CAJ | 학술논문

目的：通过回顾性分析脑干海绵状血管瘤（ BSCM）患者的临床资料，旨在探讨BSCM患者手术入路的选择与患者疗效的关系。方法：选择2003年7月至2014年6月在浙江大学医学院附属第二医院神经外科住院接受手术治疗的23例BSCM患者，其中男性13例，女性10例，平均年龄（41±18）岁，收集并分析患者的临床资料，包括病史、影像学检查、手术记录、术后恢复情况和随访情况等。结果：23例患者中病变位于中脑5例，位于脑桥16例，位于延髓2例。这些患者手术方式共采用了枕下后正中入路、乙状窦后入路、幕下小脑上入路、Poppen入路、翼点入路、Kawase入路、经纵裂胼胝体三脑室入路这7种不同的手术入路，其中最后两种手术入路均首次应用于BSCM手术。病灶全切22例，次全切1例；结果神经功能障碍改善15例，无明显变化7例，加重1例，无手术中死亡病例。15例患者平均随访了3、5年，均恢复良好，未见血管瘤复发。结论：根据BSCM患者具体情况个体化选择最佳的手术入路，精确定位病灶，可减少对周围正常神经组织的损伤，完整切除病灶，避免术后复发。
목적：통과회고성분석뇌간해면상혈관류（ BSCM）환자적림상자료，지재탐토BSCM환자수술입로적선택여환자료효적관계。방법：선택2003년7월지2014년6월재절강대학의학원부속제이의원신경외과주원접수수술치료적23례BSCM환자，기중남성13례，녀성10례，평균년령（41±18）세，수집병분석환자적림상자료，포괄병사、영상학검사、수술기록、술후회복정황화수방정황등。결과：23례환자중병변위우중뇌5례，위우뇌교16례，위우연수2례。저사환자수술방식공채용료침하후정중입로、을상두후입로、막하소뇌상입로、Poppen입로、익점입로、Kawase입로、경종렬변지체삼뇌실입로저7충불동적수술입로，기중최후량충수술입로균수차응용우BSCM수술。병조전절22례，차전절1례；결과신경공능장애개선15례，무명현변화7례，가중1례，무수술중사망병례。15례환자평균수방료3、5년，균회복량호，미견혈관류복발。결론：근거BSCM환자구체정황개체화선택최가적수술입로，정학정위병조，가감소대주위정상신경조직적손상，완정절제병조，피면술후복발。
Objective: To analyze the clinical characteristics and surgery approach for patients with brainstem cavernous malformation (BSCM).Methods: The clinical data of 23 BSCM patients ( 5 cases at midbrain, 16 cases at pons, and 2 cases at medulla ) treated in the Second Affiliated Hospital Zhejiang University School of Medicine from July 2003 to June 2014 were retrospectively reviewed.The medical history, radiological findings, operation records, postoperative course and follow-up results were analyzed. Results: Suboccipital approach, retrosigmoid approach, subtentorial supracerebella approach, Poppen approach, pterional approach, Kawase approach, interhemispheric transcallosal third ventrical approach were applied for the surgery of BSCM patients. Among them, Kawase approach and interhemispheric transcallosal third ventrical approach were firstly reported in treatment of BSCM.Total resection was achieved in 22 cases.Neurological function was improved in 15 cases, unchanged in 7 cases and deteriorated in 1 case.Fifteen cases were followed up for a mean period of 3.5 years and signs of recurrence was found.Conclusion: Proper selection of surgical approach is important to assure total resection of the lesions, to protect surrounding normal vital structures and to avoid post-surgical complications.