CAJ | 학술논문

目的探讨脑干血管畸形的显微外科手术治疗方法和预后.方法显微手术切除脑干血管畸形19例.6例经枕下正中第四脑室底入路切除;9例经枕下乙状窦后入路切除;3例经小脑延髓裂入路切除;1例经枕下正中入路上抬蚓垂后切除.结果 19例病灶均镜下全切,其中海绵状血管瘤15例,动静脉畸形4例.13例症状改善,5例出现并发症,1例因下呼吸道感染死亡.随访中GOS 5分15例,GOS 4分2例,GOS 3分1例.MRI复查无病灶残留.结论在恰当选择手术适应证、手术时机和手术入路的基础上,运用娴熟的显微外科技术,脑干血管畸形的手术治疗结果是令人满意的.
목적 탐토뇌간혈관기형적현미외과수술치료방법화예후.방법 현미수술절제뇌간혈관기형19례.6례경침하정중제사뇌실저입로절제;9례경침하을상두후입로절제;3례경소뇌연수렬입로절제;1례경침하정중입로상태인수후절제.결과 19례병조균경하전절,기중해면상혈관류15례,동정맥기형4례.13례증상개선,5례출현병발증,1례인하호흡도감염사망.수방중GOS 5분15례,GOS 4분2례,GOS 3분1례.MRI복사무병조잔류.결론 재흡당선택수술괄응증、수술시궤화수술입로적기출상,운용한숙적현미외과기술,뇌간혈관기형적수술치료결과시령인만의적.
Objective To investigate the microsurgical treatment of brainstem vascular malformation and evaluate the surgical outcome. Method Brain stem vascular malformations in 19 cases were resected by microsurgical techniques. Six cases of cavernous malformations ( CM ) in the dorsal of pons and medulla underwent operations via through the base of the forth ventrical approach. Another nine cases of CM in lateral and ventral lateral pons were treated via suboccipito - retrosigmoid approach. Three cases of arteriovenous malformation(AVM) in cerebellomedullary fissure were treated via telovelar approach. One case of AVM in the dosal medulla were resected via transvermian approach. Results All the lesions were totally resected. Pathologic diagnosis were CM( 15 cases) and AVM(4 cases). The diameter of all the CM were less than 1 centimeter. One AVM was 1.5 centimeter in diameter, the other two lesions was 2. 0 centimeter, the last one was 2. 5 centimeter. The functional disorders were improved after operation in 13 cases. Complications appeared in five patients, which improved between one week and three months. One patient died of sever pneumonia. During two months to six years after operation, the brainstem vascular malformation didn't recrudesce and re - bleed. No one patient appeared new syndromes. Conclusions The microsurgical management of brainstem vascular malformation can effectively prevent re - bleeding. Selecting different surgical approach basing on the locations can reduce the neurofunction damage. In order to accelerate the recovery of damaged brainstem, early surgery should be choosen for the patients with surgical indications. Basing on the correct choice of surgical indications, using the extensive knowledge of microanatomy,new concept of minimal invasive surgery and skillful microsurgical techniques, the surgical results of brainstem vascular malformation are satisfactory.