脑膜瘤自发性出血的临床特点及机制探讨  

Acute spontaneous hemorrhagic presentation of intracranial meningiomas

作　　者：王洪财[1] 孙成丰[1] 陈海[1] 陈茂送[1] 沈罡[1] 王波定[1] 

机构地区：[1]宁波市医疗中心李惠利医院神经外科,浙江315040

出　　处：《中华神经外科杂志》2015年第4期337-340,共4页Chinese Journal of Neurosurgery

摘　　要：目的 总结脑膜瘤自发性出血的主要临床特点,分析其可能的出血机制.方法 2010年7月至2013年6月宁波市医疗中心李惠利医院神经外科连续收治109例脑膜瘤患者,回顾性分析其中7例（6.4％）经影像学和病理学证实的Ⅰ、Ⅱ级脑膜瘤自发性出血患者的临床特征、病理学类型,肿瘤内血管成熟度及肿瘤细胞增殖情况.结果 7例中,肿瘤位于大脑镰旁2例,矢状窦旁1例,左蝶骨嵴内侧1例,左额顶叶、左颞叶及右顶叶凸面各1例.手术Simpson切除分级Ⅰ级4例,Ⅱ级2例,Ⅳ级1例.病理学分型,血管瘤型、非典型性各2例,纤维型、脑膜上皮型及过渡型各1例;肿瘤内血管成熟度和细胞增殖活跃程度不一：CD34（-）、CD31（＋）、Ki-67表达Ⅰ级1例,CD34（-）、CD31（＋）、Ki-67表达Ⅱ级1例,CD34（＋）、CD31（＋）、Ki-67表达Ⅰ级4例,CD34（＋）、CD31（＋）、Ki-67表达Ⅱ级1例.术后随访13～48个月,1例遗留轻度肢体偏瘫,2例肿瘤复发.结论 各种病理学类型脑膜瘤均可发生出血,相关出血机制可能不同,与肿瘤细胞增殖速度及肿瘤内新生不成熟血管亦无明确关系。Objective To explore the clinical features and possible mechanisms of intracranial meningiomas with acute hemorrhage.Method Retrospectively studied 7 patients with meningiomas whose acute onset were due to haemorrhage,the clinical data were evaluated and the associated literatures were reviewed.Results （1） In this study,4 patients were male and 3 were female.The age ranged from 32 to 68 years.The haemorrhagic meningiomas were located on the cerebral falx in 2 cases,parasagital areas in 1,skull base in 1,and convexity in 3.All patients experienced a stroke-like onset characterized by the sudden onset of headache,vomiting,hemiparalysis,or disturbance of consciousness;（2） On CT and MRI,the imaging showed extracerebral lesion and associated acute hemorrhage.All lesions were given operations：4 lesions were totally removed,2 lesions was subtotally resected,and 1 lesion was grossly removed.Histologically,there were 5 subtypes,angiomatous （n =2）,atypical （n =2）,fibroblastic （n =1）,meningothelial （n =1）,and transitional （n =1）.The cell proliferation activities and the type of vessels were various in different patients：Ⅰ patient was CD34（-） 、CD31 （＋） 、Ki-67 （grade Ⅰ）,1 patient was CD34（-） 、CD31 （＋） 、Ki-67 （grade Ⅱ）,4 patients were CD34（＋） 、CD31 （＋） 、Ki-67 （grade Ⅰ）,and 1 patient was CD34 （＋）、C D31 （＋）、Ki-67 （grade Ⅱ）;（3） One patient lived with mild paralysis,one with recurrent tumors received the second operation,and one with recurrent tumors was given radiotherapy.Conclusion Hemorrhage due to meningiomas is a rare initial presentation and patients would experience a stroke-like onset.The haemorrhagic mechanism is not clear and many factors played roles in the occurrence of haemorrhage in meningiomas.

关 键 词：脑膜瘤 颅内出血 疾病特征 预后 病理学 

分 类 号：R739.45[医药卫生—肿瘤]