腦干海綿狀血管瘤的臨床表現及預后分析_《華西醫學》

作者：

孫季冬 , 劉翼 , 賀民 , 孫鴻 ,  游潮

四川大學華西醫院神經外科（成都，610041）;

關鍵詞：

腦干海綿狀血管瘤海綿狀血管畸形預后

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【摘要】　目的　探討腦干海綿狀血管瘤患者臨床表現及影響預后的相關因素。　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。　結果　 20例（74.1%）患者CT顯示出血及血腫。急性或突然神經功能廢損22例，漸進性功能障礙15例，病情平穩4例。顯微手術12例，放射治療6例，保守觀察9例。長期隨訪25例，2例再次出血，無新發病灶，無患者死亡。手術組患者年齡（P lt;0.05）、術前病情嚴重程度（P lt;0.05）與術后KPS評分相關。非手術組不良預后評分與患者高齡及再出血有關。　結論　展神經麻痹和面癱患者功能恢復較差。年齡、術前病情嚴重程度及手術時機影響患者預后，術中全切病灶對復發和并發癥發生起主要作用，如何處理合并發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險，但其適應證尚有爭議。
【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及預后分析. 華西醫學, 2011, 26(3): 355-358. doi: 復制

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. 顯微手術切除腦干海綿狀血管瘤的臨床分析[J]. 中國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. 　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. 顯微手術切除腦干海綿狀血管瘤的臨床分析[J]. 中國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.

《華西醫學》

腦干海綿狀血管瘤的臨床表現及預后分析

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《華西醫學》

腦干海綿狀血管瘤的臨床表現及預后分析

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