SYMPTOMATIC BRAINSTEM CAVERNOMAS
SYMPTOMATIC BRAINSTEM CAVERNOMAS
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DOI：
10.1227/01.neu.0000335158.11692.53
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发表时间：
2009-01-01
期刊：
影响因子：
4.8
通讯作者：
Samson, Duke
中科院分区：
文献类型：
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作者：
Hauck, Erik F.;Barnett, Samuel L.;Samson, Duke
目的：本研究的目的是分析有症状的脑干海绵状血管瘤的自然病程方法：我们回顾性分析了1995年至2007年（n = 44）所有到我们机构就诊的有症状的脑干海绵状血管瘤患者的临床资料。首次神经系统事件发生后，中位无事件间隔为2年，年事件发生率为42%。在第二次神经系统事件（新发神经功能缺损或既往神经功能缺损显著恶化）后，中位无事件间期仅为5个月，月事件发生率为8%。在长达8年的观察期后，所有患者最终都接受了手术。在95%的患者中，手术在中位随访期11个月（1个月-7年; P < 0.001）内成功预防了进一步的事件。术后事件发生率在前2年为每年5%，此后为0%。在多变量分析中，只有术前改良兰金量表评分可预测手术结局（比值比，36.7; P = 0.015）。在1年随访期间，2例患者（5%）的状况与术前状况相比在临床上更差;其中1例患者的状况是由复发事件引起的。结论：症状性病变的事件发生率似乎很高，特别是在复发事件后。手术发病率可能较低。对于有症状的脑干海绵状血管瘤，建议及时完整的手术切除，以防止患者因复发事件而导致功能下降。
OBJECTIVE: The goal of this study was to analyze the natural history of symptomatic brain) stem cavernomas (medulla, pons, or midbrain) and outcome after surgical resection.METHODS: We retrospectively analyzed clinical data of all patients who presented to our institution with symptomatic brainstem cavernomas between 1995 and 2007 (n = 44).RESULTS: After a first neurological event, the median event-free interval was 2 years, with) an annual event rate of 42%. After a second neurological event (new neurological deficit or significant worsening of the previous deficit), the median event-free interval was only 5 months, with a monthly event rate of 8%. After an observation period of up to 8 years, all patients ultimately underwent surgery. In 95% of the patients, surgery successfully prevented further events during a median follow-up period of 11 months (1 month-7 years; P < 0.001). The postoperative event rate was 5% per year in the first 2 years and 0% thereafter. In the multivariate analysis, only the preoperative modified Rankin scale score was predictive of the surgical outcome (odds ratio, 36.7; P = 0.015). The conditions of 2 patients (5%) were clinically worse compared with their preoperative conditions during the 1-year follow-up period; in one of these patients, this was caused by recurrent events. There was no mortality.CONCLUSION: The event rate of symptomatic lesions seems to be high, particularly after recurrent events. Surgical morbidity can be low. Timely and complete surgical resection is recommended for symptomatic brainstem cavernomas to prevent patients' functional decline owing to recurrent events.