Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes Clinical article
Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes Clinical article
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DOI：
10.3171/2010.5.jns091159
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发表时间：
2011-03-01
影响因子：
4.1
通讯作者：
Lawton, Michael T.
中科院分区：
文献类型：
--
作者：
Chang, Edward F.;Gabriel, Rodney A.;Lawton, Michael T.
对象。切除位于幕上腔室功能健全区域的海绵状畸形（CMs）是有争议的。未经治疗的病变出血可导致毁灭性的神经损伤，但手术有潜在的严重风险。我们假设一个有组织的方法系统可以指导手术计划，并使手术患者获得可接受的神经预后。作者回顾了手术的表现。以及79名连续接受幕上CMs微切除术的患者的预后（基底神经节27例，感觉运动皮层23例，语言皮层3例，丘脑6例，视觉皮层10例，胼胝体10例）。共13种不同的显微外科入路分为4组：浅表、外侧、内侧半球。和后路入路。大多数患者（93.7%）有症状。出血导致局灶性神经功能缺损是53例（67%）患者中最常见的表现。术后磁共振成像显示，76例患者（96.2%）实现了完全切除。总体而言，患者在出院时和随访时进行显微手术解剖后，功能神经状态得到改善。6个月时，64例患者（81.0%）较术前改善，14例患者（17.7%）无变化。结果良好（修正Rankin量表评分）
Object. Resection of cavernous malformations (CMs) located in functionally eloquent areas of the supratentorial compartment is controversial. Hemorrhage from untreated lesions can result in devastating neurological injury, but surgery has potentially serious risks. We hypothesized that an organized system of approaches can guide operative planning and lead to acceptable neurological outcomes in surgical patients.Methods. The authors reviewed the presentation, surgery. and outcomes of 79 consecutive patients who underwent microresection of supratentorial CMs in eloquent and deep brain regions (basal ganglia [in 27 patients], sensorimotor cortex [in 23], language cortex [in 3], thalamus [in 6], visual cortex [in 10], and corpus callosum [in 10]). A total of 13 different microsurgical approaches were organized into 4 groups: superficial, lateral transsylvian, medial interhemispheric. and posterior approaches.Results. The majority of patients (93.7%) were symptomatic. Hemorrhage with resulting focal neurological deficit was the most common presentation in 53 patients (67%). Complete resection, as determined by postoperative MR imaging, was achieved in 76 patients (96.2%). Overall, the functional neurological status of patients improved after microsurgical dissection at the time of discharge from the hospital and at follow-up. At 6 months, 64 patients (81.0%) were improved relative to their preoperative condition and 14 patients (17.7%) were unchanged. Good outcomes (modified Rankin Scale score