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华西医学  2011 

脑干海绵状血管瘤的临床表现及预后分析

, PP. 355-358

Keywords: 脑干,海绵状血管瘤,海绵状血管畸形,预后

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Abstract:

【】 目的 探讨脑干海绵状血管瘤患者临床表现及影响预后的相关因素。 方法 回顾分析2008年9月-2010年9月27例脑干海绵状血管瘤患者临床资料。 结果 20例(74.1%)患者CT显示出血及血肿。急性或突然神经功能废损22例,渐进性功能障碍15例,病情平稳4例。显微手术12例,放射治疗6例,保守观察9例。长期随访25例,2例再次出血,无新发病灶,无患者死亡。手术组患者年龄(P<0.05)、术前病情严重程度(P<0.05)与术后KPS评分相关。非手术组不良预后评分与患者高龄及再出血有关。 结论 展神经麻痹和面瘫患者功能恢复较差。年龄、术前病情严重程度及手术时机影响患者预后,术中全切病灶对复发和并发症发生起主要作用,如何处理合并发生的静脉畸形有待讨论。立体定向放射治疗明显降低再出血风险,但其适应证尚有争议。【Abstract】 Objective Todiscusstheclinicalmanifestationsandprognosticfactorsofbrainstemcavernoushemangioma. Methods Basedontheliterature,theclinicaldataof27patientshavingbrainstemcavernoushemangiomafromSeptember2008toSeptember2010werereviewedandanalyzed. Results Twentypatients(74.1%)presentedwithhemorrhageandhematomainCTscan.Acuteorsuddenneurologicaldeteriorationoccurredto22patients,progressivein15andstablein4.Twelvepatientsunderwentsurgicalremovalofthelesion;6underwentradiosurgery;and9continuedwithconservativemanagement.Twenty-fivepatientswerefollowedup.Twopatientshadrehaemorrhagia.Therewerenodenovolesionsordeath.TheriskfactorsindicativeofapossiblepoorpostoperativeKPSscoreintheoperativegroupincludedage(P<0.05)andtheinitialclinicalcondition(P<0.05).Inthenon-operativegroup,oldageandrehaemorrhagiawereobviouslyrelatedtothepooroutcome. Conclusions Patientswithabducensandfacialpalsyhavepoorfunctionalrecovery.Age,theinitialclinicalconditionandtimingofoperationarethemajorfactorscorrelatedtosurgicaloutcome.Thefactorthataffectsrecurrenceandtheoccurrenceofcomplicationsiscompleteresectionduringtheoperation.Howtodealwiththeconcomitantvenousmalformationshouldbefurtherstudied.Theindicationsforstereotacticradiosurgeryarestillcontroversial,althoughithasconferedareductionintheriskofrehaemorrhagia.

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