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目的总结脑干海绵状血管瘤(BSC)的临床特点、手术入路选择、显微外科切除技术要点,评价手术治疗BSCH的疗效。方法对海军总医院神经外科2003年1月-2011年4月行显微手术切除的41例BSC患者的临床资料以及手术治疗情况进行回顾性分析。男23例,女18例,年龄8～62岁。主要临床表现包括头痛、头晕,脑神经功能障碍、肢体麻木、肌力减退等长束征以及共济失调等。根据病灶所在部位,遵循“最短距离”的原则选择手术入路,术中行短潜伏期体感诱发电位(SSEP)和听觉诱发电位(AEP)监测。结果 41例患者中35例获BSC全切除,6例巨大病变有少部分残留。无手术死亡病例。术后27例神经功能障碍得到改善,14例出现新的神经功能缺失或原有神经障碍加重,其中2例呼吸功能受影响,人工辅助呼吸1周后恢复自主呼吸。平均随访38个月,有神经功能缺失的患者多数得到恢复,1例残余肿瘤再次出血,其余患者未见复发。结论根据病变部位和病灶突向的方式,选择个体化的手术入路,遵循“最短距离”原则,手术切除BSC能获得良好的预后,术中导航和脑干电生理学监测有助于减少手术损伤及降低并发症。
Objective To summarize the clinical features of brain stem cavernous hemangioma (BSC), surgical approaches, microsurgical resection techniques and evaluate the efficacy of surgical treatment of BSCH. Methods The clinical data and surgical treatment of 41 BSC patients underwent microsurgical resection from January 2003 to April 2011 in Department of Neurosurgery, Naval General Hospital were retrospectively analyzed. 23 males and 18 females, aged 8 to 62 years. The main clinical manifestations include headache, dizziness, cranial nerve dysfunction, limb numbness, muscle weakness and other long bundle sign and ataxia. According to the site of the lesion, follow the principle of “shortest distance ” to select the surgical approach, short-term somatic episode somatosensory evoked potential (SSEP) and auditory evoked potential (AEP) monitoring. Results Of the 41 cases, 35 cases were completely resected by BSC, and a small part of 6 cases were found with huge lesions. No surgical deaths. After operation, 27 cases of neurological dysfunction improved, 14 cases of new neurological deficits or the original neurological disorders increased, of which 2 cases were affected by respiratory function, artificial resuscitation after 1 week resumed spontaneous breathing. After an average follow-up of 38 months, most of the patients with neurological deficits recovered. One patient had residual hemorrhage again and the rest had no recurrence. Conclusion According to the principle of “shortest distance” according to the pathology of lesion and protrusion, individualized surgical approaches are selected. Surgical resection of BSC can achieve good prognosis. Intraoperative navigation and brainstem electrophysiological monitoring can help reduce Surgery and reduce complications.