Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations Clinical article
Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations Clinical article
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DOI：
10.3171/2013.7.jns13462
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发表时间：
2013-10-01
影响因子：
4.1
通讯作者：
Zhang, Jun-Ting
中科院分区：
文献类型：
--
作者：
Li, Da;Yang, Yang;Zhang, Jun-Ting
目的。本研究的目的是通过长期随访评估手术治疗的脑干海绵状血管瘤（CM）的术前和术后再出血风险、神经功能结果和预后因素。方法。作者对 1999 年至 2010 年间接受手术治疗的 242 名脑干 CM 患者的临床数据进行了回顾性审查。检查了患者病历、影像学表现和结果。结果。该研究纳入了 242 名患者，男女比例为 1.3，平均年龄 32.6 岁。入院时、出院时、术后 3 个月和 6 个月以及最近评估时的平均改良 Rankin 量表评分分别为 2.2、2.6、2.3、1.8 和 1.5。术前计算的年出血率和再出血率分别为5.0%和60.9%。完全切除率为95%。 112 名患者 (46.3%) 发生手术并发症。 85 名患者（35.1%）在手术后立即表现出病情恶化；其中 34 名（41.0%）和 51 名（61.4%）患者在术后 3 个月和 6 个月内恢复到基线水平。平均随访89.4个月，患者病情改善147例（60.7%），无变化70例（28.9%），恶化25例（10.3%）。 6例患者共发生8次出血，术后年出血率为0.4%。 65 名患者 (26.9%) 仍存在永久性发病情况。术前再出血的不利因素为年龄≥50岁、体积≥2cm、病灶周围水肿。术后出血的危险因素是发育性静脉异常和切除不完全。长期结果的独立不良因素是年龄增加、多发性出血、腹侧病变和术前状态不佳。随着时间的推移，术后缺陷的良好、完全改善与良好的术前神经功能和术后的持续改善相关。结论。通过手术实现了良好的长期结果和显着降低的术后年出血率。应尝试完全切除，以尽量减少对神经功能的损伤；然而，术后缺陷可以在术后过程中得到改善。建议对具有预测再出血不良因素的患者进行放射学检查的密切随访。
Object. The aim of this study was to evaluate the pre- and postoperative rehemorrhage risk, neurological function outcome, and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with long-term follow-up.Methods. The authors conducted a retrospective review of the clinical data from 242 patients with brainstem CMs that were surgically treated between 1999 and 2010. Patient charts, imaging findings, and outcomes were examined.Results. The study included 242 patients, with a male-to-female ratio of 1.3 and mean age of 32.6 years. The mean modified Rankin Scale scores on admission, at discharge, at 3 and 6 months after surgery, and at recent evaluation were 2.2, 2.6, 2.3, 1.8, and 1.5, respectively. The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0% and 60.9%, respectively. The complete resection rate was 95%. Surgical morbidity occurred in 112 patients (46.3%). Eighty-five patients (35.1%) demonstrated worsened condition immediately after surgery; 34 (41.0%) and 51(61.4%) of these patients recovered to their baseline level within 3 and 6 months after surgery, respectively. At a mean follow-up of 89.4 months, the patients' condition had improved in 147 cases (60.7%), was unchanged in 70 cases (28.9%), and had worsened in 25 cases (10.3%). A total of 8 hemorrhages occurred in 6 patients, and the postoperative annual hemorrhage rate was 0.4%. Permanent morbidity remained in 65 patients (26.9%). The adverse factors for preoperative rehemorrhage were age >= 50 years, size >= 2 cm, and perilesional edema. The risk factors for postoperative hemorrhage were developmental venous anomaly and incomplete resection. The independent adverse factors for long-term outcome were increased age, multiple hemorrhages, ventral-seated lesions, and poor preoperative status. Favorable, complete improvement in the postoperative deficits over time was correlated with good preoperative neurological function and continuing improvement thereafter.Conclusions. Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates were achieved via surgery. Total resection should be attempted with an aim of minimal injury to neurological function; however, postoperative deficits can improve during the postoperative course. Close follow-up with radiological examination is proposed for patients with adverse factors predictive of rehemorrhage.