中枢神经系统海绵状血管瘤的显微手术治疗

目的探讨中枢神经系统（central nervous system，CNS）海绵状血管瘤（CA）的影像学特征和显微手术治疗的手术体会及效果评价。方法回顾分析5年间23例经病理学证实的CNS海绵状血管瘤，脑内16例（幕上11例，幕下5例）。脑外5例，椎管内2例。23例全部行CT检查，21例同时行MRI检查，18例行DSA检查。全部病例均行显微手术治疗，21例行镜下全切除（91．3％），2例行次全切除（8．7％）。结果23例患者中，19例痊愈（82．6％），4例好转（17．4％），术后随访6个月-4年，无死亡及术后神经功能症状加重病例。结论CNS海绵状血管瘤在CT及MRI上有特征性的表现，MRI对CA的敏感性优于CT。DSA检查为阴性，但对于鉴别诊断很有帮助。显微手术是治疗CNS海绵状血管瘤的首选方法，合理的手术入路、熟练掌握显微操作技术及显微解剖知识是手术成功的关键。

Microsurgical treatment of central nervous system cavernous angiomas

Objective To study the clinical and radiological features,and the microsurgical treatment of CNS cavernous angiomas (CA).Methods During a 5-year period, 23 cases of CNS CA,intracranial or intraspinal,all verified by histopathology later,were examined by CT,with 21 of them by MRI and 18 of them by DSA as well.Microsurgery achieved complete removal of intracranial CA in 21 cases (91.3%) and subtotal removal in 2 cases (8.7%).Results In the 23 patients,19 were cured (82.6%),4 got improved (17.4%),no one died or advanced during a mean follow-up of 2.1 years (0.5-4 a).ConclusionCT or MRI is essential for diagnosis of CNS CA,MRI is more sensitive than CT.DSA is negative for CA, but is informative in establishing its differential diagnosis.Microsurgery is of first choice for CNS CAs.The chioce of approach,microsurgical technique,as well as the microanatomical knowledge,are the keys to successful treatment.