CAJ | 학술논문

目的探讨脑干海绵状血管瘤的手术适应证和手术入路选择. 方法回顾性分析51例显微手术治疗脑干海绵状血管瘤的临床资料.中脑海绵状血管瘤9例,间脑-中脑交界处1例,中脑-桥脑交界处2例,桥脑海绵状血管瘤33例,延髓海绵状血管瘤4例,桥脑-延髓交界处2例.49例亚急性手术,2例慢性期手术. 结果术中均采用神经电生理监测引导手术,11例采用神经导航定位.根据肿瘤的部位选择手术入路.肿瘤全切49例,2例次全切,肿瘤全切除率为96.1％.术中19例伴有明显的静脉畸形,予以保护.神经功能障碍改善23例,无明显变化25例,术后症状改善和稳定率为94.1％(48/51).无手术死亡. 结论正确选择手术适应证和个体化选择手术入路,术中神经电生理监测和神经导航辅助手术,有助于提高肿瘤全切除率.
목적 탐토뇌간해면상혈관류적수술괄응증화수술입로선택. 방법 회고성분석51례현미수술치료뇌간해면상혈관류적림상자료.중뇌해면상혈관류9례,간뇌-중뇌교계처1례,중뇌-교뇌교계처2례,교뇌해면상혈관류33례,연수해면상혈관류4례,교뇌-연수교계처2례.49례아급성수술,2례만성기수술. 결과 술중균채용신경전생리감측인도수술,11례채용신경도항정위.근거종류적부위선택수술입로.종류전절49례,2례차전절,종류전절제솔위96.1％.술중19례반유명현적정맥기형,여이보호.신경공능장애개선23례,무명현변화25례,술후증상개선화은정솔위94.1％(48/51).무수술사망. 결론 정학선택수술괄응증화개체화선택수술입로,술중신경전생리감측화신경도항보조수술,유조우제고종류전절제솔.
Objective To explore the microsurgical indication and surgical approaches of brain stem cavernous malformations (BCMs).Methods A retrospective review of 51 patients diagnosed as having BCM,admitted to and underwent microsurgical resection in our hospital from June 2004 to May 2013,was performed; their clinical manifestations,surgical indications,and surgical methods and approaches were analyzed.Among them,9 lesions were situated in the mesencephalon,1 in diencephalon-mesencephalic junction,2 in pontomesencephalic junction,33 in pons,4 in medulla oblongata and 2 in pontomedullary junction.The surgical approaches were selected according to tumor location for all cases; 49 were operated at the subacute stage and 2 at the chronic stage.Results The lesions were removed by the guide of monitoring of neuroelectrophysiology and neuro-navigation in 11 cases.Of the 51 BCMs,total resection and subtotal resection were achieved in 49 and 2,respectively,with a total resection rate reaching 96.1％.Nineteen patients were associated with venous anomaly.At the discharge,neurological deficits were improved in 23 patients and kept the same level in 25 cases.A total of 94.1％ (48/51) patients achieved stable outcomes.No operative mortality was noted.Conclusion The correct candidates and individual microsurgical approaches,intraoperative neuroelectrophysiological monitoring and neuronavigation are the important prerequisite for BCMs,and benefit to improve total resetion rate.