脑(脊髓)内外海绵状血管瘤的影像学特征与显微外科治疗

目的探讨脑(脊髓)内外海绵状血管瘤(CA)的影像学特点及治疗方法。方法脑内CA 13例,分别位于脑皮层深部、海马、外侧裂Broca氏区、中央前回、后回、丘脑深部、桥脑及小脑半球；胸髓内CA 3例；位于海绵窦、鞍旁颅中窝的脑(轴)外CA 2例；髓外(T_(12))CA 1例。所有病例均行CT、MRI检查并接受显微外科手术治疗。结果脑(脊髓)内CA在MRI的T1、T2像上,病变周围可有典型的含铁血黄素黑环征；脑(脊髓)外CA的CT、MRI表现不具特征性。所有脑(脊髓)内CA在显微镜下(部分病例使用立体定向配合)获得全切；因轴外CA血供异常丰富,只作部分切除。结论MRI对于脑(脊髓)内CA具有诊断意义,对于反复出血病例宜争取显微手术全切；因轴外CA术中出血凶猛,应慎重决定其治疗方案。

Imaging features of intra/extra cerebral (spinal) cavernous angioma and its microsurgical treatment

Objective To discuss the imaging features of intra/extra cerebral/spinal cavernous angioma (CA) and its treatment methods.Methods Thirteen intra-cerebral CAs were sited in the deep cerebral cortex,hippocampus,Broca's area,anterior/posterior central gyrus,deep thalamus,pons,cerebellar hemisphere and 3 intra-spinal CAs were located in thoracic cord.3 extra-axial (cerebral/spinal) CAs, including 2 extra-cerebral CAs,and 1 extra-spinal CA,were located in cavernous sinus,parasellar region, and T_(12) level of the spinal cord respectively.All cases underwent CT scan,MRI examination and microsurgical treatment.Results Intra-cerebral/spinal CAs showed the typical change,hemosiderin ring surrounding the CAs,on the T1 and T2-weighted MRI images.Extra-axial CAs showed no characteristic change on CT or MRI.A11 intra-cerebral/spinal CAs were total removed by microneurosurgical technique and the extra-axial CAs were partly resected because of the especially rich blood supply.Conclusion MRI is the best choice for the diagnosis ofintra-cerebral/spinal CA.If the CA appeared repeat hemorrhage, it should be totally removed by microneurosurgical technique.Because of severe intraoperative bleeding,it is should be careful to decide the strategy for extra-axial CA.