• 四川大學(xué)華西醫(yī)院神經(jīng)外科（成都，610041）;

【摘要】　目的　 探討腦干海綿狀血管瘤患者臨床表現(xiàn)及影響預(yù)后的相關(guān)因素。　方法　 回顧分析2008年9月-2010年9月27例腦干海綿狀血管瘤患者臨床資料。　結(jié)果　 20例（74.1%）患者CT顯示出血及血腫。急性或突然神經(jīng)功能廢損22例，漸進(jìn)性功能障礙15例，病情平穩(wěn)4例。顯微手術(shù)12例，放射治療6例，保守觀察9例。長(zhǎng)期隨訪25例，2例再次出血，無新發(fā)病灶，無患者死亡。手術(shù)組患者年齡（P lt;0.05）、術(shù)前病情嚴(yán)重程度（P lt;0.05）與術(shù)后KPS評(píng)分相關(guān)。非手術(shù)組不良預(yù)后評(píng)分與患者高齡及再出血有關(guān)。　結(jié)論　 展神經(jīng)麻痹和面癱患者功能恢復(fù)較差。年齡、術(shù)前病情嚴(yán)重程度及手術(shù)時(shí)機(jī)影響患者預(yù)后，術(shù)中全切病灶對(duì)復(fù)發(fā)和并發(fā)癥發(fā)生起主要作用，如何處理合并發(fā)生的靜脈畸形有待討論。立體定向放射治療明顯降低再出血風(fēng)險(xiǎn)，但其適應(yīng)證尚有爭(zhēng)議。
【Abstract】　Objective　 To discuss the clinical manifestations and prognostic factors of brain stem cavernous hemangioma.　Methods　 Based on the literature, the clinical data of 27 patients having brain stem cavernous hemangioma from September 2008 to September 2010 were reviewed and analyzed.　Results　 Twenty patients (74.1%) presented with hemorrhage and hematoma in CT scan. Acute or sudden neurological deterioration occurred to 22 patients, progressive in 15 and stable in 4. Twelve patients underwent surgical removal of the lesion; 6 underwent radiosurgery; and 9 continued with conservative management. Twenty-five patients were followed up. Two patients had rehaemorrhagia. There were no de novo lesions or death. The risk factors indicative of a possible poor postoperative KPS score in the operative group included age (P lt;0.05) and the initial clinical condition (P lt;0.05). In the non-operative group, old age and rehaemorrhagia were obviously related to the poor outcome.　Conclusions　 Patients with abducens and facial palsy have poor functional recovery. Age, the initial clinical condition and timing of operation are the major factors correlated to surgical outcome. The factor that affects recurrence and the occurrence of complications is complete resection during the operation. How to deal with the concomitant venous malformation should be further studied. The indications for stereotactic radiosurgery are still controversial, although it has confered a reduction in the risk of rehaemorrhagia.

引用本文： 孫季冬,劉翼,賀民,孫鴻,游潮. 腦干海綿狀血管瘤的臨床表現(xiàn)及預(yù)后分析. 華西醫(yī)學(xué), 2011, 26(3): 355-358. doi: 復(fù)制

1. 　Di Rocco C, Iannelli A, Tamburrini G. Cavernous angiomas of the brain stem in Children[J]. Pediatr Neurosurg, 1997, 27(2): 92-99.
2. 　Vias FC, Gordon V, Cuthikonda M, et al. Surgical management of cavernous malformations of the brainstem[J]. Neurol Res, 2002, 24(1): 61-72.
3. 　Moriarity JL, Clatterbuck RE, Rigamonti D. The natural history of cavernous malformations[J]. Neurosurg Clin North Am, 1999, 10(3): 411-417.
4. 　Fritschi JA, Reulen HJ, Spetzler RF, et al. Cavernous malformations of the brain stem. A review of 139 cases[J]. Acta Neurochir (Wien), 1994, 130(1-4): 35-46.
5. 　Kondziolka D, Lunsford LD, Kestle JRW. The nature history of cerebral cavernous malformations[J]. J Neurosurg 1995, 83(5): 820-824.
6. 　Huang AP, Chen JS, Yang CC, et al. Brain stem cavernous malformations [J]. J Clin Neurosci, 2010, 17(1): 74-79.
7. 　Poter PJ, Willinsky PA, Harper W, et al. Cerebral cavernous malformations: nature history and prognosis after clinical deterioration with or without hemorrhage [J]. J Neurosurg, 1997, 87(2): 190-197.
8. 　李浩, 游潮, 賀民, 等. 腦干海綿狀血管瘤的顯微外科治療[J]. 中華外科雜志, 2006, 44(10): 692-693.
9. 　陳凌, 陳立華, 凌峰, 等. 顯微手術(shù)切除腦干海綿狀血管瘤的臨床分析[J]. 中國(guó)耳鼻喉顱底外科雜志, 2010, 16(2): 105-111.
10. 　Ferroli P, Sinisi M, Franzini A, et al. Brainstem cavernomas: long-term results of microsurgical resection in 52 patients[J]. Neurosurgery, 2005, 56(6): 1203-1214.
11. 　Hauck EF, Barnett SL, White JA, et al. Symptomatic brainstem cavernomas[J]. Neurosurgery, 2009, 64(1): 61-70.
12. 　Eugenio P, Nicola A, Francesco T, et al. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas[J]. Neurosurgy, 1996, 38(4): 662-670.
13. 　Abdulrauf SI, Kaynar MY, Awad IA. A comparison of the clinical profile of cavernous malformations with and without associated venous malformations[J]. Neurosurgery, 1999, 44(1): 41-46.
14. 　Porter RW, Detwiler PW, Spetzler RF, et al. Cavernous malformations of the brainstem: experience with 100 patients[J]. J Neurosurg, 1999, 90(1): 50-58.
15. 　Hasegawa T, Mclnerney J, Kondziolka D, et al. Long-term results after stereotactic radiosurgery for patients with cavernous malformations[J]. Neurosurgery, 2002, 50(6): 1190-1197.
16. 　Liscák R, Vladyka V, Simonová G, et al. Gamma knife surgery of brain cavernous hemangiomas[J]. J Neurosurg, 2005, 102 (Suppl): 207-213.
  1. 1. 　Di Rocco C, Iannelli A, Tamburrini G. Cavernous angiomas of the brain stem in Children[J]. Pediatr Neurosurg, 1997, 27(2): 92-99.
  2. 2. 　Vias FC, Gordon V, Cuthikonda M, et al. Surgical management of cavernous malformations of the brainstem[J]. Neurol Res, 2002, 24(1): 61-72.
  3. 3. 　Moriarity JL, Clatterbuck RE, Rigamonti D. The natural history of cavernous malformations[J]. Neurosurg Clin North Am, 1999, 10(3): 411-417.
  4. 4. 　Fritschi JA, Reulen HJ, Spetzler RF, et al. Cavernous malformations of the brain stem. A review of 139 cases[J]. Acta Neurochir (Wien), 1994, 130(1-4): 35-46.
  5. 5. 　Kondziolka D, Lunsford LD, Kestle JRW. The nature history of cerebral cavernous malformations[J]. J Neurosurg 1995, 83(5): 820-824.
  6. 6. 　Huang AP, Chen JS, Yang CC, et al. Brain stem cavernous malformations [J]. J Clin Neurosci, 2010, 17(1): 74-79.
  7. 7. 　Poter PJ, Willinsky PA, Harper W, et al. Cerebral cavernous malformations: nature history and prognosis after clinical deterioration with or without hemorrhage [J]. J Neurosurg, 1997, 87(2): 190-197.
  8. 8. 　李浩, 游潮, 賀民, 等. 腦干海綿狀血管瘤的顯微外科治療[J]. 中華外科雜志, 2006, 44(10): 692-693.
  9. 9. 　陳凌, 陳立華, 凌峰, 等. 顯微手術(shù)切除腦干海綿狀血管瘤的臨床分析[J]. 中國(guó)耳鼻喉顱底外科雜志, 2010, 16(2): 105-111.
  10. 10. 　Ferroli P, Sinisi M, Franzini A, et al. Brainstem cavernomas: long-term results of microsurgical resection in 52 patients[J]. Neurosurgery, 2005, 56(6): 1203-1214.
  11. 11. 　Hauck EF, Barnett SL, White JA, et al. Symptomatic brainstem cavernomas[J]. Neurosurgery, 2009, 64(1): 61-70.
  12. 12. 　Eugenio P, Nicola A, Francesco T, et al. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas[J]. Neurosurgy, 1996, 38(4): 662-670.
  13. 13. 　Abdulrauf SI, Kaynar MY, Awad IA. A comparison of the clinical profile of cavernous malformations with and without associated venous malformations[J]. Neurosurgery, 1999, 44(1): 41-46.
  14. 14. 　Porter RW, Detwiler PW, Spetzler RF, et al. Cavernous malformations of the brainstem: experience with 100 patients[J]. J Neurosurg, 1999, 90(1): 50-58.
  15. 15. 　Hasegawa T, Mclnerney J, Kondziolka D, et al. Long-term results after stereotactic radiosurgery for patients with cavernous malformations[J]. Neurosurgery, 2002, 50(6): 1190-1197.
  16. 16. 　Liscák R, Vladyka V, Simonová G, et al. Gamma knife surgery of brain cavernous hemangiomas[J]. J Neurosurg, 2005, 102 (Suppl): 207-213.