史堡匡堂盘查2111生!旦!!旦筮!!鲞筮箜翅堕型丛鲤』￡bi塑：!!P!!坐!望!!：垫!!：!!!：塑：盟!：箜延髓血管母细胞瘤的手术治疗严勇陈菊祥卢亦成胡国汉孙克华丁学华骆纯吴小军张磊徐涛林靖【摘要】目的探讨延髓血管母细胞瘤(HB)临床特点和诊治策略，提高手术治愈率，减少并发症和死亡率。方法回顾性分析2002至2012年上海长征医院神经外科手术治疗的12例延髓血管母细胞瘤的I艋床表现、影像学特征、诊治经过和手术效果。结果主要症状为头痛、躯体麻木和肢体肌力下降。磁共振发现病变均为单发。位于延髓近脑桥1例，延髓中部7例，延颈交界4例；位于软膜下9例，髓内3例；3例有囊性变。5例行数字剪影血管造影(DSA)，供血动脉主要为小脑后下动脉和小脑前下动脉分支，1例行术前栓塞。完整切除11例，1例仅行电灼。术后症状改善8例，加重2例，死亡2例。随访3个月～10年，McCormick神经功能I一Ⅱ级，1例术后7年复发。结论位于延髓中下段髓内、囊性HB和中小型延髓背侧HB手术安全性较高，术后神经功能可获改善，手术应作为一线治疗选择。延桥交界和位于延髓背侧的大型HB(I>3am)手术风险大，术后可能出现呼吸衰竭、神经源性肺水肿和脑积水等，手术须慎重。【关键词】血管母细胞瘤；脑干肿瘤；显微外科手术；栓塞Surgicaltreatmentofhemangioblastomainmedullaoblongata：areportof12casesYANyo昭，CHENJu-xiang，LUYi—cheng，HUGuo—han，SUNICe—hua，DINGXue-hua，LUOChun，彤UXiao-jun，ZHANGLei，XUTao，LIN如强ShanghaiNeurosurgicalInstitute；DepartmentofNeurosurgery，ChangzhengHospital，SecondMilitaryMedicalUnivenity，Shanghai200003，ChinaCorrespondingauthor：LUK—cheng。Email：lyc305@126．con【Abstract】ObjectiveToexploretheclinicalcharacteristics，diagnosticstrategiesandsurgicaltechniquesofhemangioblastoma(HB)inmedullaoblongata．MethodsTheclinicalandradiologicalcharacteristics，therapeuticprocessesandoutcomesof12HBcasestreatedatourdepartmentfrom2002to2012werestudiedbyretrospectiveanalysis．ResultsHeadache，somaticnumbnessandlimbmuscleweaknesswerethemajorsymptomsofoblongataHB．Magneticresonanceimagingbeforesurgeryrevealedatotalof12singletumors．Amongthesetumors，upper(n=1)，middle(拜=7)andlower(玮=4)partsofmedullaoblongatawereinvolved．Thelocationsweresurface(n=9)andintramedullary(n=3)．Thinettunorshadcyst．Digitalsubtractionangiography(DSA)Wasperformedon5casesanditrevealedthatthemainbloodsupplyarteriesoftumorswerebranchesofposteriorinferiorcerebellarartery(PICA)andanteriorinferiorcerebellarartery(AICA)．Onecaseunderwentpre—surgicalembolismduringangiography．Eleventumorsweretotallyresectedand1wasfulgurized．Symptomsimproved(n=8)andworsened(rt=2)．Andtwopatientsdied．Allsurvivorswerefollowedupfor3monthsto10yearsandhadaMcCormickfunctionalgradingofI．II．Onecaserelapsed7yearlater．ConclusionForCysticHB．smallormediumsizedsubstantialHBinmiddleandlowerpartofoblongata，surgicalremovalisoftensafeandsymptomsmaybelessened。Itcallbeusedasafirst-linetreatment．Forlarge(I>3am)substantialHBorHBinupperpartofoblongata，seriouspostoperativecomplicationssuchasrespiratoryfailure，neurogenicpulmonaryedemaoracuteobstructivehydrocephalusmayoccur,Thussurgicalresectionshouldbeprudentlyconsideredandpossibleconsequencesthoroughlydiscussedwiththepatients．【Keywords】Hemangioblastoma；Brainstemneoplasms；Microsurgery；Embolism血管母细胞瘤(HB)是一种血运丰富、全切除可以治愈的良性血管瘤。脑干HB由于临近重要的神DOI：10．3760／cma．j．issn．0376-2491．2013．35．009作者单位：200003上海，第二军医大学附属长征医院神经外科上海市神经外科研究所通信作者：卢亦成，Email：1yc305@126．COIll·2799·．临床研究．经结构，且病变极易出血...
