脳幹部海綿状血管腫の５直達手術の経験

Abstract

Based on the results of 11 cases of symptomatic brainstem cavernous angiomas (CA), we studied treatment strategy, surgical indication, selection of surgical approaches and other clinical problems. CAs were the pons in 8, the midbrain in 2 and the medulla in 1 patient. Five of the 11 cases were treated by direct surgery and the others had conservative treatment. Surgical cases commonly had progressive or persistent neurological deficits caused by repeated episodes of hemorrhage. The selected surgical approaches were trans 4th ventricular in 3 (via suprafacial triangle in 2, infrafacial triangle in 1), occipital transtentorial in 1 and retrosigmoid in 1 patient. Two recent patients had brainstem mapping or monitoring during operation. Total removal was done in 3, and partial removal with coagulation of CA was done in 2 cases. Transient PPRF and facial dysfunctions developed in all cases with the trans 4th ventricular approach. But permanent facial paralysis remained in 1 patient without intraoperative monitoring. Long-term follow-up (mean of 54.6 months) showed no recurrent hemorrhage and mean KPS score was 84. These results indicate that direct surgery to brainstem CA is safely and successfully performed by appropriate selection of patients and surgical approaches under careful monitoring.