颅后窝血管网织细胞瘤及显微外科手术

目的：提高颅后窝血管网织细胞瘤的诊疗水平。方法：回顾总结31例颅后窝血管网织细胞瘤诊断方式及显微外科手术治疗效果。结果：31例肿瘤（囊性23例，实性8例），全切除30例（囊性23例，实性7例），次全切除1例（实性1例），术后神经功能明显改善27例（囊性23例，实性4例），加重3例（均为实性肿瘤），死亡1例（实性）。随访期间有3例复发（囊性1例，实性2例，其中1例实性为颈髓段再发）。结论：明确肿瘤解剖关系及血供情况，囊性肿瘤采用锁孔入路，实性肿瘤骨窗开颅，采用显微外科技术是提高疗效的重要方法。     

第四脑室肿瘤的显微外科治疗

目的 研究第四脑室肿瘤显微外科治疗的效果。方法 通过显微外科手术切除第四脑室肿瘤３４例,其中手术全切除３１例,近全切除３例。 结果 脑瘤基底附着第四脑室底１５例,全切除１２例,近全切除３例;肿瘤基底附着脉络丛、第四脑室和侧壁１９例,均全切除。病理：室管膜瘤１４例,髓母细胞瘤８例,星形细胞瘤４例,血管网状细胞瘤３例,脉络丛乳头状瘤２例,脑膜瘤２例,脑脂瘤１例;手术死亡１例。结论 脑肿瘤基底附着第四脑     

颈髓髓内肿瘤显微手术治疗32例

目的 总结颈髓髓内肿瘤显微外科手术治疗的临床经验.方法 回顾性分析应用显微外科手术切除的32例颈髓髓内肿瘤的临床资料.显微镜下分离蛛网膜,于脊髓最薄弱处或后正中沟锐性切开,肿瘤与脊髓之间有可区分界面者,从肿瘤上、下极锐性分离,整块切除肿瘤;肿瘤与脊髓之间无可区分界面者,瘤内分块部分切除病变.结果 32例颈髓髓内肿瘤中,星形细胞瘤18例,肿瘤全切除3例,次全切除11例,部分切除或活检4例;髓内室管膜瘤13例,肿瘤全切除9例,次全切除4例;血管网织细胞瘤1例,仅行减压.术后无并发症发生.结论 应用显微外科手术切除可提高颈髓髓内肿瘤治疗效果和降低并发症的发生.     

中枢神经细胞瘤的显微外科手术治疗探讨

目的 报道中枢神经细胞瘤的显微外科手术和放射治疗的效果，探讨最佳的治疗方法。方法 回顾分析1999年1月-2004年1月收治5例中枢神经细胞瘤的临床资料并对显微外科手术和放射治疗的疗效进行比较。结果 临床治疗5例中，显微手术全切除2例，1例治愈，随访5年患者生活自理，肿瘤无复发，1例死亡。显微外科手术次全切除加放射治疗3例，存活3例，恢复工作，随访肿瘤无复发。结论 显微外科手术适合中枢神经细胞瘤的治疗，放射治疗可提高次全切除的临床疗效。     

小脑实质性血管网织细胞瘤

目的：探讨小脑实质性血管网织细胞瘤的诊断和治疗。方法：回顾性分析8例小脑实质性血管网织细胞瘤的临床表现及辅助检查，手术方法，结果：术后病人均明确诊断为小脑实质性血管网织细胞瘤，全切难度大。结论：术前应充分考虑到小脑实性变可为实质性血管网织细胞瘤，术前栓塞供血动脉，术中先处理供血动脉和静脉后再切除肿瘤，能降低手术风险和肿瘤复发率。     

后颅窝血管网织细胞瘤三种手术方式探讨

目的探讨后颅窝血管网织细胞瘤最佳的手术方式。方法回顾性分析1995年1月-2001年12月40例后颅窝血管网织细胞瘤的诊断、显微镜下切除的3种具体方式及治疗效果。结果安全区扩大“楔形”切除方式效果最好，囊壁瘤结节切除方式效果次之。结论后颅窝血管网织细胞瘤的安全区扩大“楔形”切除安全．可减少或避免多发瘤结节，特别是小于0．5cm的瘤体及亚临床病灶遗漏至复发，应作为首选手术方式。     

中枢神经细胞瘤的诊断和显微外科治疗

目的 探讨提高中枢神经细胞瘤的诊疗水平。方法 回顾总结11例中枢神经细胞瘤的临床表现、诊断方式及显微外科手术治疗效果。结果 手术治疗11例，其中8例全切除，3例大部分切除，手术后常规行放射治疗，通过6～31个月的随访观察，效果良好。结论显微手术切除肿瘤可有效减少致残率和死亡率，术后放疗可减少本病复发。     

毛细胞型星形细胞瘤的显微外科手术治疗

目的 探讨显微外科手术在毛细胞型星形细胞瘤治疗中的应用效果。方法回顾性分析1999年1月至2005年6月经显微手术并证实的毛细胞型星形细胞瘤29例临床资料，根据术后随访判定临床效果。结果肿瘤全切除22例，次全切除4例，大部分切除3例。术后早期症状明显改善23例，无改善4例，2例出现神经功能缺失，无死亡病例。结论显微手术对于提高毛细胞型星形细胞瘤术后生存质量及生存率有显著的作用，是治疗毛细胞型星形细胞瘤的首选方法。     

颈髓髓内血管网织细胞瘤的诊断及显微外科治疗

目的探讨颈髓髓内血管网织细胞瘤的诊断及显微外科治疗。方法分析26例患者的MRI表现及其显微外科手术治疗的效果。其中男19例，女7例，年龄17～55岁。结果根据肿瘤在MRI上的表现可分为囊肿型12例，实体型14例，均行肿瘤全切除术。术后患者神经系统症状好转者17例，7例无改善，2例加重。结论颈髓MRI能对颈髓髓内血管母细胞瘤作出定位诊断，并可将其分型，以利选择不同的手术方法。颈髓髓内、即使累及延髓的血管母细胞瘤宜行积极手术治疗；根据肿瘤类型不同选择不同手术方法，在手术显微镜下沿正确的界面进行分离，先离断动脉后处理静脉，避免分块切除而力争全切，是减少术中出血和避免神经功能损害的关键。     

Von Hippel—Lindau病的泌尿系临床和病理观察（附三例报告）

为了提高对Ｖｏｎ Ｈｉｐｐｅｌ－Ｌｉｎｄａｕ（ＶＨＬ）病的认识，对１９９２年１１月到１９９５年１１月收治的３例ＶＨＬ病，就其在泌尿系的临床病理表现、治疗原则及鉴别诊断进行讨论。认为ＶＨＬ病实际是血管壁错构性组织的病变，可遍布身体各器官，其肾实性血管网织细胞瘤极似肾透明细胞癌，但多为良性发展过程。对脑血管网织细胞瘤，一经诊断即应手术切除；对肾实性血管网织细胞瘤，亦应手术切除，但应最大限度保存正常肾组     

Use of gadolinium-enhanced magnetic resonance imaging in the diagnosis and management of posterior fossa hemangioblastomas

The diagnosis of central nervous system hemangioblastoma as well as the surgical treatment requires the accurate radiologic visualization of both the cystic and solid components of the tumor. We report two cases of posterior fossa hemangioblastoma examined with gadolinium-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging, which clearly defined the tumor nodule that was not visualized on noncontrast magnetic resonance imaging, contrast-enhanced computed tomography scans, or angiography. In both cases the operative findings precisely correlated with the gadolinium-enhanced magnetic resonance image. Gadolinium-enhanced magnetic resonance imaging is the examination of choice for preoperative evaluation of posterior fossa hemangioblastoma. In cases of von Hippel-Lindau syndrome, magnetic resonance imaging is a useful tool for clinical screening as well as follow-up.     

颅后窝胆脂瘤显微外科治疗

目的 为了提高颅后窝胆脂瘤的手术治疗效果。方法 回顾性总结１６２例颅后窝胆脂瘤的临床症状、诊断方式、显微手术入路与疗效。 结果 １４９例（９２．０％）肿瘤获全切除;１３例（８．０％）为次全切除。４例（２．５％）于术后２周内因脑干缺血、水肿或肺部感染而死亡。１３４例获长期随访（平均４．５年）,其中１２９例（９６．３％）恢复良好,２例（１．５％）肿瘤复发。 结论 采用显微手术治疗颅后窝胆脂瘤是一种安全     

Hemangioblastoma in posterior cranial fossa. Report of 56 cases]

The diagnosis of hemangioblastoma in the posterior cranial fossa was confirmed in 56 patients operatively and pathologically. The tumors were cystic in 44 patients and solid in 12; 87.5% of the tumors occurred in the cerebellar hemisphere and 7.1% in the vermis. The main symptoms and signs were increased ICP and cerebellar incoordination. 64 surgical operations had been performed in the 56 patients. Seven patients died and 8 (14%) had recurrence postoperatively. The effect of surgical intervention in 40 patients with cystic hemangioblastoma was satisfactory. Among 5 patients with solid tumor, 2 recovered completely and 3 still had partial neurological disability.     

第四脑室肿瘤的显微外科治疗

目的探讨第四脑室肿瘤手术入路和显微手术技巧,以提高第四脑室肿瘤的手术疗效。方法84例第四脑室肿瘤患者,行显微镜下切除肿瘤、后颅窝骨瓣成形及复位术。其中,61例采用正中孔-小脑蚓部入路,19例采用小脑延髓裂入路,4例取正中孔-小脑蚓部与小脑延髓裂联合入路。术前行侧脑室外引流4例,术中行侧脑室-枕大池分流3例,术后行侧脑室外引流术1例。结果本组全切除肿瘤63例(75.0%),次全切除21例(25.0%),无手术死亡病例。术后并发症:上消化道出血6例,小脑缄默症2例,四脑室血肿1例,脑积水1例,颅神经功能障碍1例。随访82例,平均38.4个月,死亡9例。结论术前正确判断肿瘤性质及其基底部所在位置,选择适宜的手术入路,熟练应用显微外科技术,是手术成功治疗的第四脑室肿瘤关键。     

A case of hemangioblastoma with subarachnoid dissemination

A case is reported in which a diffuse subarachnoid dissemination occurred after successful removal of a posterior fossa hemangioblastoma. The patient was a 51-year-old man who suffered from headache and gait disturbance, and who was admitted to our hospital on September 25, 1985. Neurological examination revealed trunkal ataxia and increased intracranial pressure. A CT scan with contrast media revealed a high-density lesion with surrounding low-density area in the posterior fossa. Right vertebral angiography demonstrated a round tumor stain behind the medulla oblongata, which was fed by the right posterior inferior cerebellar artery. The complete resection of the tumor was carried out. A biopsy specimen from the tumor showed a picture characteristic of hemangioblastoma. Fourteen months later the patient was readmitted due to the sudden onset of disturbance of consciousness. A CT scan revealed a large intracerebral hematoma in the right putaminal region. Right carotid angiography demonstrated two small tumor stains in the right temporal lobe. An emergency operation to extirpate the hematoma was performed. But the disturbance of consciousness did not improve, and the patient died. At necropsy a lot of small round tumors were recognized at the surface of the bilateral cerebral and cerebellar cortex. They were present in the subarachnoid space and partially invaded the cerebral and cerebellar parenchyma, extending through Virchow-Robin's space. There was no recurrence of the tumor at the site of the original operation. No doubt, a subarachnoid dissemination had occurred. However the histological findings of tumors were similar to the findings recorded in the first biopsy.     

Metastasis of carcinoma to hemangioblastoma cerebelli: case report

A patient with a long-standing posterior fossa tumor developed symptoms that it was growing rapidly. The increasing growth resulted from secondary prostatic carcinoma complicating the cystic cerebellar hemangioblastoma.     

Optic nerve hemangioblastoma. Case report

A solitary hemangioblastoma of the optic nerve was found in a 36-year-old male with a distinct family history of intracranial hemangioblastoma. The patient was admitted with complaints of visual loss and exophthalmos of the right eye. X-rays showed enlargement of the right optic canal. Right carotid angiography revealed a hypervascular tumor in the orbital apex, supplied by the ophthalmic artery. Computed tomography disclosed a pear-shaped, isodense mass with moderate contrast enhancement in the orbital apex. The right optic nerve was enlarged along its entire course and was involved with the apical mass. Surgery via the right frontal extradural approach disclosed a solid, vascular tumor involving the optic nerve at the apex of the orbit. Histological examination showed the tumor to be a characteristic hemangioblastoma. Over 90% of intracranial hemangioblastomas are located in the posterior fossa. Supratentorial hemangioblastomas, especially those arising in the optic nerve, are extremely rare. In addition, optic nerve hemangioblastomas are frequently familial and are associated with infratentorial hemangioblastomas, angiomatosis retinae, and cysts of the abdominal viscera.     

An intracranial aneurysm on the feeding artery of a cerebellar hemangioblastoma. Case report.

A case of cerebellar hemangioblastoma with a coexistent arterial aneurysm on the feeding artery of the tumor is reported. The patient presented with an acute onset of headache, loss of consciousness, and left-sided hemiparesis due to a posterior fossa hemorrhage found adjacent to a hemangioblastoma. Four-vessel angiography revealed an aneurysm on the anterior inferior cerebellar artery (AICA), which was the main feeding vessel of the hemangioblastoma. Successful total excision of the hemangioblastoma and clipping of the AICA aneurysm achieved in a one-stage operation was demonstrated on postoperative angiography.