切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2016, Vol. 02 ›› Issue (05) : 296 -301. doi: 10.3877/cma.j.issn.2095-9141.2016.05.009

所属专题: 文献

专题笔谈

脑干海绵状血管瘤的治疗策略与技巧
陈立华1,(), 徐如祥1   
  1. 1. 100700 北京,陆军总医院附属八一脑科医院
  • 收稿日期:2016-04-28 出版日期:2016-10-15
  • 通信作者: 陈立华

Treatment strategies and techniques of brainstem cavernous malformations

Lihua Chen1,(), Ruxiang Xu1   

  1. 1. Affiliated Bayi Brain Hospital, The Military General Hospital, Beijing 100700, China
  • Received:2016-04-28 Published:2016-10-15
  • Corresponding author: Lihua Chen
  • About author:
    Corresponding author: Chen Lihua, Email:
引用本文:

陈立华, 徐如祥. 脑干海绵状血管瘤的治疗策略与技巧[J/OL]. 中华神经创伤外科电子杂志, 2016, 02(05): 296-301.

Lihua Chen, Ruxiang Xu. Treatment strategies and techniques of brainstem cavernous malformations[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(05): 296-301.

脑干海绵状血管瘤(BSCM)的特性是易反复出血,从而导致病变周围含铁血黄素及胶质样变范围扩大,肿瘤像"滚雪球"样逐渐增大。完整、安全地切除病灶可获得治愈,避免肿瘤增大或瘤内反复出血。然而,在脑干这一狭小区域内布满了神经核团和上下行神经纤维束,手术存在很大的风险和挑战性。本文重点介绍BSCM的手术目的和原则、手术技巧和最新进展,治疗的效果,以便于指导临床手术治疗,对于安全切除病灶、降低再出血风险至关重要。

Repeated hemorrhage is one of the characteristics of brainstem cavernous hemangioma, resulting in containing hemosiderin and glial like variable scope around the lesion expanded, tumor increased gradually like snowball. Remove the lesion completely and safely can cure the disease and avoid tumor enlargement or recurrent hemorrhage in the tumor. However, brainstem is full of small nuclei and up and down nerve fiber bundle, and the operation is very risky and challenging. This article focuses on purpose and principles, surgical techniques and recent advances, therapeutic effect of BSCM, in order to guide the clinical operation, which is essential for the safety of resection of lesions and decrease of bleeding risk.

表1 文献报道BSCM手术治疗的疗效对比表
[14]
Li D, Yang Y, Hao SY, et al. Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations[J]. J Neurosurg, 2013, 119(4): 996-1008.
[15]
Cenzato M, Stefini R, Ambrosi C, et al. Post-operative remnants of brainstem cavernomas: incidence, risk factors and management[J]. Acta Neurochir (Wien), 2008, 150(9): 879-886.
[16]
Kyoshima K, Kobayashi S, Gibo H, et al. A study of safe entry zones via the floor of the fourth ventricle for brainstem lesions. Report of three cases[J]. J Neurosurg, 1993, 78(6): 987-993.
[17]
Sindou M, Yada J, Salord F. Functional results after microsurgical resection of brain stem cavernous malformations (retrospective study of a 12 patient series and review of the recent literature)[J]. Acta Neurochir (Wien), 2000, 142(8): 843-852.
[18]
Steinberg GK, Chang SD, Gewirtz RJ, et al. Microsurgical resection of brainstem, thalamic, and basal ganglia angiographically occult vascular malformations[J]. Neurosurgery, 2000, 46(2): 260-270.
[19]
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.
[20]
Garcia RM, Ivan ME, Lawton MT. Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes[J]. Neurosurgery, 2015, 76(3): 265-278.
[21]
Mathiesen T, Edner G, KihlstrÊm L. Deep and brainstem cavernomas: a consecutive 8-year series[J]. J Neurosurg, 2003, 99(1): 31-37.
[22]
Ohue S, Fukushima T, Kumon Y, et al. Surgical management of brainstem cavernomas: selection of approaches and microsurgical techniques[J]. Neurosurg Rev, 2010, 33(3): 315-322.
[23]
Cauley KA, Andrews T, Gonyea JV, et al. Magnetic resonance diffusion tensor imaging and tractography of intracranial cavernous malformations: preliminary observations and characterization of the hemosiderin rim[J]. J Neurosurg, 2010, 112(4): 814-823.
[24]
Ulrich NH, Kockro RA, Bellut D, et al. Brainstem cavernoma surgery with the support of pre - and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients[J]. Neurosurg Rev, 2014, 37(3): 481-491.
[25]
McLaughlin N, Kelly DF. Corticospinal tractography as a prognosticator for motor improvement after brainstem cavernoma resection[J]. Br J Neurosurg, 2013, 27(1): 108-110.
[26]
Flores BC, Whittemore AR, Samson DS, et al. The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernousmalformations[J]. J Neurosurg, 2015, 122(3): 653-662.
[27]
Abla AA, Lekovic GP, Turner JD, et al. Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients[J]. Neurosurgery, 2011, 68(2): 403-414.
[28]
Faraji AH, Abhinav K, Jarbo K, et al. Longitudinal evaluation of corticospinal tract in patients with resected brainstem cavernous malformations using high-definition fiber tractography and diffusion connectometry analysis: preliminary experience[J]. J Neurosurg, 2015, 123(5): 1133-1144.
[29]
Kashimura H, Inoue T, Ogasawara K, et al. Pontine cavernous angioma resected using the subtemporal, anterior transpetrosal approach determined using three-dimensional anisotropy contrast iimaging: technical case report[J]. Neurosurgery, 2006, 58(1 Suppl): ONS-E175.
[30]
Sandalcioglu IE, Wiedemayer H, Secer S, et al. Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results[J]. J Neurol Neurosurg Psychiatry, 2002, 72(3): 351-355.
[31]
Ishihara H, Bjeljac M, Straumann D, et al. The role of intraoperative monitoring of oculomotor and trochlear nuclei-safe entry zone to tegmental lesions[J]. Minim Invasive Neurosurg, 2006, 49(3): 168-172.
[32]
Sarnthein J, Bozinov O, Melone AG, et al. Motor-evoked potentials(MEP) during brainstem surgery to preserve corticospinalfunction[J]. Acta Neurochir (Wien), 2011, 153(9): 1753-1759.
[33]
Bertalanffy H, Tissira N, Krayenbuhl N, et al. Inter-and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle[J]. Neurosurgery, 2011, 68(1 Suppl Operative): 23-31.
[34]
Nayak NR, Thawani JP, Sanborn MR, et al. Endoscopic approaches to brainstem cavernous malformations: Case series and review of the literature[J]. Surg Neurol Int, 2015, 6: 68.
[35]
Ramina R, Mattei TA, de Aguiar PH, et al. Surgical management of brainstem cavernous malformations[J]. Neurol Sci, 2011, 32(6): 1013-1028.
[36]
Samii M, Eghbal R, Carvalho GA, et al. Surgical management of brainstem cavernomas[J]. J Neurosurg, 2001, 95(5): 825-832.
[37]
Dukatz T, Sarnthein J, Sitter H, et al. Quality of life after brainstem cavernoma surgery in 71 patients[J]. Neurosurgery, 2011, 69(3): 689-695.
[38]
Tarnaris A, Fernandes RP, Kitchen ND. Does conservative management for brain stem cavernomas have better long-term outcome[J]? Br J Neurosurg, 2008, 22(6): 748-57.
[39]
Li D, Yang Y, Hao SY, et al. Hemorrhage risk, surgical management, and functional outcome of brainstemv cavernous malformations[J]. J Neurosurg, 2013, 119(4): 996-1008.
[40]
Pandey P, Westbroek EM, Gooderham PA, et al. Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients[J]. Neurosurgery, 2013, 72(4): 573-589.
[41]
Chotai S, Qi S, Xu S. Prediction of outcomes for brainstem cavernous malformation[J]. Clin Neurol Neurosurg, 2013, 115(10): 2117-2123.
[42]
Li D, Hao SY, Tang J, et al. Surgical management of pediatric brainstem cavernous malformations[J]. J Neurosurg Pediatr, 2014, 13(5): 484-502.
[43]
Amin-Hanjani S, Ogilvy CS, Ojemann RG, et al. Risks of surgical management for cavernous malformations of the nervous system[J]. Neurosurgery, 1998, 42(6): 1220-1228.
[1]
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.
[2]
Menon G, Gopalakrishnan CV, Rao BR, et al. A single institution series of cavernomas of the brainstem[J]. J Clin Neurosci, 2011, 18(9): 1210-1214.
[3]
Bertalanffy H, Benes L, Miyazawa T, et al. Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients[J]. Neurosurg Rev, 2002, 25(1-2): 54-55.
[4]
Conway JE, Rigamonti D. Cavernous malformations: a review and current controversies[J]. Neurosurg Quart, 2006, 16(1): 15-23.
[5]
Brown AP, Thompson BG, Spetzler RF. The two-point method evaluating brainstem lesions[J]. BNI Quarterly, 1996, 12(1): 20-24.
[6]
Zimmerman RS, Spetzler RF, Lee KS, et al. Cavernous malformations of the brain stem[J]. J Neurosurg, 1991, 75(1): 32-39.
[44]
Sola RG, Pulido P, Pastor J, et al. Surgical treatment of symptomatic cavernous malformations of the brainstem[J]. Acta Neurochir (Wien), 2007, 149(5): 463-470.
[7]
Mai JC, Ramanathan D, Kim LJ, et al. Surgical resection of cavernous malformations of the brainstem: evolution of a minimally invasive technique[J]. World Neurosurg, 2013, 79(5-6): 691-703.
[8]
Chen LH, Zhang HT, Chen L, et al. Minimally invasive resection of brainstem cavernous malformations: surgical approaches and clinical experiences with 38 patients[J]. Clin Neurol Neurosurg, 2014, 116: 72-79.
[9]
Maurer AJ, Bonney PA, Strickland AE, et al. Brainstem cavernous malformations resected via miniature craniotomies: technique and approach selection[J]. J Clin Neurosci, 2015, 22(5): 865-871.
[10]
Chen X, Weigel D, Ganslandt O, et al. Diffusion tensor-based fiber tracking and intraoperative neuronavigation for the resection of a brainstem cavernous angioma[J]. Surg Neurol, 2007, 68(3): 285-291.
[11]
Ferroli P, Sinisi M, Franzini A, et al. Brainstem cavernomas: long-term results of microsurgical resection in 52 patients[J]. Neurosurgery, 2005, 56(6): 1203-1212.
[12]
Gross BA, Batjer HH, Awad IA, et al. Brainstem cavernous malformations: 1390 surgical cases from the literature[J]. World Neurosurg, 2013, 80(1-2): 89-93.
[13]
Gross BA, Batjer HH, Awad IA, et al. Brainstem cavernous malformations[J]. Neurosurgery, 2009, 64(5): E805-818.
[1] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[2] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[3] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[4] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[5] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[6] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[10] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[11] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[12] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[13] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[14] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[15] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
阅读次数
全文


摘要