海绵窦海绵状血管瘤的磁共振成像诊断及显微外科手术治疗  

Magnetic Resonance Imaging Diagnosis and Microsurgical Treatment of Cavernous Sinus Hemangiomas

作　　者：周玮[1] 祝跃明[1] 苏忠周[2] 潘锋[1] 

机构地区：[1]浙江省湖州市中心医院放射科,浙江湖州313000 [2]浙江省湖州市中心医院神经外科,浙江湖州313000

出　　处：《中国医学科学院学报》2013年第6期677-682,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的总结海绵窦海绵状血管瘤(CSH)的磁共振成像(MRI)特征及显微外科手术方法。方法回顾性分析经手术及病理证实的23例CSH患者的临床资料,所有患者均行MR平扫及增强扫描,其中,19例行MR扩散加权成像(DWI),7例行单体素氢质子磁共振波谱(1HMRS)检查。所有患者均采用显微外科手术治疗,其中,改良翼点入路11例,额颞联合耳前颞下入路12例。19例病灶体积较大的患者术前采用γ刀治疗。结果 CSH均为单发病灶,体积较大,呈球状或卧葫芦状跨蝶鞍生长。MRI扫描后T1WI呈等或稍低信号,T2WI及FLAIR呈明显高信号,增强扫描呈均匀或不均匀显著强化;19例DWI呈等或稍低信号;7例1HMRS均表现为NAA峰、Cr峰和Cho峰消失,其中6例出现Lip峰。23例肿块中全切除18例,次全切除3例,部分切除2例,无死亡病例。术后患者症状改善17例,症状无明显改善4例,术后出现新神经症状2例,经3周治疗后症状有所改善或恢复。针对5例次全切或部分切除的患者术后进行γ刀治疗后,4例残余肿块缩小,1例肿块无明显变化。结论 CSH具有一定MRI特征,MRI检查有助于提高术前定位及定性诊断的准确率。采用改良翼点入路和额颞联合耳前颞下入路的显微外科手术治疗是目前治疗该病的有效方法之一。Objective To summarize the magnetic resonance imaging （MRI） features and microsurgi- cal treatment of cavernous sinus hemangiomas （CSH） . Methods Twenty-three patients with surgically and pathologically verified CSH were reviewed. All patients underwent computed tomography （CT） and MR scan, 19 cases underwent MR dlffusion-weighted imaging （DWI） and 7 underwent single voxel 1H magnetic resonance spectroscopy （1HMRS） before operation. The microsurgery through modified pterional approach was performed in 11 cases and 12 cases removal was achieved in combined fronto-temporal preauricular subtemporal approach. Nin- teen cases with large tumors were treated by Leksell Gamma knife （LGK） before operation. Results CSHs were single, large, and spherical/lie gourd-shaped tumors across the inside and outside the sella. CSH showed equal or slightly low signal on T1WI, high signal on T2WI and FLAIR, homogeneous or heterogeneous great enhancement on MR enhancement scan; 19 cases showed equal or slightly low signal on DWI, 7 cases showed no NAA, Cr, and Cho peak, and 6 cases showed Lip peak on ~HMRS. In 23 cases, the tumors were totally removed in 18, subtotally removed in 3, and partially removed in 2. No perioperative death was reported. The postoperative symptoms were improved in 17 cases but remained unchanged in 4 cases ; two patients suffered from new nervous symptoms after the surgery, which were improved or cured after three weeks of treatment. In 5 patients who had received subtotal or partial removal of the lesions, LGK was peformed postoperatively, which resulted in smaller residual tumors in 4 cases and unchanged tumor in one patient. Conclusions CSH has some unique MRI fea- tures, and therefore MRI is helpful to improve the preoperative localization and qualitative diagnosis. The micro- surgery through modified pterional approach combined with fronto-temporal preauricular subtemporal approach is an effective procedure for CSH.

关 键 词：海绵窦 海绵状血管瘤 磁共振成像 显微手术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.9[医药卫生—诊断学]