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目的探讨神经导航和脑皮质电图监测切除脑海绵状血管畸形(CM)的手术适应证、手术方法和效果。方法1997—2003年收治70例CM病人,男53例,女17例,年龄8~62岁(平均33岁)。首发症状脑出血31例(443%),癫痫29例(414%),头痛5例(71%),神经功能缺损4例(57%),体检发现1例(14%)。病灶直径5~50mm,平均21mm。病灶部位大脑半球深部39例,底节、丘脑11例,脑干9例,小脑半球5例,多发6例。手术前头皮贴5个标记物行MRI扫描,将资料输入导航工作站,画出肿瘤轮廓,并完成三维重建。幕上病灶经皮质的脑沟和脑裂入路,手术显微镜下分离切除病灶。对29例合并癫痫的病人,手术中予以脑皮质电图监测,病灶切除后,多处皮质热灼术,消除癫痫波。结果所有病例术后复查CT和/或MRI均未见残留。本组无手术死亡病例,手术后致残率86%。术后有4例病人出现一过性神经功能障碍。对术前有癫痫发作病例24例随访,时间6~24个月(平均194个月),其中19例(792%)无发作,5例(208%)癫痫症状改善。结论对于有过出血史及药物难以控制的癫痫或病人不愿意长期服用抗癫痫药物的脑CM应考虑手术切除病变。应用神经导航和脑皮质电图监测切除脑CM手术是安全的,可以减少手术后致残率,并有效地控制癫痫。
Objective To investigate the surgical indications, surgical methods and effects of neurological navigation and cortical electrofluorography in resection of cavernous vascular malformations (CM). Methods Between 1997 and 2003, 70 patients with CM were admitted, including 53 males and 17 females, aged from 8 to 62 years (average 33 years). The first symptom was intracerebral hemorrhage in 31 cases (443%), epilepsy in 29 cases (414%), headache in 5 cases (71%), neurological deficit in 4 cases (57%) and physical examination in 1 case (14%). Lesion diameter of 5 ~ 50mm, an average of 21mm. Lesions in the deep part of the cerebral hemisphere in 39 cases, the bottom of the thalamus in 11 cases, 9 cases of brainstem, cerebellar hemisphere in 5 cases, 6 cases. Before surgery scalp posted five markers MRI scan, the data input navigation workstation, draw the outline of the tumor, and complete the three-dimensional reconstruction. The supratentorial lesions through the cortical sulci and brain crack into the road, surgical resection of the lesion under the microscope. 29 cases of patients with epilepsy, intraoperative electrocorticogram monitoring, removal of the lesion, multiple cortical cautery to eliminate epileptic waves. Results All patients had no residual CT and / or MRI after the operation. No cases of surgical death in this group, postoperative disability rate of 86%. Postoperative 4 patients had transient neurological dysfunction. Twenty-four patients with seizure before surgery were followed up for 6-24 months (average 194 months), of which 19 (792%) had no seizures and 5 (208%) had seizures improved. Conclusions Surgical excision should be considered for patients with epilepsy who have had a history of bleeding and who are refractory to drugs or who are not willing to take antiepileptic drugs for long periods of time. The application of neuronavigation and cortical electrogrammetry for the surgical resection of brain CM is safe and can reduce postoperative morbidity and effectively control epilepsy.