Retrosigmoid Suprafloccular Transhorizontal Fissure Approach for Resection of Brainstem Cavernous Malformation
Retrosigmoid Suprafloccular Transhorizontal Fissure Approach for Resection of Brainstem Cavernous Malformation
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DOI：
10.1227/01.neu.0000369703.67562.bb
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发表时间：
2010-06-01
期刊：
影响因子：
4.8
通讯作者：
Ohnishi, Takanori
中科院分区：
文献类型：
--
作者：
Ohue, Shiro;Fukushima, Takanori;Ohnishi, Takanori
目的：探讨乙状窦后叶上经短裂入路切除脑干海绵状畸形(CMS)的可行性。方法：对3具身体进行乙状窦后叶上经短裂入路的解剖学研究。对10例采用该入路行脑干CMS显微手术的患者的临床过程进行了回顾分析。结果：在解剖学研究中，在标准的枕下乙状窦后开颅手术后，在上半月小叶和小叶之间解剖了小脑岩表面的水平裂。此入路可通过上半月小叶的上回显露三叉神经和小脑中脚的入根区。然后，在根部进入区周围可以很容易地看到桥的侧表面。该入路用于10例脑干CMS，完全切除9例(90%)。在这项研究中没有遇到死亡。4例术后早期出现新的神经功能障碍，3例为一过性神经功能障碍。4例(40%)术后神经功能恢复，5例(50%)无变化，1例(10%)较术前差。结论：乙状窦后叶上经短池入路可用于桥脑外侧CMS的切除。
OBJECTIVE: This study examined the usefulness of a surgical approach (retrosigmoid suprafloccular transhorizontal fissure approach) for resection of brainstem cavernous malformations (CMs).METHODS: An anatomic study concerning the retrosigmoid suprafloccular transhorizontal fissure approach was performed with 3 cadaveric heads. Clinical course was retrospectively reviewed for 10 patients who underwent microsurgical resection of brainstem CMs with this approach. Medical, surgical, and neuroimaging records of these patients were evaluated.RESULTS: In the anatomic study, after standard suboccipital retrosigmoid craniotomy, the horizontal fissure on the petrosal surface of the cerebellum was dissected between the superior semilunar lobule and flocculus. With this approach, the root entry zone of the trigeminal nerve and the middle cerebellar peduncle could be exposed by superior retraction of the superior semilunar lobule. The lateral surface of the pons was then easily visible around the root entry zone. When this approach was used for 10 brainstem CMs, complete resection was achieved in 9 patients (90%). No mortality was encountered in this study. New neurological deficits occurred in the early postoperative period for 4 patients but were transient in 3 patients. Neurological status at final follow-up was improved in 4 patients (40%), unchanged in 5 patients (50%), and worse in 1 patient (10%) compared with preoperative conditions.CONCLUSION: The retrosigmoid suprafloccular transhorizontal fissure approach is useful for the resection of lateral pontine CMs.