Microsurgery For 51 Cases Of Brain Stem Lesion And Retrospective Analysis

Objective To explore the clinical manifestation, neuroimaging, approach, microsurgical operation and intraoperative neuromonitoring (IOM) on brain stem lesion.Methods 51 patients with brainstem lesion were analyzed respectively from January 2005 to April 2010. All of them underwent surgical treatment and confirm by pathological examination after operation. IOM including EMG, BAEP and SEP were used in 30 of them. The average of lesion was 2.4cm and the maximum diameter was 4cm. Among these patients,8 of them were suboccipito-retromastoid approach; 31 were posteromedian-suboccipital approach; 8 were retrosigmoid approach; 5 were Poppen approach,3 were far, lateral approach,2 were pterional approach and 2 were subtemporal approach.Results In the series of the patients,35 of them were totally excised in 35 cases,11 were subtotally excised, ablation in 5cases. There is no mortality. All patients were followed up from 5 months to 4 years, during the follow-up, we evaluate the surgery effect by Karnofsky point table. We make sure the last follow-up as the final evaluating time. We select the 50% as the dividing line between excellent and terrible. We regard the score beyond 50% as excellent. The surgery result is 92.1%(47/51) is excellent. Conclusions MRI is the first choice examination to brainstem lesion and DSA is useful as the accessory examination. Fine therapeutic efficacy and low disability rate could be obtained while applying microsurgical techniques to resect brain stem lesions under appropriate intraoperative neurophysiologic monitoring with correct indication,appropriate approach and elaborate.