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目的探讨脑干占位病变外科手术治疗和非手术治疗的适应证、方法、手术入路、切除方式和并发症防治等问题。方法分析总结1999￣2005年我院住院治疗的55例脑干占位病变的临床资料。接受显微手术治疗40例,其中颞下经天幕入路5例,经中孔-小脑延髓裂入路15例,经蚓体切开入路12例,经小脑半球切开入路2例,经桥小脑角脑干侧方入路4例,经纵裂-第三脑室入路2例。术后接受放疗和(或)化疗13例。非手术治疗15例,接受放疗5例,化疗3例。结果手术治疗者术后6个月随访,Karnofsky生活质量评分为90￣100分8例,70￣80分17例,40￣60分6例,20￣30分3例,10￣0分6例(手术后1个月内死亡)。非手术治疗者住院后6个月随访,Karnofsky生活质量评分为90￣100分1例,70￣80分4例,40￣60分2例,20￣30分3例,10￣0分5例(死亡4例)。结论脑干占位病变以出血性病变(包括海绵状血管畸形)、星型胶质细胞瘤和室管膜瘤多见。出血患者多数可在早期进行手术治疗,出血较少和已进入出血后期可采用非手术治疗。脑干肿瘤中胶质细胞瘤最常见,除弥漫生长型不适合手术和放化疗外,其他生长类型的肿瘤都可以进行显微手术治疗,术后根据病理性质接受放化疗。手术入路的选择和脑干切开的部位取决于病变在脑干中的位置,可以利用的神经功能缺损,患者可以耐受的神经功能缺损;在具体操作时采取循瘤原则、最短原则和避重就轻原则。经中孔-小脑延髓裂入路可以满足大部分经脑干背侧切除占位病变的需要。
Objective To investigate the indications, methods, surgical approaches, surgical approaches and complications prevention and treatment of surgical treatment and non-surgical treatment of brain stem space lesions. Methods To summarize the clinical data of 55 lesions of the brain stem in our hospital from 1999 to 2005. Underwent microsurgical treatment of 40 cases, of which 5 cases under the temporal infratentorial approach through the mesopore - Cerebellar bulbar approach in 15 cases, by the earthworm incision in 12 cases, 2 cases by the cerebellar hemispheric incision, Transcranial cerebellopontine lateral approach in 4 cases, the longitudinal split - third ventricle in 2 cases. Postoperative radiotherapy and / or chemotherapy in 13 cases. Non-surgical treatment in 15 cases, 5 cases received radiotherapy, chemotherapy in 3 cases. Results Surgical treatment of patients after 6 months follow-up, Karnofsky quality of life score of 90 to 100 points in 8 cases, 70 to 80 points in 17 cases, 40 to 60 points in 6 cases, 20 to 30 points in 3 cases, 10 to 0 points in 6 cases (Died within 1 month after surgery). Non-surgical treatment of patients after 6 months of follow-up, Karnofsky quality of life score of 90 to 100 in 1 case, 70 to 80 points in 4 cases, 40 to 60 points in 2 cases, 20 to 30 points in 3 cases, 10 to 0 points in 5 cases (4 deaths). Conclusion Hemorrhagic lesions (including cavernous vascular malformations), astrocytomas and ependymomas are more common in brain stem space lesions. Most patients with bleeding in the early surgical treatment, less bleeding and has entered the late bleeding can be used non-surgical treatment. Brain stem tumors in the most common glioblastoma, in addition to diffuse growth type is not suitable for surgery and radiotherapy and chemotherapy, the other growth types of tumors can be microsurgical treatment of postoperative radiotherapy and chemotherapy based on pathological properties. The choice of surgical approach and the site of brain stem incision depends on the location of the lesion in the brain stem, the available neurological deficits, the neurological deficits the patient can tolerate; the principle of tumorigenesis, the shortest principle and Avoid the principle of light. The mesopore - cerebellar bulbar approach to meet most of the brain stem by dorsal excision lesions need.