CAJ | 학술논문

目的探讨显微外科手术与伽玛刀治疗脑干海绵状血管畸形的疗效差异. 方法回顾性分析广州军区广州总医院神经外科自2002年1月至2011年12月收治的有完整随访资料的脑干海绵状血管畸形显微外科手术治疗15例患者与伽玛刀治疗22例患者的临床资料,对比2组患者治疗后临床症状改善情况、格拉斯哥预后评分、远期生活质量评估及美国国立卫生研究院卒中量表(NIHSS)评分. 结果显微外科手术组:1例桥脑病灶术后有残余,未见再出血及死亡病例,2例出现不可逆性神经功能障碍加重.临床症状改善11例(73.3％).术后格拉斯哥预后评分、远期生活质量评估较术前分别提高0.20分和6.66分,NIHSS评分降低1.20分.伽玛刀组:2例因再出血而病灶增大、3例出现灶周脑水肿并经治疗后好转,未见死亡病例.临床症状改善9例(40.9％).术后格拉斯哥预后评分及远期生活质量评估较术前分别提高0.05分和1.82分,NIHSS评分降低0.82分. 结论显微外科手术较伽玛刀治疗脑干海绵状血管畸形更有效,若患者无手术条件或拒绝手术者亦可选择伽玛刀治疗,但需谨慎.
목적 탐토현미외과수술여가마도치료뇌간해면상혈관기형적료효차이. 방법 회고성분석엄주군구엄주총의원신경외과자2002년1월지2011년12월수치적유완정수방자료적뇌간해면상혈관기형현미외과수술치료15례환자여가마도치료22례환자적림상자료,대비2조환자치료후림상증상개선정황、격랍사가예후평분、원기생활질량평고급미국국립위생연구원졸중량표(NIHSS)평분. 결과 현미외과수술조:1례교뇌병조술후유잔여,미견재출혈급사망병례,2례출현불가역성신경공능장애가중.림상증상개선11례(73.3％).술후격랍사가예후평분、원기생활질량평고교술전분별제고0.20분화6.66분,NIHSS평분강저1.20분.가마도조:2례인재출혈이병조증대、3례출현조주뇌수종병경치료후호전,미견사망병례.림상증상개선9례(40.9％).술후격랍사가예후평분급원기생활질량평고교술전분별제고0.05분화1.82분,NIHSS평분강저0.82분. 결론 현미외과수술교가마도치료뇌간해면상혈관기형경유효,약환자무수술조건혹거절수술자역가선택가마도치료,단수근신.
Objective To explore the efficacy ofmicrosurgery and gamma knife treatment on brainstem cavernous malformations.Methods Retrospective analysis was performed on the clinical data of 15 patients with brainstem cavernous malformations treated by microsurgery and 22 patients by gamma knife in our hospital from January 2002 to December 2011.The clinical symptom improvement,scores of Glasgow Outcome Scale,scores of Karnofsky Performance Scale and scores of National Institutes of Health Stroke Scale before and after treatment were observed and compared between the two groups.Results Patients in the micro-surgery group enjoyed the following results:one patient with pontine lesion had residual postoperation; no re-bleeding or death was noted; two had irreversible neurological dysfunction; clinical symptoms improved in 11 patients (73.3％); the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.20 and 6.6 as compared with the preoperative ones; The postoperative scores of National Institutes of Health Stroke Scale decreased 1.20 as compared with the preoperative ones.Patients in Gamma Knife group enjoyed the following results:the lesions of two patients increased due to re-bleeding; three had perifocal brain edema; no death was noted;the clinical symptoms improved in 9 patients (40.9％); the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.05 and 1.82 as compared with the preoperative ones; the postoperative scores of National Institutes of Health Stroke Scale decreased 0.82 as compared with the preoperative ones.Conclusion Micro-surgery may be more effective than Gamma Knife in treating brainstem cavernous malformations; however,patients with non-surgical conditions or refusing surgery could choose Gamma Knife treatment; gamma knife treatment should be cautiously chosen.