，2例癫痫患者症状明显改善。我们得出结论，交互式图像引导手术治疗深部海绵状血管畸形是一种非常准确和安全的方法。
