颅内动脉瘤样骨囊肿一例并文献复习  

One case of intracranial aneurysmal bone cyst and a review of literature

作　　者：张元隆[1] 郑师兴[2] 梅文忠[1] 吴喜跃[1] 林元相[1] 康德智[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005 [2]福建医科大学附属第三医院神经外科,福州350108

出　　处：《中华小儿外科杂志》2018年第1期23-26,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨颅内动脉瘤样骨囊肿的临床特点、影像学特征及手术方法，提高对颅内动脉瘤样骨囊肿的认识。方法收集本院1例经手术病理证实的左侧后颅窝动脉瘤样骨囊肿患儿的临床资料，结合复习文献进行讨论和分析。男，5岁，临床主要表现为颅高压及小脑性共济失调，术前CT平扫显示左枕骨内板膨胀性溶骨破坏区，左侧小脑半球密度不均的多囊腔占位性病变，囊内可见液平面；MRI平扫＋增强示左小脑半球类圆形肿块，伴多囊变及液－液平面，囊腔之间的间隔与囊壁厚薄不等，强化明显。结果患儿行显微镜下手术全切除病变，大小约5.5 cm ×5.0 cm ×4.5 cm。术中见左枕骨因膨胀性病变仅残存部分骨皮质包壳，病变呈漏斗样向内突破硬脑膜突入硬膜下，左侧小脑半球受压；术后临床症状消失，随访2年未见复发。结论颅内动脉瘤样骨囊肿少见，术前诊断可根据特征性的影像学表现如CT扫描显示病变局部骨皮质膨胀形成骨包壳，MRI扫描示病灶内多囊腔及液-液平面和明显强化的囊壁及囊间隔等，显微手术全切除为首选治疗原则。ObjectiveTo explore the clinical characteristics, imaging features and surgical approaches of intracranial aneurysmal bone cyst and to improve its recognition.MethodsThe clinical data were collected from a 5-year-old boy with pathologically confirmed aneurysmal bone cyst of left posterior cranial fossa. His clinical profiles were analyzed with a literature review. The major clinical manifestations included high intracranial pressure and cerebellar ataxia. Preoperative scan of computed tomography（CT） indicated expansive osteolytic destruction of left occipital plate, uneven density of left cerebellar hemisphere, polycystic space-occupying lesions, fluid level visible in cysts; plain and enhanced scans of magnetic resonance imaging（MRI） revealed round mass in left cerebellar hemisphere, polycystic changes, liquid-liquid plane and capsule wall thickening.ResultsTumors were resected totally microscopically. Intraoperative findings showed that left occipital remnants of cortical bone cladding due to expansive lesions, tumor infiltrating through dura into subdural like a funnel and a compression of left cerebellar hemisphere. Clinical symptoms disappeared after operation. There was no recurrence during a follow-up period of 2 years.ConclusionsIntracranial aneurysmal bone cyst is rare. Preoperative diagnosis may be made according to the characteristic CT imaging findings of swelling bone cortex of lesions forming bone shell. Magnetic resonance scan demonstrated polycystic cavity, liquid-liquid plane, obvious enhancement of cyst wall and capsule interval in lesions. Surgical excision is still the first choice of treatment for intracranial aneurysmal bone cyst.

关 键 词：骨囊肿 动脉瘤样 脑肿瘤 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤]