颅内海绵状血管瘤的临床特点与治疗  

The clinical features and treatment of intracranial cavernous angiomas

作　　者：何百祥[1] 徐高峰[1] 鲍刚[1] 谢昌厚[1] 郭世文[1] 张晓东[1] 李奇[1] 

机构地区：[1]西安交通大学医学院第一附属医院神经外科,陕西西安710061

出　　处：《现代肿瘤医学》2009年第9期1656-1659,共4页Journal of Modern Oncology

摘　　要：目的:探讨颅内海绵状血管瘤(CA)的临床特点与治疗策略。方法:回顾性分析1998年1月至2008年6月我院神经外科收治的46例颅内CA的临床资料,并复习相关文献。结果:脑内型CA40例。临床观察6例,4例随访1-6年无特殊不适,2例随访1年后症状加重;手术治疗9例,均采用神经导航辅助显微手术,随访0.5-3年均恢复良好;γ-刀治疗25例,7例0.5-1年再次出血,1年后仅6例病灶体积缩小。脑外型CA6例,均采用翼点或扩大翼点入路,其中病灶全切除3例,大部分切除2例,部分切除1例。全切除的3例病人随访3月-2年MRI复查未见血管瘤复发。不全切除的3例患者术后均行γ-刀治疗,1年后复查MRI见病灶体积不同程度缩小,临床症状改善。结论:脑外型CA应首选显微手术治疗,残留部分可行γ-刀治疗;脑内型CA,无症状者可临床观察。一旦出现临床症状则应积极手术治疗,合理采用微侵袭神经外科技术并遵循个体化原则有利于提高手术疗效。γ-刀治疗必须慎重。Objective：To discuss the clinical features and treatment of intracranial cavernous angiomas （CA）. Methods ： The clinical data of 46 cases with intracranial CA were analyzed retrospectively and a review of relevant literature was conducted. Results：There were 40 cases with intracerebral CA. Clinical observation in 6 cases,4 of them did not have special discomfort in the time of follow - up 1 - 6 years, symptoms became more serious after one year in 2 cases ;9 cases underwent neuronavigation -assisted microsurgery. The time of follow -up was 0.5 -3 years, all cases were well recovery or no change;Stereotactic radiosurgery in 25 cases ,7 of them bleeded again after 0.5 -1 year, only 6 of them received diminish of lesion. The 6 patients with extracerebral CA underwent pterional or expanded pterional approach. Total tumor removal was achieved in 3 cases, majority removel in 2 and partial removal in 1. Three patients achieved total tumor removal were followed - up without tumor recurrence during 3 months to 2 years. Three patients achieved incomplete tumor removal underwent postoperative stereotactic radiosurgery, all patients improved in clinical symptom and decreased with different degree in focus size after 1 year. Conclusion：Microsurgery is the first choice for the treatment of extracerebral CA, stereotactic radiosurgery can be used for treatment of remaining foeas; The cases with intracerebral CA may be clinically observed if they have no symptom, but surgery should be carried out actively once they have, reasonablely introduction of minimally invasive neurosurgical technique and following individualizied rule make for improving surgery effectiveness. The benefits and risks must be carefully balanced before the use of stereotactic radiosurgery for the intracerebral CA.

关 键 词：颅内海绵状血管瘤 显微手术 伽玛刀 

分 类 号：R739.41[医药卫生—肿瘤]