经侧裂入路切除岛叶海绵状血管畸形
Surgical resection of insular cavernomas with a transsylvian approach
目的 探讨岛叶海绵状血管畸形(CMs)手术治疗方法与效果.方法 回顾性分析2007年12月至2013年8月手术治疗的4例岛叶CMs患者,采用术中B超(2例联合神经导航)辅助下经侧裂入路切除岛叶CMs,分析手术策略及术后神经功能状态.结果 4例岛叶CMs患者,均以癫痫发作为首发症状,经侧裂-经岛叶入路完整切除CMs.术后随访3~ 72个月(平均36.75个月),1例患者术后神经学恶化,永久神经学缺陷;1例出现语言缺陷,1周后逐渐恢复.Engel疗效分级,4例患者癫痫预后均为Ⅰ级.结论 经侧裂入路可安全可靠的暴露并切除岛叶CMs;神经导航、术中B超可为成功切除岛叶CMs提供指导.
更多Objective To explore the surgical strategy for insular cavernous malformations (CMs).Methods Between Dec.2007 and Aug.2013,4 patients with insular CMs were treated surgically through transsylvian approach by using image guidance system (neuronavigation in two cases,ultrasound in four cases).Results The seizure was the initial symptom in 4 patients with insular CMs.The image guidance system provided high-quality intraoperative imaging and guided the perfect operative approach of insular cortex dissection.All CMs were completely removed via transsylvian-transinsular approach.The mean follow-up period was 36.75 months (ranged from 3 to 72 months).Permanent neurologic morbidity after surgery was observed in 1 patient.One patient with dominant hemisphere lesion had temporary dysphonia,and the language function was recovered after 1 week.4 patients were Engel class Ⅰ.Conclusions Surgical resection of insular CMs through transsylvian approach was safe.Neuronavigation and intraoperative ultrasound were recommended,especially for patients whose lesion was located in the dominant hemisphere.
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