脑海绵状血管瘤选择性治疗  

The alternative treatment for cerebral cavernous angioma

作　　者：李明洙[1] 王宏伟[2] 张国荣[2] 高乃康[1] 富春雨[1] 刘沙[2] 朱利峯[2] 

机构地区：[1]内蒙古医学院附属医院神经外科,010050 [2]内蒙古医学院附属医院伽玛刀治疗中心

出　　处：《立体定向和功能性神经外科杂志》2006年第4期201-205,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的 观察选择手术切除及伽玛刀治疗脑海绵状血管瘤效果。探讨伽玛刀治疗的适应证。方法 回顾1996～2005年手术10例，伽玛刀治疗26例，随访4个月～9年。对癫痫、出血、病灶及局部神经功能障碍控制、变化、改善观察和评估。结果 手术10例，8例恢复正常，2例遗留轻度限局神经功能障碍，可做轻工作。CT、MRI复查：9例病灶消失，1例疑有病灶部分残留行伽玛刀治疗，无再出血及癫痫发作病例。伽玛刀治疗26例，随访21例。随访时间4个月～28个月。局部神经功能障碍观察：治疗前4例有锥体束征，治疗后3例恢复，1例无变化。癫痫发作观察：治疗前发作者19例，16例治疗后半年无发作而停药始无发作。3例治疗后偶有发作，服药半年停药，再未发作。CT及MRI复查：治疗后2～28个月，复查1～3次。病灶消失1例，4例无变化，缩小16例，其中2例灶周水肿、1例水肿伴灶内出血症状加重，经治疗逐好转。结论 神经外科显微手术切除是首选根治方法。对病灶位于难以手术部位，多发灶难以一次切除，病人难以承受手术或不接受手术症状显著者，伽玛刀是一种安全可选择的治疗方法。对降低出血率、癫痫及病灶控制、改善症状是有效的。对病灶缩小或消失、降低出血率的机制等问题，尚需进一步研究。Objective To analysis the outcome of alternative operation and gamma knife treatment in cerebral cavernous angioma （CCA） and to evaluate the indication of gamma knife treatment. Methods From 1996 to 2005,10 CCA patients were treated by operation and 26 cases by gamma knife, after 4 months to 9 years followed-up duration to observe the therapeutic effect in epilepsy,hemorrhage and neurological deficits. Results 8 of 10 CCA patients who underwent operation recovered but 2 cases remain slightly neuro-disfunction, 9 cases CCA lesions disappear in CT and MRI image and 1 case with residual lesion was treated by gamma knife. Without rebleeding and epilepsy attack cases. 21 cases of 26 （CCA） patients were followed after gamma knife treatment,3 of 4 patients with pyramid sign disappeared after therapy, 16 of 19 patients with epilepsy showed no attacks yet 3 cases showed attacks by chance via 6 months pharmacotherapy symptom vanished and drug withdrawal. Rechecked CT or MRI image from 2 months to 28 months after gamma knife treatment at 1 to 3 times observed focus of lesions disappeared in 1 case and shrinkaged in 16 cases,2 cases showed edema around lesions and 1 case intralesional hemorrhage meanwhile symptom increased and symptom improved after suffering pharmacotherapy. Conclusion Microsurgery is a chief treatment method in CCA patients meanwhile gamma knife treatment is also a safe device in which lesions located hard to operating or multiple focus or patient could not suffer operation. Gamma knife treatment is effective in controlling hemorrhage and epilepsy attack however it need further study in medical mechanism.

关 键 词：海绵状血管瘤 伽玛刀治疗 

分 类 号：R743.4[医药卫生—神经病学与精神病学]