脑多发海绵状血管畸形的手术治疗

Surgical treatment of multiple cerebral cavernous malformations

摘要:

目的 脑多发海绵状血管畸形手术治疗报道少见，探讨脑多发海绵状血管畸形患者的临床特征及手术治疗效果。方法 回顾分析39例手术治疗脑多发海绵状血管畸形病例，采用改良MRS评分对患者神经功能状态进行评估。配对T检验对术前与随访时MRS评分进行比较，用Pearson相关分析对年龄、病变数量、术前MRS评分等对预后的影响因素进行相关性分析。结果 1例小脑脚海绵状血管畸形患者术后出现不全性面瘫，1例桥脑病变患者术后出现肢体偏瘫，经治疗后均逐渐好转。平均随访29.5月，无再次出血患者。随访时16例（41%）患者神经功能状态较术前明显改善，23例（59%）较前无变化，无病情加重患者。经统计学分析，术前与随访时MRS评分比较P=0.01，有统计学意义。性别、年龄、首发症状距手术时间、病变数量、出血次数、随访时间与预后不相关。手术病变部位（P=0.02）及术前MRS（P=0.01）与预后相关。结论 脑多发海绵状血管畸形患者行致病病变切除多数患者效果良好，手术病变部位及术前MRS是影响预后的相关因素。

Abstract:

Objective Reports of surgical treatment of cerebral cavernous malformations are rare. Therefore, we will discuss the clinical features and surgical outcomes of patients with multiple cerebral cavernous malformations.Methods Thirty-nine multiple cerebral cavernous malformation patients treated with surgical operation were analyzed retrospectively. The modified Rankin Scale (mRS) was used to assess the nerve functions of those patients. We used paired t-test to compare preoperative and follow-up mRS scores. Pearson's correlation analysis was applied to determine the association of age, number of lesions, and preoperative mRS scores with the patient's prognosis.Results One patient experienced partial facial paralysis following the resection of cavernous malformation in the cerebellar peduncle, while another patient experienced hemiplegia after the resection of cavernous malformation in the pontine area. After treatment, these two patients' conditions improved. During the follow-up period of 29.5 months on average, no patients bled again. Sixteen patients (41%) had significant improvement in nerve functions, 23 patients (59%) showed no change in nerve functions, and no patient became worse during the follow-up. Statistical analysis indicated a significant difference between the preoperative and follow-up mRS scores (P=0.01). Sex, age, the time from initial symptoms to operation, the number of lesions, the number of times of bleeding, and the time of follow-up are not associated with the prognosis. The lesion location during surgery (P=0.02) and preoperative mRS score (P=0.01) were associated with the patient's prognosis.Conclusions Surgical resection of the lesions can achieve good results in most patients with multiple cerebral cavernous malformations. The lesion location during surgery and the preoperative mRS score are relevant factors that will affect the prognosis of patients.