Symptomatic Brainstem Cavernoma of Elderly Patients: Timing and Strategy of Surgical Treatment. Two Case Reports and Review of the Literature
Symptomatic Brainstem Cavernoma of Elderly Patients: Timing and Strategy of Surgical Treatment. Two Case Reports and Review of the Literature
复制标题
老年患者有症状的脑干海绵体瘤：手术治疗的时机和策略。
DOI：
10.1016/j.wneu.2017.12.111
复制
发表时间：
2018
期刊：
影响因子：
2
通讯作者：
Morioka M
中科院分区：
文献类型：
--
作者：
Negoto T;Terachi S;Baba Y;Yamashita S;Kuramoto T;Morioka M
脑干海绵状细胞瘤(BSCs)是一种罕见且难于治疗的肿瘤。对老年患者的症状性皮损的治疗策略仍不清楚。在这篇综述中，我们讨论了老年患者的最佳治疗策略，并考虑了有效的手术策略。患者平均年龄(73.3±3.13)岁，最常见的部位为脑桥。手术前至少有4例出现多发性再出血，临床表现和手术方式因部位不同而不同。9例行手术切除，1例行放射外科治疗。平均随访时间26.1±18.2个月。5例术后神经功能改善，1例术后神经功能减退。结论对症状较重的老年海绵状血管瘤患者，尤其是有多次再出血的患者，建议根治性切除海绵状肿瘤。从外科的角度来看，我们认为亚急性期是切除老年出血患者海绵状肿瘤的最佳时机。然而，多个再出血事件可能会加剧神经功能障碍。因此，从第一次或第二次再出血开始的亚急性期可能是手术切除的最佳时机。在手术干预中，保留周围脑应该优先于完全切除海绵状血肿和血肿。
BackgroundBrainstem cavernomas (BSCs) are rare and difficult to treat. The treatment strategy for symptomatic lesions in elderly patients remains unclear. In this review, we discuss the optimal treatment strategy and consider effective surgical strategies in elderly patients.Case DescriptionThe clinical data of 8 elderly patients (age >70 years) with symptomatic BSCs drawn from the literature and 2 of our cases are summarized in this review. The mean patient age was 73.3 ± 3.13 years, and the most common location was the pons. Multiple rebleeding before surgery was seen in at least 4 cases, with clinical presentation and surgical approach varying depending on the location. Surgical removal was performed in 9 cases, and 1 case was treated with radiosurgery. The mean duration of clinical follow-up was 26.1 ± 18.2 months. Neurologic improvement was found in 5 cases, and postoperative decline was seen in 1 of the surgery cases.ConclusionsRadical resection of the cavernoma with severe symptoms might be recommended in elderly patients, especially in those with multiple rebleeding events. From the viewpoint of surgery, we consider the subacute phase the optimal time to remove cavernomas in elderly hemorrhagic patients. However, multiple rebleeding events might exacerbate the neurologic deficit. Therefore, the subacute phase from the first or second rebleeding might be the best time for the surgical resection. At surgical intervention, preservation of the surrounding brain should be prioritized over complete removal of the cavernoma and hematoma.