脑室内海绵状血管畸形的临床特点及手术疗效  

Clinical features and surgical outcomes of intraventricular cavernous malformations

作　　者：程立冬 朱洪涛 陈志业 赵恺[1] 王俊文[1] 舒凯[1] 雷霆[1] Cheng Lidong;Zhu Hongtao;Chen Zhiye;Zhao Kai;Wang Junwen;Shu Kai;Lei Ting(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2022年第8期784-788,共5页Chinese Journal of Neurosurgery

摘　　要：目的:探讨脑室内海绵状血管畸形(IVC)的临床和影像学特点及手术疗效。方法:2012年10月至2020年10月华中科技大学附属同济医院神经外科收治482例颅内海绵状血管畸形患者,纳入其中15例(3.1%)IVC患者进行回顾性研究。分析患者的临床和影像学特点、手术情况及疗效。结果:术前影像学显示病变位于侧脑室体部5例、额角4例、三角区4例、枕角1例,病变累及鞍上、第三脑室、侧脑室1例。7例患者伴急性脑室内出血,2例合并急性梗阻性脑积水。病变最大直径为(2.6±0.8)cm(1.5~4.9 cm)。增强MRI显示均匀强化2例,无强化13例;2例患者有中心混杂信号而外周低信号环的"铁环征"表现;5例行磁敏感加权成像(SWI)检查者,病变均呈典型的"爆米花"征。术前2例误诊为脉络丛乳头状瘤,2例误诊为脑膜瘤,1例误诊为颅咽管瘤。15例均采用手术治疗,其中采用经额皮质造瘘入路4例、经纵裂-胼胝体入路5例,经颞皮质造瘘入路6例。术中显示病变起源于脑室壁10例,起源于脉络丛5例。15例患者的病变均为全切除。术后1例患者合并手术通道脑内血肿,1例合并硬膜外血肿,均经保守治疗治愈。15例患者术后中位随访时间为48.6个月(6个月至9年),改良Rankin量表评分(mRS)均较术前降低,术后mRS 0分10例,1分4例,3分1例。结论:IVC发病率低,急性出血症状多见;具有一定的影像学特征,但部分患者表现不典型,较易误诊;手术疗效良好。Objective To investigate the clinical and imaging features and surgical outcomes of intraventricular cavernous malformations(IVC).Methods From October 2012 to October 2020,482 patients with IVC were admitted to the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,and 15(3.1%)patients with IVC were included for a retrospective study.We analyzed the clinical and imaging features,surgical data and efficacy of the patients.Results Preoperative imaging showed that the lesions were located in the body of the lateral ventricle in 5 cases,in the frontal horn of the lateral ventricle in 4 cases,in the triangular region in 4 cases,and in the occipital horn of the lateral ventricle in 1 case.Seven patients had acute intraventricular hemorrhage,and two had acute obstructive hydrocephalus.The maximum diameter of the lesions was 2.6±0.8 cm(1.5-4.9 cm).Enhanced MRI showed homogeneous enhancement in 2 cases and no enhancement in 13 cases;5 cases of susceptibility-weighted imaging(SWI)showed typical"popcorn"sign.Before surgery,2 cases were misdiagnosed as choroid plexus papilloma,2 cases were misdiagnosed as meningiomas,and 1 case was misdiagnosed as craniopharyngioma.All 15 cases were treated by surgery,including 4 cases of transfrontal approach,5 cases of interhemispheric-transcallosal approach,and 6 cases of transtemporal approach.During the operation,it was shown that the lesions originated from the ventricle wall in 10 cases and the choroid plexus in 5 cases.All 15 patients underwent total resection.Postoperatively,1 patient had intracerebral hematoma in the surgical pathway,and 1 patient had epidural hematoma,both of which were cured by conservative treatment.The median follow-up time of the 15 patients after operation was 48.6 months(6 months to 9 years).The modified Rankin scale score(mRS)was lower than that before operation,and the postoperative mRS scores were 0 points in 10 cases,1 point in 4 cases,and 3 points in 1 case.Conclusions The incidence of IVC is

关 键 词：脑室 血管瘤 海绵状 疾病特征 显微外科手术 

分 类 号：R651.12[医药卫生—外科学]