听神经瘤临床行为与其磁共振信号和病理特征之问的相关性研究

目的分析听神经瘤的大小、生长速率及增殖与其磁共振信号、组织学特征之间的相互关系.方法回顾分析听神经瘤43例,依MR信号分为均匀、不均匀及囊性变,组织学包括Antoni A、Antoni B以及纤维化、含铁血黄素沉淀、黄色瘤样细胞.结果信号均匀的听神经瘤肿瘤较小、生长较慢、增殖指数较低,组织学以Antoni A结构占优;不均匀和囊性听神经瘤肿瘤较大、生长较快、增殖指数较高,以混合型结构占优;不均匀和囊性听神经瘤中含铁血黄素沉淀、黄色瘤样细胞以及不均匀听神经瘤的纤维化明显增多,它们均有统计学意义.结论较大的听神经瘤不仅MR表现为不均匀信号,而且组织学主要表现混合型结构,也可能有其他变化,主要是含铁血黄素沉淀和囊性变.     

听神经瘤临床行为与其磁共振信号和病理特征之间的相关性研究

目的　分析听神经瘤的大小、生长速率及增殖与其磁共振信号、组织学特征之间的相互关系。方法　回顾分析听神经瘤 4 3例 ,依MR信号分为均匀、不均匀及囊性变 ,组织学包括AntoniA、AntoniB以及纤维化、含铁血黄素沉淀、黄色瘤样细胞。结果　信号均匀的听神经瘤肿瘤较小、生长较慢、增殖指数较低 ,组织学以AntoniA结构占优 ;不均匀和囊性听神经瘤肿瘤较大、生长较快、增殖指数较高 ,以混合型结构占优 ;不均匀和囊性听神经瘤中含铁血黄素沉淀、黄色瘤样细胞以及不均匀听神经瘤的纤维化明显增多 ,它们均有统计学意义。结论　较大的听神经瘤不仅MR表现为不均匀信号 ,而且组织学主要表现混合型结构 ,也可能有其他变化 ,主要是含铁血黄素沉淀和囊性变。     

囊性听神经瘤

目的 探讨听神经瘤囊变原因、细胞增殖及其临床治疗效果。方法 回顾分析16例囊变听神经瘤的临床资料,计算其生长速率,免疫组织化学（PCNA、Ki-67）检查,以计算细胞增殖指数。结果 本组病例10例面神经功能保留,其中4例神经功能正常（House-Brackmann评分1分）,4例部分保留听力;囊变听神经瘤的病理以Antoni B型结构占优;生长指数显高于非囊变,而细胞增殖指数显低于非囊变。结论 听神经瘤囊变主要是由肿瘤缺血或出血所致,MRI是诊断听神经瘤囊变的最好方法,其手术效果（面神经、听神经的保留）较好。     

中国汉族家族性脑海绵状血管瘤：1家系谱回顾分析

目的　探讨汉族人家族性脑海绵状血管瘤的临床、影像学及病理特点。方法 对1家族性脑海绵状血管瘤家系进行临床、影像学和病理分析,并绘制家系遗传图谱。结果 该家系16人共4人发病,符合常染色体显性不完全外显遗传,临床以头痛、出血、局灶性神经功能障碍为主要表现,头颅MRITlWI多呈混杂信号,T2WI多为不均匀高信号为主的混杂信号,内部可见夹杂低信号,边缘为低信号环。镜下脑海绵状血管瘤由缺乏肌层和弹力纤维的大小不等的海绵状血管窦组成,病灶内可见玻璃样变、钙化或不同阶段的出血,病灶周围可有胶质增生带,病灶内部或周围含有含铁血黄素。结论 家族性脑海绵状血管瘤是常染色体不完全显性遗传病。头颅MRIT2加权像病灶周围含铁血黄素沉积的“铁环征”,是脑海绵状血管瘤的特征性MRI表现。其病理结构是其易反复少量出血及MRI影像表现复杂多样的主要原因。     

囊性听神经瘤的诊断与治疗(附12例分析)

目的　总结听神经瘤囊性变性的临床诊断与治疗特点。方法　回顾性分析１２ 例囊性听神经瘤的临床资料。结果　听神经瘤囊性变性有部分囊变、大部分囊变及多囊结构。ＣＴ／ＭＲ 检查均可发现囊性改变，但后者更可靠。手术切除疗效满意。病理检查发现有典型Ａｎｔｏｎｉ Ａ、Ｂ结构。结论　听神经瘤的囊变可能与肿瘤生长所致的组织缺血有关。囊性听神经瘤手术可以获得较好的面听神经保留。     

听神经瘤囊变和肿瘤内出血的研究进展

听神经瘤是颅神经肿瘤中最常见的一种，占颅内肿瘤的8％-10%，占桥小脑角区肿瘤的80％。听神经瘤在生长过程中可以发生囊变和肿瘤内出血。因此，本文结合近期国内外对听神经瘤囊变和肿瘤内出血的研究进展做一综述。     

松果体区肿瘤的影像学分析

目的 探讨CT和MRI对松果体区肿瘤的诊断价值及在肿瘤治疗中的作用.方法 对经开放手术病理诊断明确的72例松果体区肿瘤患者的CT和MRI资料进行回顾性分析.结果 大部分松果体区肿瘤缺乏一致性较好的影像特征.总体上,混合性生殖细胞肿瘤、成熟畸胎瘤、非成熟畸胎瘤等含不同发生来源或多胚层组织的肿瘤形态欠规则,密度/信号混杂,囊实性混杂,强化不均匀.生殖细胞瘤、绒癌、松果体细胞瘤、松果体母细胞瘤等单一细胞肿瘤形态相对规则,密度/信号一致性较好,强化基本均匀.当混合性肿瘤或多胚层肿瘤以某一种组织成分为主时,影像学表现与单一细胞肿瘤相似.胶质瘤影像学表现差异较大,但多可依据与周围脑组织的关系,脑水肿部位,静脉移位方向做出诊断.脑膜瘤多较大,小脑幕/大脑镰强化"拖尾征"少见,其他征象典型,诊断不难.囊肿病理多样,表皮样囊肿破裂肉芽肿形成时影像表现与畸胎瘤类似.结论 松果体区肿瘤中生殖细胞肿瘤、松果体实质细胞肿瘤影像学检查的局限性比较明显,难以进一步区分各种单一细胞肿瘤或多组织肿瘤,因此依据影像学表现做出治疗方案决定应慎重.     

垂体瘤继发黄色肉芽肿的临床特征分析

目的探讨垂体瘤继发黄色肉芽肿的临床特征及诊断、治疗与预后。方法回顾性分析5例经手术治疗的垂体瘤继发黄色肉芽肿患者的临床资料;并结合文献分析其病理特点、发病机制、临床表现、影像学特征及治疗措施。结果术前MRI检查示2例患者垂体瘤内有T₁WI和T₂WI高信号。5例患者均行手术治疗,术中见瘤内有黄色液态内容物者2例,术后组织病理检查有含铁血黄素沉着3例;术后出现暂时性尿崩3例,对症治疗后症状改善,1例患者需长期激素替代治疗。结论不同程度垂体前叶功能减退是垂体瘤合并黄色肉芽肿的临床特点。MRI示垂体瘤在T₁WI和T₂WI均有高信号囊变灶要考虑垂体瘤继发黄色肉芽肿的可能;影像学和病理学检查发现有含铁血黄素提示黄色肉芽肿可能与垂体腺瘤的多次少量出血有关;手术治疗可获得良好的预后。     

脊索瘤样型脑膜瘤

脊索瘤样型脑膜瘤是组织学形态类似脊索瘤的一种脑膜瘤亚型,大多数病例在影像学上呈现幕上难切除的大型占位性病变。组织病理学观察肿瘤呈不典型分叶状,嗜碱性黏液背景,梭形上皮样细胞排列呈索状或带状(图1),泡沫细胞或空泡细胞的存在使其组织学表现类似脊索瘤(图2);脊索瘤样区域与典型的脑膜瘤区域相混杂,鲜见组织学完全单一的细胞形态,可伴     

神经纤维瘤病的CT和MRI表现及诊断价值

目的探讨神经纤维瘤病的CT和MRI影像表现,并就二者的优劣进行比较,以提高诊断准确性。方法收集14例经临床和手术证实的神经纤维瘤病患者的CT和MRI资料,分析其影像学特点。结果 NF-2型患者表现为双侧听神经瘤,伴或不伴胶质瘤、脑膜瘤及脊膜瘤。NF-1型患者表现为单发或多发胶质瘤。CT图像中,双侧听神经瘤表现为等低密度,增强扫描呈不均匀性强化。多发脑膜瘤表现为等或略高密度,增强扫描呈均匀性明显强化。胶质瘤表现为边界不清的低密度,增强扫描无强化或轻度不均匀性强化。MRI图像中,双侧听神经瘤,呈等长T1、等长T2信号,增强扫描呈不均匀明显强化。脑膜瘤呈略长T1、略长T2信号,增强扫描呈均匀性明显强化,胶质瘤呈略长T1、略长T2信号,不均匀强化。结论神经纤维瘤病患者的颅脑和脊柱有特征性的CT、MRI表现,其中MRI技术能够全面准确显示病灶的分布、大小、形态和信号特征以及其与相邻组织结构的关系。     

大型囊性听神经瘤的临床特点及显微手术治疗

目的 探讨大型囊性听神经瘤的临床特征,总结显微手术治疗经验.方法 对经显微手术治疗的24例大型囊性及50例大型实性听神经瘤进行回顾性对比分析.结果 囊性肿瘤全切17例(71%),次全切6例(25%),大部切除1例(4%),面神经解剖保留20例(83%).实性肿瘤全切45例(90%),次全切5例(10%),面神经解剖保留45例(90%).囊性肿瘤首发症状多不典型,病程短,脑积水发生率高.结论 大型囊性听神经瘤发展迅速,应及时手术治疗.应用显微外科技术,对与神经组织紧密粘连的肿瘤,采取次全切除的策略,有助于面神经的保护,提高临床效果.     

Cystic acoustic neuromas: surgical outcome in a series of 58 patients.

We aimed to analyze the clinical characteristics and surgical outcomes of surgically treated cystic acoustic neuromas, and to determine the prognostic significance of the presence of cystic components, by comparing surgical outcomes for solid and cystic tumors. A total of 58 patients (20.4%) with newly diagnosed cystic tumor were studied. The surgical outcome was analyzed in terms of extent of tumor removal, facial nerve preservation, morbidity and mortality; and was compared with that in patients with solid tumors. Facial nerve preservation rates were much better for solid tumors (82.7%) than for cystic tumors (67.9%). The extent of tumor removal was complete in 75.9% of patients with cystic tumors as compared with 90.2% for solid acoustic neuromas. Overall mortality was 8.6%. Cystic tumors differ from solid acoustic neuromas by having a rapid growth pattern, short clinical history and more frequent facial nerve involvement. They are associated with a poorer surgical outcome in terms of facial preservation and overall result.     

Giant cervico-thoracic schwannoma with long clinical history. Case report

An unusual case of a giant intraspinal schwannoma in a 45-year-old woman with 14-year history of preoperative symptoms was presented. MRI of the spine revealed an intradural, extramedullary tumor extending from the intervertebral space C4/C5 to T4 vertebral body level (2 x 1.2 x 12 cm) and filling almost the entire spinal canal. Microscopical examination showed a typical neurinoma pattern with two distinct zones of Antoni A and Antoni B tissue. Some areas exhibited nuclear atypia and hyperchromasia reflecting the degenerative changes in this slowly growing nerve sheath tumor. A rich pericellular reticulin network was seen in the areas composed of Antoni A tissue. Immunohistochemically, the tumor cells were strongly positive for S-100 protein. The diagnostic difficulties in the presented case of longstanding schwannoma resulted in the late surgical treatment. The importance of the early diagnosis of spinal nerve sheath tumors for the patient's quick recovery is stressed.     

伽玛刀治疗听神经瘤(附98例分析)

目的 评价伽玛刀治疗听神经的效果。方法 应用OUR旋转式伽玛刀治疗听神经98例。肿瘤直径512～29．7min．平均18.8mm。采用多个放射中心联合照射，周边等剂量曲线为45％-70％，边缘剂量10-13Gy。结果 81例获14。84个月随访，平均39个月。MRI示41例（50．6％）肿瘤缩小，38例（46.9％）无变化，2例（2．5％）增大；25例（30.9％）肿瘤中心失增强。无面瘫和面部麻木，听力保留率59.2％。结论 伽玛刀对听神经瘤有较高的肿瘤控制率，并能保留有用听力，对面神经、三又神经损伤小，是小至中等大小听神经瘤可供选择的治疗方法，及术后残余和复发肿瘤的重要辅助治疗手段。     

Correlation of facial nerve paresis and histopathological type of vestibular schwannoma

The objective of the study was to evaluate the dependence of facial nerve paresis, as a symptom of cerebellopontine angle tumour, on the histopathological subtype of vestibular schwannoma, diagnosed from a post-operative histopathological examination. We retrospectively analysed 91 surgically treated patients with vestibular schwannoma. We studied the histopathological subtype and the preoperative condition of the facial nerve. The following WHO 2000 subtypes were distinguished: neurinoma cellular (51 cases), neurinoma conventional (23 cases), neurinoma ancient (11 cases), (other types: 2 neurofibroma and 2 ganglioneuroma). We analysed the dependence of facial nerve paresis on the histological subtype of tumours and their sizes. The analysis was based on the traditional classification: Antoni A (11 cases), Antoni B (12 cases) Antoni A/B (23 cases) and Antoni B/A (40 cases). 30 patients (30%) in the analysed group had paresis of the facial nerve preoperatively. Preoperative facial paresis occurred frequently in subtypes "cellular" and Antoni B, and rarely in subtypes conventional and Antoni A and B/A. In the small tumour cases (up to 20 mm), facial nerve paresis occurred frequently in subtypes cellular and conventional, as well as in Antoni A and A/B.     

Facial neuroma masquerading as acoustic neuroma

Facial nerve neuromas are rare benign tumors that may be initially misdiagnosed as acoustic neuromas when situated near the auditory apparatus. We describe a patient with a large cystic tumor with associated trigeminal, facial, audiovestibular, and brainstem dysfunction, which was suspicious for acoustic neuroma on preoperative neuroimaging. Intraoperative investigation revealed a facial nerve neuroma located in the cerebellopontine angle and internal acoustic canal. Gross total resection of the tumor via retrosigmoid craniotomy was curative. Transection of the facial nerve necessitated facial reanimation 4 months later via hypoglossal-facial cross-anastomosis. Clinicians should recognize the natural history, diagnostic approach, and management of this unusual and mimetic lesion.     

伽玛刀治疗听神经瘤229例疗效分析

[目的]评价伽玛刀治疗听神经瘤的疗效.[方法]采用OUR旋转式伽玛刀治疗229例听神经瘤患者,观察术后病情变化.[结果]本组伽玛刀治疗病例随访6～60个月,其中肿瘤缩小98例,肿瘤体积不变115例,肿瘤增大16例,治疗前存在有用听力病例中38例听力下降;130例患者有用听力得到保留;54例出现患侧面瘫;11例出现三叉神经功能部分受损.[结论]伽玛刀对听神经瘤有较高的肿瘤控制率,并能保留有用听力,对面神经、三又神经损伤小,是小至中等大小听神经瘤可供选择的治疗[方法],及术后残余和复发肿瘤的重要辅助治疗手段.     

听神经瘤的临床特征与其细胞增殖之间的相关性

目的分析听神经瘤临床特性与Ki-67、PCNA增殖指数之间的相关性.方法回顾性分析43例听神经瘤,计算其生长速率,Ki-67、PCNA免疫组织化学观察肿瘤增殖,Spearman等级相关回归分析年生长率与Ki-67、PCNA增殖指数之间的相关性.结果发现患者病程、肿瘤生长指数与增殖指数之间有显著的相关性,复发肿瘤的增殖指数显著高于非复发肿瘤,囊性肿瘤的增殖指数显著低于非囊性肿瘤,肿瘤直径＞3.5cm的增殖指数显著高于≤3.5cm者.结论本研究结果提示肿瘤增殖指数越高,肿瘤生长越快,肿瘤直径＞3.5cm的肿瘤更易增殖.