海绵窦海绵状血管瘤的临床诊断及显微外科治疗  

Clinical Diagnosis and Microsurgical Treatment of Cavernous Hemangioma in the Cavernous Sinus

作　　者：余信远[1] 易伟[1] 刘仁忠[1] 简志宏[1] 冯艳萍[2] 

机构地区：[1]武汉大学人民医院神经外科,武汉430060 [2]武汉大学人民医院麻醉科,武汉430060

出　　处：《华中科技大学学报（医学版）》2015年第2期226-228,234,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨海绵窦海绵状血管瘤的临床特点,并分析其显微外科治疗方法及效果,为海绵窦海绵状血管瘤的治疗提供临床经验。方法回顾性分析2001年1月至2011年12月武汉大学人民医院收治的海绵窦海绵状血管瘤患者的临床及随访资料,并复习相关文献。结果 15例中男3例,女12例;年龄34-69岁,平均47.8岁;MRI扫描T2WI明显高信号和显著均质强化是海绵窦海绵状血管瘤的特征性表现;该组患者均经改良翼点或眶颧翼点开颅,其中9例经中颅窝底硬膜外入路,6例经额颞硬膜下入路切除肿瘤,结果9例完全切除,6例次全切除。术后11例出现同侧第Ⅲ、Ⅳ、Ⅴ或Ⅵ颅神经麻痹,1例出现对侧偏瘫,无死亡病例。结论显微手术切除是海绵窦海绵状血管瘤的有效治疗方法,经中颅窝底硬脑膜外入路是手术切除海绵窦海绵状血管瘤较优的手术方式。放射治疗可使部分肿瘤缩小,缓解临床症状,是一种安全有效的治疗方法,亦可作为手术的辅助治疗,但其远期效果尚需进一步临床验证。Objective To investigate the clinical characteristics of cavernous hemangioma in the cavernous sinus and its micro-neurosurgical treatment in order to provide clinical experience.Methods Clinical data of 15 patients with cavernous hemangioma in the cavernous sinus who underwent surgical treatments in Renmin Hospital of Wuhan University,China,between Jan.2001 and Dec.2011 were retrospectively analyzed.The related literatures were reviewed.Results There were 3males and12females（age：34-69years）with an average age of 47.8years in the cohort.Hyperintensity on T2-weighted images and marked homogeneous enhancement were the characteristics of cavernous hemangiomas.The craniotomy through modified pterional approach or orbitozygomatic pterional approach was performed in all 15 patients.In 9cases the lesions were taken via the extradural middle fossa approach,and in the other 6cases the tumors were removed via the expanding pterional intradural approach.The cavernous hemangiomas were totally removed in 9patients and sub-totally in 6patients.The main postoperative complications included ipsilateral palsy ofⅢ,Ⅳ,Ⅴ,orⅥ cranial nerves in 11 patients and contralateral hemiparalysis in one patient.No death occurred in the cohort.Conclusion Total resection of tumors by microneurosurgery is effective in the treatment for cavernous hemangioma in the cavernous sinus.The extradural middle fossa approach is an optimal procedure.Radiation therapy can shrink the tumors,and thereby relieve the clinical symptoms.It is safe and effective and can serve as an adjuvant therapeutic strategy for cavernous hemangioma in the cavernous sinus.However,longer-term efficacy of radiation therapy warrants further clinical verification.

关 键 词：海绵窦 海绵状血管瘤 临床诊断 显微手术 

分 类 号：R651.12[医药卫生—外科学]