术前栓塞联合显微手术治疗后颅窝大型实性血管母细胞瘤的效果分析  

Outcome of preoperative embolization combined with microsurgery for the treatment of giant solid hemangioblastoma in the posterior fossa

作　　者：杨凤东[1] 毛文斌 翟一轩 杜伟[1] 魏新亭[1] 薛亚轲[1] Yang Fengdong;Mao Wenbin;Zhai Yixuan;Du Wei;Wei Xining;Xue Yake(Department of Neurosurgery,the First Afiliated Hopital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450000

出　　处：《中华神经外科杂志》2023年第6期561-566,共6页Chinese Journal of Neurosurgery

基　　金：河南省高等学校重点科研项目(19A320075)。

摘　　要：目的探讨术前栓塞联合显微手术切除治疗后颅窝大型实性血管母细胞瘤(HB)的可行性和效果,并分析可能影响患者术后并发症发生的因素.方法回顾性分析2012年6月至2022年1月郑州大学第一附属医院神经外科收治的21例大型HB(最大直径>30 mm)患者[占同期收治后颅窝HB患者的8.8%(21/238)]的临床资料.5例(23.8%)合并Von Hippel-Lindau(VHL)病.肿瘤位于小脑半球9例(42.9%);小脑脑桥角区4例(19.0%);第四脑室顶及小脑上、下蚓部,枕骨大孔区8例(38.1%).病灶累及脑干4例(19.0%),肿瘤多发2例(9.5%).所有患者均采用血管内栓塞供血动脉以及显微手术切除肿瘤治疗.评估术后并发症的发生率,入院及末次随访时的改良Rankin量表评分(mRS),并探讨可能影响HB患者术后并发症发生的因素.结果21例患者均完成术前肿瘤供血动脉栓塞,栓塞程度为60%~80%.所有患者的肿瘤均获全切除.共7例(33.3%)患者发生术后并发症,包括颅内出血1例,呼吸功能障碍2例,后组脑神经功能障碍2例,面瘫1例,偏侧肢体无力1例,脑积水1例,肺部感染3例,颅内感染1例,脑脊液漏1例,皮下积液1例,平衡障碍加重1例.单因素分析结果显示,仅肿瘤侵袭脑干为影响HB患者术后并发症发生的危险因素(P=0.006),而患者的性别、年龄、病程、病变大小或质地、术前有无脑积水、术前mRS与术后并发症的发生无明显相关(均P>0.05).术后2例患者死亡(1例术后因再出血死亡,1例死于呼吸系统并发症),其余19例获得随访,随访时间为6~114个月,中位时间为22个月.末次随访mRS:0分9例,1分5例,2分4例,3分1例.随访期间,肿瘤复发2例,均为合并VHL病的患者;新发额叶胶质瘤1例,脑积水2例.结论对于后颅窝大型实性HB,术前肿瘤供血动脉栓塞联合显微手术切除肿瘤多可获得良好的效果;肿瘤累及脑干者术后并发症的发生率较高.Objective To explore the feasibility and fficacy of preoperative embolization combined with microsurgical resection for the treatment of large solid hemangioblastoma(HB)in the posterior fossa and the possible factors affecting the outcome.Methods A retrospective study was performed on the clinical data of 21 patients with large HB[maximum diameter>30 mm,accounting for 8.8%(21/238)of HB patients in the posterior fossa treated during the same period]in the posterior cranial fossa who were admitted to the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from June 2012 to January 2022.Five cases(23.8%)were associated with Von Hippel-Lindau(VHL)disease.The.tumor was located in the cerebellar hemisphere in 9 cases(42.9%),cerebellopontine angle in 4(19.0%),and other regions(including the roof of fourth ventricle,superior vermis and inferior vermis of cerebellum,and foramen magnum area)in 8(38.1%).There were 4 cases(19.0%)with brainstem invasion and 2 cases(9.5%)with mutiple lesions.The treatment methods ineluded preoperative endovascular embolization and microsurgical resection of tumor.Clinical data included incidence of postoperative complication,the modified Rankin scale(mRS)score at admission and the last follow-up.Possible factors affecting the occurrence of postoperative complications were explored.Results All 21 patients underwent preoperative embolization of tumor feeding artery and the degree of embolization was 60%-80%.All patients underwent microsurgery and the tumors were completely removed.A total of 7 patients(33.3%)had postoperative complications,including 1 case of postoperative bleeding,2 cases of respiratory dysfunction,2 cases of lower cranial nerve dysfunction,1 case of facial paralysis,1 case of hemiplegia,1 case of hydrocephalus,3 cases of lung infection,1 case of intracranial infection,1 case of cerebrospinal fluid leakage,I case of subcutaneous effusion and 1 case of aggravated dystaxia.Univariate analysis showed that tumor invasion of the brain stem might be the i

关 键 词：血管母细胞瘤 显微外科手术 栓塞 治疗性 治疗结果 手术后并发症 影响因素分析 

分 类 号：R732.2[医药卫生—肿瘤]