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目的探讨皮质运动区海绵状血管瘤的显微外科操作技巧。方法回顾性分析25例海绵状血管瘤主体部分位于皮质运动区患者的术前主要临床资料,包括肢体肌力、癫痫发作、影像学检查结果、术中操作要点、术后肢体瘫痪及癫痫发作情况等。结果全切除23例(92.0%),次全切除2例(8.0%)。无手术死亡病例。与术前相比术后出现肢体瘫痪或瘫痪加重11例(44.0%),肢体肌力减退无变化4例(16.0%),肌力正常10例(40.0%)。经保守治疗并随访5月~4年,其中肢体肌力减退得到随访者14例,恢复正常12例,轻瘫2例;术前癫痫发作者得到随访18例,完全消失16例,发作明显减少2例。其它临床症状均基本恢复正常。结论在神经电生理监测下采取合理的脑沟入路、精细的显微外科操作技巧及皮层低功率电凝热灼术可获得满意疗效。
Objective To investigate the microsurgical technique of cavernous hemangioma in cortical area. Methods The main clinical data of 25 patients with cavernous hemangiomas in the cortical motor area were retrospectively analyzed. The results included limb muscle strength, seizures, imaging findings, operative points, postoperative paralysis and seizures Wait. Results Total resection in 23 cases (92.0%), subtotal resection in 2 cases (8.0%). No surgical deaths. There were 11 cases (44.0%) with limb paralysis or paralysis aggravated after surgery, 4 cases (16.0%) had no change of limb muscle weakness, and 10 cases (40.0%) had normal muscle strength. After conservative treatment and follow-up for 5 months to 4 years, 14 cases were followed up, 12 cases returned to normal, and 2 cases were paralyzed. The preoperative seizures were followed up in 18 cases, completely disappeared in 16 cases and the seizure was significantly reduced 2 cases. Other clinical symptoms were returned to normal. CONCLUSIONS: Appropriate curative effect can be obtained by taking reasonable sulcus approach, fine microsurgical operation technique and cortical low-power electrocautery cauterization under neuroelectrophysiological monitoring.