颅内海绵状血管瘤的外科治疗  

Clinical features and treatment of intracranial cavernous malformations

作　　者：张剑宁[1] 程岗[1] 王亚明[1] 刘锐[1] 王洪伟[1] 李志超[1] 于新[1] 赵全军[1] 赵虎林[1] 章翔[2] 

机构地区：[1]海军总医院神经外科,北京 100048 [2]第四军医大学西京医院神经外科

出　　处：《中华神经外科杂志》2012年第10期1034-1039,共6页Chinese Journal of Neurosurgery

摘　　要：目的总结颅内海绵状血管瘤（CMs）的临床特点、影像学特征和治疗原则，为颅内CMs的临床诊治提供依据。方法对2005年9月至2011年9月西京医院、海军总医院显微手术切除的127例颅内CMs的临床资料进行回顾性分析。结果本组127例，男63例、女64例，年龄5～68岁。颅内病灶共139个，其中脑内病灶133个（幕上103个，幕下30个），脑外病灶6个，均位于左侧海绵窦。癫痫是最常见临床症状（58／127），其他症状包括头痛、脑神经功能障碍等。脑内CMs的典型MRI特征为“桑葚”样团块影，而脑外CMs的MRI特征与脑内CMs不同。所有病例均手术治疗，5例巨大病变有少部分残留，其余病灶均全切；1例遗留有轻偏瘫，生活可自理；有癫痫症状的58例患者中，4例术后仍需口服抗癫痫药物治疗，偶有癫痫发作，其余患者症状消失。结论脑内CMs是最常见的颅内CMs类型，主要位于幕上，手术治疗能取得良好疗效，是首选治疗方法。脑外CMs少见，主要位于海绵窦区，手术和放疗均有良好的效果。Objective To summarize the clinical features, imaging features and treatment principles of intracranial cavernous malformations （ CMs）, and provide evidence for effective treatment of intracranial CMs. Methods Clinical data of 127 patients with intracranial CMs treated by microsurgical resection from September 2005 to September 2011 were retrospectively analyzed. Results There were 63 males and 64 females included in 127 patients aged 8 to 62 years. A total of 139 lesions were found with 133 intra - axial （ 103 supratentorial lesions and 30 infratentorial lesions） and 6 extra - axial lesions （ all located in left cavernous sinus）. Epilepsy was the most common clinical symptom; other symptoms included headache and impairment of cranial nerves. ＂mulberry - like＂ appearance was the typical features of intra - axial lesions in MRI, while extra - axial lesions had different features. All patients received microsurgical treatment. All but five giant lesions were totally removed. One patient suffered post- operative mild hemiparesis. Four patients with pre - operative epilepsy still need anti - epileptic treatment, but no post - operative seizures were found. Conclusions Intra - axial CMs, mainly supratentorial, are the most common type of intracranial CM. Surgical treatment, the first treatment choice, can get good results. Extra - axial CMs are a rare type of intracranial CM that mainly locates in cavernous sinus. Both surgical resection and radiosurgery can get satisfactory results.

关 键 词：海绵状血管瘤 海绵窦 外科手术 

分 类 号：R651.1[医药卫生—外科学]