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目的探讨脑干海绵状血管瘤手术适应证和手术入路的选择。方法回顾分析70例手术治疗的脑干海绵状血管瘤,其中位于:中脑15例、中脑-桥脑交界8例、桥脑34例、桥脑-延髓交界5例、延髓8例。我们共采用8种手术入路:经菱形窝27例、颞下或颞-枕入路14例、远外侧经髁7例、外侧小脑上幕下7例、中线小脑上幕下8例、枕经天幕4例、乳突后2例,以及眶颧1例。结果本组病例的年出血率为2.9%(77/2364),占同期颅内海绵状血管瘤的44%(70/159);97%的病例手术选择在亚急性或慢性期、且所有患者均有颅神经症状和(或)运动功能障碍、感觉障碍、共济失调(包括失平衡)。中脑病变手术入路选择以中线小脑上(46.7%,7/15)、颞下或颞-枕(26.7%,4/15)为主;桥脑病变多选择菱形窝(58.8%,20/34)、颞下或颞-枕(23.5%,8/34);而病变位于延髓者以远外侧经髁(62.5%,5/8)和菱形窝入路(37.5%,3/8)为主。结论脑干海绵状血管瘤表现为进行性神经功能缺失、具有占位效应、接近脑干表面者可考虑手术治疗;个体化地选择手术入路、术中神经电生理监测以及直接的电刺激是手术成功的关键。
Objective To explore the surgical indications and surgical approach of cavernous hemangiomas in the brain stem. Methods Retrospective analysis of 70 cases of surgical treatment of cavernous hemangiomas of the brain stem, which located: 15 cases of midbrain, midbrain - bridge junction in 8 cases, pontine in 34 cases, pontine - medulla oblongata junction in 5 cases, medulla oblongata in 8 cases. We used a total of 8 kinds of surgical approaches: 27 cases of rhombic fossa, 14 cases of infratemporal or temporal-occipital approach, 7 cases of distal lateral meridian, 7 cases of lateral cerebellum, 8 cases of midline cerebellum, 4 cases, 2 cases after mastoid, and 1 case of orbital zygoma. Results The annual bleeding rate was 2.9% (77/2364) in this group of patients, accounting for 44% (70/159) of the intracranial cavernous hemangiomas in the same period. In 97% of cases, the surgical options were subacute or chronic and all the patients Have cranial nerve symptoms and / or motor dysfunction, sensory disturbances, ataxia (including imbalance). Midline cerebral infarction (46.7%, 7/15), infratemporal or temporal-occipitocele (26.7%, 4/15) (62.5%, 5/8) and rhombus fossa approach (37.5%, 3/8) in the distal medulla oblongata, respectively the Lord. Conclusions The cavernous hemangiomas of the brain stem manifest as progressive neurological deficits with mass-bearing effect. Surgical treatment of the cavernous surface may be considered. Surgical approach is required for the individual selection of neurosurgery and direct electrical stimulation The key to successful operation.