中枢神经系统血管母细胞瘤的显微外科治疗  

The microsurgical treatment of central nervous system hemangioblastoma

作　　者：尚寒冰[1] 赵卫国[1] 沈建康[1] 濮春华[1] 蔡瑜[1] 林东[1] 成侃[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,200025

出　　处：《中国现代神经疾病杂志》2008年第1期52-55,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨中枢神经系统血管母细胞瘤的临床特征、诊断和鉴别诊断,以及外科手术治疗特点。方法对1999年2月-2006年5月施行手术治疗的21例中枢神经系统血管母细胞瘤患者(肿瘤位于小脑半球者14例,第四脑室内延髓背侧2例,延髓下部1例和脊髓内4例)的临床资料进行回顾性总结与分析。结果手术全切除肿瘤患者14例,次全切除7例,其中2例于手术前施行微导管超选择性肿瘤供血动脉栓塞术。手术后神经系统症状明显改善18例,2例因脑积水症状未改善行侧脑室-腹腔分流术,1例手术后并发出血,再次手术。12例患者平均随访25个月,9例恢复正常工作和生活,1例遗留小脑性共济失调,2例肿瘤复发(1例再次手术全切除肿瘤;1例多部位复发而行γ-刀治疗,随访7个月肿瘤无增大)。本组无死亡病例。结论中枢神经系统血管母细胞瘤为良性肿瘤,肿瘤全切除可获得根治。应用显微外科技术、手术前供血动脉栓塞以及立体定向放射外科等综合措施可提高疗效。Objective Tostudy the clinical features, diagnosis and differential diagnosis, and operation of central nervous system hemangioblastoma. Methods The clinical data of 21 patients （February, 1999-May, 2006） with central nervous system hemangioblastoma （14 cases at cerebellar hemisphere, 2 at dorsal bulb in the fourth ventricular of cerebrum, one at the lower part of bulb and 4 at spinal cord） were retrospectively analyzed. All patients underwent microsurgical resection. Results The tumors of 14 patients were totally removed, subtotal removal in 7 and 2 of them who received hyper-selective pre-operative embolization with microcatheter at the blood-supplying artery of the tumor. Neural function improved significantly in 18 cases after operation. Due to hydrocephalus post-operative ventriculoperitoneal shunt was performed in 2 cases. Post-operative hemorrhage occurred in one case and operation was performed again. In 12 follow-up （mean 25 months） patients, 9 patients can work as normal, one patient remained cerebellar ataxia. Two cases with recurrence were found during the follow-up period. One of them was given total resection and another one with multiple recurrence was treated by γ-knife therapy; no tumor enlargement occurred during the 7 month-follow-up. No dead case was seen. Conclusion Hemangioblastomas are histologically benign lesions of the central nervous system. Total resection can achieve radical cure. A combined strategy with microsurgical technique, pre-operative embolization of blood-supplying arteries and stereotaxic radiosurgery can enhance curative effect.

关 键 词：成血管细胞瘤 中枢神经系统肿瘤 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]