Surgical Management of Brainstem Cavernous Malformation: Report of 67 Patients
Surgical Management of Brainstem Cavernous Malformation: Report of 67 Patients
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DOI：
10.1016/j.wneu.2018.11.008
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发表时间：
2019-02-01
影响因子：
2
通讯作者：
Zhang, Junting
中科院分区：
文献类型：
--
作者：
Gui, Songbai;Meng, Guolu;Zhang, Junting
背景：脑干海绵状血管畸形（CM）是一种良性病变，通常表现为急性发作，并导致高发病率。手术切除可抑制反复出血引起的神经功能进行性恶化。本研究旨在总结手术时机、方法和技术，并评估治疗结果。方法：2011年3月至2013年5月，67例脑干CMs患者（男32例，女35例;平均年龄40岁;范围14-68岁）接受手术治疗。结果：共采用7种手术入路，其中眶正中入路1例，枕下经小脑幕入路1例，枕下经小脑幕入路1例，经枕下经小脑幕入路1例（Poppen方法;颞下经小脑幕入路颞下经小脑幕/前岩切除入路9例，枕下乙状窦后入路3例，枕下中线入路16例，远外侧入路3例。所有病例（100%）均实现脑干CM全切除。无手术死亡。9例患者术后出现新症状：复视3例，面部麻木3例，对侧肢体麻木1例，短暂性失语1例，对侧肢体肌力下降1例。23例（34.3%）患者症状明显改善，36例（53.7%）患者症状无变化，9例（13.4%）患者术后出现新症状。
BACKGROUND: Brainstem cavernous malformations (CMs) are benign lesions, often show an acute onset, and result in a high rate of morbidity. Surgical resection could inhibit the progressive deterioration of neurologic function caused by repetitive hemorrhage. This study aimed to summarize timing, approaches, and techniques of surgery and to evaluate outcomes of treatment.METHODS: Between March 2011 and May 2013, 67 patients (32 male, 35 female; average age 40 years; range, 14-68 years) with brainstem CMs received surgical treatment. Clinical presentation, surgical approaches, and results of follow-up were retrospectively analyzed.RESULTS: Seven surgical approaches were used: orbitozygomatic approach (1 case), suboccipital transtentorial approach (Poppen approach; 3 cases), subtemporal transtentorial approach (32 cases), subtemporal transtentorial/anterior petrosectomy approach (9 cases), suboccipital retrosigmoid approach (3 cases), midline suboccipital approach (16 cases), and far lateral approach (3 cases). Total resection of the brainstem CM was achieved in all cases (100%). No operative mortality was encountered. Nine patients had new symptoms after surgery: 3 had diplopia, 3 had facial numbness, 1 had numbness of contralateral limbs, 1 had transient aphasia, and 1 had reduced muscle strength of contralateral limbs. Symptoms significantly improved in 23 patients (34.3%), symptoms were unchanged in 36 patients (53.7%), and new postoperative symptoms occurred in 9 patients (13.4%).CONCLUSIONS: Choosing a proper surgical approach and using appropriate techniques are fundamental for favorable outcomes of patients with brainstem CMs.