海绵窦海绵状血管瘤的MRI表现及伽玛刀治疗(附14例报告)  

Characteristic MR imaging findings and Gamma knife treatment of cavernous hemangiomas of the cavernous sinus:14 cases report

作　　者：王恩敏[1] 潘力[1] 王滨江[1] 张南[1] 董亚非[1] 吴瀚峰[1] 

机构地区：[1]复旦大学华山医院神经外科伽玛刀中心,上海200040

出　　处：《中华神经外科杂志》2006年第5期267-270,共4页Chinese Journal of Neurosurgery

摘　　要：目的总结海绵窦海绵状血管瘤(CHCS)的MRI特点,分析伽玛刀(γ刀)治疗的初步结果。方法应用Leksell γ刀治疗CHCS 14例。肿瘤的MRI特点:T1W上呈低或略等信号,T2W上呈均匀的高信号,增强时肿瘤为均匀强化的高信号。14例肿瘤最大径为22．0-50．0mm。照射肿瘤中心的平均剂量为24．5Gy,周边平均剂量为12．3Gy。平均随访时间为42个月。结果γ刀治疗后, 所有患者均未出现新的颅神经受损症状,3例首选γ刀治疗和2例术中仅作活检的患者,γ刀术后 6-10个月症状改善或消失。γ刀术后3例肿瘤几乎消失,9例明显缩小,1例缩小不明显;1例γ刀术后5个月开颅手术,切除肿瘤时出血明显减少,病理学发现肿瘤内胶原组织增生,血窦内血栓形成。结论γ刀是治疗中小型和部分大型(<40mm)CHCS有效方法之一。Objective To summarize the characteristic MRI findings of cavernous hemangiomas of the cavernous sinus （CHCS） and evaluate the effects of Leksell Gamma knife （LGK） on these lesions. Methods From June 1999 to February 2005, 14 patients with CHCS were treated by LGK. Of the 14 patients, 11 had residual tumor after surgery, 3 were diagnosed by neuroradiology in recent two years. There were 5 male and 9 female patients with mean age of 48 years old. The MR images showed hypointensity on T1 - weighted images and well - defined, homogeneous hyperintensity on 1＂2 - weighted images. On contrast-enhanced T1-weighted images, all of these tumors were homogeneously and densely enhanced. The mean maximum diameter of these lesions was 36.0 mm （ range, 22.0 - 50. 0mm ）. The volume of the tumors ranged between 4.1 - 51. 0cm^3, with mean 16.7cm^3. The tumor margin dose ranged from 9 to 16Gy （ mean, 12.3Gy）. The mean follow-up period was 42 months （ ranged from 10 to 77 months）. Results Of the 14 tumors, 3 almost disappeared, 8 decreased markedly in size at 6 months or one year after LGK, although some tumors were large or giant. One tumor kept stable. One patient with large tumor was operated on by open surgery 5 months after LGK. No serious bleeding was found during operation in this reopened patient. Histopathology showed the vessel cavities were narrow and filled with thrombus, and proliferation of collagen inside the lesion. Neurologically, none of these patients showed any deterioration, and 5 patients demonstrated an obvious improvement in trigeminal function and ocular movement. At last follow-up, there were no complications related to radiosurgery and no tumor had progression. Conclusions LGK for CHCS is safe and effective with consistent tumor shrinkage and an excellent alternative treatment.

关 键 词：海绵窦 海绵状血管瘤 伽玛刀 MRI 诊断 

分 类 号：R739.4[医药卫生—肿瘤]