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脑干海绵状血管瘤的诊治体会
脑干海绵状血管瘤(brain stem cavernous malformation, BCM)位置深在,邻近重要的神经传导束及神经核团,目前其治疗方法主要有保守治疗、放射治疗及显微外科治疗,但在治疗方法的选择方面尚有分歧.
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家族性脑海绵状血管畸形同一家族五例并文献复习
脑海绵状血管畸形(cerebral cavernous malformation,CCM)曾被认为是少见疾病,目前国内少有报道.作者自1995年9月至2000年6月,发现姐妹二人子女11人中陆续有5人被诊为CCM,报告如下.
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Objective To evaluate the efficacy of electrocorticographic (ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy.
Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years (mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated.
Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I (75.00%), 5 were class II (13.89%), 2 were class III (5.56%), and 2 were class IV (5.56%), thus the total effective rate (class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes (P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes (P=0.041).
Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes. -
多次脑干出血的海绵状血管瘤1例报道
颅内海绵状血管瘤(cerebral cavernous malformation,CCM) 是中枢神经系统血管畸形的一种,可见于任何年龄,以20岁~50岁多见,男女发病率基本相同,临床表现有癫痫、局灶性神经功能缺损、颅内出血和头痛等,也可表现为无症状.CCM多位于幕上,且以颞叶皮质下的白质中或脑室周围多见;幕下少见,多数位于小脑内.我院收治1例以脑桥左侧反复出血为表现的CCM患者,文献少见报道,现总结如下.
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中脑海绵状血管瘤合并出血1例报告
脑干海绵状血管畸形(brainstem cavernous malformation,BCM)属于海绵状血管瘤(cavernous malformation,CM)的一种.现报道1例位于大脑脚间的海绵状血管瘤,包括其临床表现及头部影像学表现.1 病例资料男性,19岁.主因视物模糊伴双眼睑下垂半月余入院.半月前剧烈运动后出现视物模糊,症状时轻时重,晨起稍好,并伴双眼睑下垂.后症状逐渐加重,无恶心、呕吐、头晕、头痛症状,无肢体活动障碍等症状.
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脑干海绵状血管瘤:如何选择手术时机和适应证
脑干海绵状血管瘤( Brainstem cavernous malformation, BSCM)因瘤内反复出血或缓慢渗血,导致肿瘤体积急性或缓慢增大,压迫脑干内重要神经核团及上、下行传导束,引起颅神经功能障碍,以及运动和感觉等神经功能缺失,若不及时采取显微手术切除病灶,可因肿瘤再次出血或多次出血,诱发神经功能障碍进行性加重。早期报道BSCM保守治疗死亡率可高达20%[1];目前,BSCM手术治疗的肿瘤全切除率可达95%以上[2-4],其死亡率降至0~1.9%[3,5-6]。手术治疗的效果明显优于保守治疗,这已成为共识,而如何选择手术适应证和佳的手术时机是决定手术疗效的关键。