脑干出血的临床与预后研究

本文报告经ＣＴ或ＭＲＩ证实的３２例脑干出血患者，其中中脑出血１４例，桥脑出血１７例，全脑干出血１例。１０例合并脑梗塞，２例确诊为脑海绵状血管瘤。死亡６例。认为剧烈头痛，频繁呕吐，昏迷，脑膜刺激征，血肿直径大于２ｃｍ，伴随脑梗塞及其它严重并发症者预后不良。并对个别病例的误诊原因进行讨论。     

OPCA的MRI影像诊断与临床

目的：探讨ＯＰＣＡ的ＭＲＩ征象，及与临床表现的关系。方法：回顾性分析３０例ＯＰＣＡ的ＭＲＩ影像学表现。结果：根据ＭＲＩ征象将ＯＰＣＡ分为轻、中和重度３度，本级轻主著５例，中度者８例，重度者７例，轻度者：小脑脑沟增多、加深，脑干略变细，桥脑无明显改变，中度者：除前者征象外，可见桥脑腹侧萎缩，四脑室扩大，脑干周围基底池扩大。重度者：小脑、桥脑腹侧，延髓橄榄重度萎缩，小脑核，桥脑被盖，小脑下部不受累，临     

桥脑海绵状血管瘤手术指征和入路选择（附12例报告）

目的探讨桥脑海绵状血管瘤的手术指征和手术入路。方法显微手术切除桥脑海绵状血管瘤12例。11例位于桥脑背侧的海绵状血管瘤,采用枕下正中经菱形窝入路切除;1例位于桥脑腹外侧的海绵状血管瘤,采用枕下经乙状窦后入路切除。结果均镜下全切除病灶,术后病理证实为脑海绵状血管瘤。术后临床表现改善者6例,3例无变化;1例术后面瘫加重;1例术后出现外展神经瘫痪;死亡1例。术后3个月,9例MRI复查,均未见病灶,脑干组织影像学修复良好。结论正确选择手术指征和手术入路,采用显微外科技术切除桥脑CM是安全和有效的。     

左旋咪唑致脱髓鞘脑病的临床及CT与MRI的比较研究

目的：研究左旋咪唑致脱髓鞘脑病的临床及ＣＴ、ＭＲＩ的诊断价值,方法：分析２６例左旋咪唑致脱离病的临床及１８例ＣＴ、２０例ＭＲＩ资料,结果：本病的主要临床表现为急性或亚急性起病的弥漫性脑损害。１例脑活检不脱髓鞘病灶。皮质激素治疗效果好。１３例ＣＴ及２０例ＭＲＩ显示脑白质区有多发病灶,ＣＴ为低密度影,ＭＲＩ为长Ｔ１长Ｔ２信号,仅１例有占位效应。ＭＲＩ的影像学诊断率明显高于ＣＴ。结论：本病的诊断依靠其临     

脑干腔隙性梗塞的MRI,TCD与临床

本文对８５例脑干腔隙性梗塞（腔梗）患者的头颅ＭＲＩ、部分ＴＣＤ及临床特征作回顾性分析。结果：本组患者发病年龄较大，７５％有长期高血压史，临床表现为复杂性、多样化特点，且多数缺乏典型的交叉或脑干孤立症征。ＭＲＩ扫描显示腔隙灶以桥脑腹侧居多，病灶＜０．５ｃｍ者可无症状或症状轻微。ＴＣＤ可很好反映椎－基底动脉系统的血管弹性及血流速度，对脑干腔梗的诊断有一定的帮助，但定位不甚准确。ＭＲＩ仍是诊断脑干腔梗的最佳手段。     

颅内海绵状血管瘤的显微外科治疗

目的探讨颅内海绵状血管瘤的诊断和治疗的进展。方法对我院连续收治的31例颅内海绵状血管瘤患者的资料进行回顾性分析。病灶位于额叶6例,额顶区皮层至室管膜下巨大病灶1例,顶叶功能区4例,岛叶基底节1例,颞后1例,一侧大脑脚3例,桥脑及桥脑臂9例,桥脑一延髓4例,延髓2例。病灶大小1～7cm,半球病灶采用最近的骨瓣开颅;脑干病灶采用4种手术入路：经幕下小脑上入路、经一侧颞枕小脑幕入路、桥小脑角入路、枕后正中入路。结果全切30例,次全切除1例。偏瘫5例术后4例肌力增加,1例无变化;癫痫4例3例术后1个月内无发作,1例有1次轻微发作;眩晕患者症状明显减轻,除1例术后新出现复视外,其余颅神经损害或减轻,或保持原状。病理结果：海绵状血管瘤。结论显微手术治疗颅内海绵状血管瘤是可行的,早期手术可能取得较好的效果。     

立体定向下开放手术切除脑内小病灶

我们自 1999年 1月～ 2 0 0 0年 7月 ,采用在ＣＴ立体定向开放手术 ,显微直视下切除老年人脑内小病灶 17例 ,取得了满意的效果。现结合文献 ,总结分析如下 :临床资料一般资料　本组 17例 ,男 10例 ,女 7例 ,年龄52～ 84岁 ,平均 6 8岁。其中小胶质瘤 12例 ,海绵状血管瘤 2例 ,脑转移瘤 2例 ,脑脓肿 1例。病灶位于顶叶 12例 ,额叶 5例。临床表现 :癫痫发作 9例 ,肢体活动障碍 8例 ,头痛 8例。影像学检查　病人均行头颅ＣＴ检查 ,11例还进行了ＭＲＩ检查 ,表现为额叶和顶叶小病灶 ,直径 1～ 3ｃｍ。各类病灶在影像学上有不同的表现。小胶质瘤…     

脑干海绵状血管瘤的显微外科治疗(附10例报告)

目的分析脑干海绵状血管瘤的显微外科治疗方法和预后。方法显微手术切除脑干海绵状血管瘤10例,病灶位于桥脑8例,延髓2例。6例桥脑、延髓背侧的海绵状血管瘤,采用枕下正中经四脑室底入路切除; 4例桥脑外侧和腹外侧的海绵状血管瘤,采用枕下乙状窦后入路切除。结果病灶均镜下全切除,病理证实为海绵状血管瘤。4例患者术后症状明显改善,5例患者出现不同程度并发症,在1周至3个月内恢复,1例患者术后因肺内感染死亡。患者术后随访3-58个月,复查MRI均未发现病灶复发,无其他并发症出现。结论在正确选择适应证的前提下,脑干海绵状血管瘤的显微外科治疗效果良好。     

脑干海绵状血管瘤的显微手术治疗

目的探讨脑干海绵状血管瘤的诊断和治疗经验。方法本组18例脑干海绵状血管瘤中,病灶位于一侧大脑脚3例,桥脑及桥脑臂9例,桥脑一延髓4例,延髓2例。分别采用经幕下小脑上人路、一侧颞枕小脑幕人路、桥小脑角人路和枕后正巾人路显微手术治疗。结果血管瘤镜下全切17例,次全切除1例。眩晕病人术后症状明显减轻,除1例术后新出现复视外,其余颅神经损害患者症状减轻,或无变化。结论显微手术治疗脑干海绵状血管瘤是可行的,早期手术可能取得较好的效果。     

颅内海绵状血管瘤的CT和MRI诊断

目的探讨颅内海绵状血管瘤的CT和MRI表现及诊断价值。方法搜集60例颅内海绵状血管瘤的CT和MRI影像资料，CT检查37例，MRI检查53例，CT和MRI检查30例，其中脑内型海绵状血管瘤57例，经手术病理证实42例，影像资料典型15例，经伽玛刀治疗随访证实；脑外型海绵状血管瘤3例，均经手术病理治疗证实。结果脑内型海绵状血管瘤可位于脑内任何部位，单发病灶多见，无明显占位效应，周围无或轻度水肿。CT检查的全部病例呈稍高及混杂密度影32例，增强扫描大都无强化；MRI检查T2WI表现为“桑葚状”混杂高信号，周围有云絮状低信号环，增强后病灶仅少数轻度强化。脑外型病灶位于中颅窝、鞍旁，MRI呈类似哑铃形或类圆形较均匀的稍长T1、明显长T2信号，增强扫描呈明显均匀强化。结论脑内与脑外型海绵状血管瘤的CT和MRI表现具有一定特征，MRI优于CT像，特别是MRI的T2WI像有助于明确诊断。     

显微手术治疗脑内型海绵状血管瘤43例

目的:探讨脑内型海绵状血管瘤(CA)的诊断和显微手术治疗效果。方法:回顾性分析2007年5月至2010年10月收治的43例经病理证实的脑内型海绵状血管瘤患者。结果:全部病例术前均行头颅MRI或CT检查,其中30例MRI检查结果为海绵状血管瘤,与病理结果相符,4例MRI检查结果与病理结果不相符。其他9例CT检查结果为脑内血肿。显微手术全部切除海绵状血管瘤,手术无死亡,效果满意。结论:MRI对脑内型海绵状血管瘤的诊断具有较高的敏感度和特异度。对于有明显临床表现的脑内型海绵状血管瘤患者,采用显微手术切除病灶,可获得良好的治疗效果。     

脑内海绵状血管瘤的MRI和CT诊断

目的分析脑内海绵状血管瘤的CT和MRI影像学特点。方法回顾性分析68例CT和MRI表现,并比较CT和MRI优缺点。结果海绵状血管瘤位于幕上55例,幕下脑干4例,小脑9例。68例病灶有出血54例,钙化17例。MRI检查。T1加权像病灶显示为短T1高信号,周边为轻度低信号影;T2加权像病灶中央呈高、低混杂信号影,周边为极低黑色信号环。增强有轻度强化或无强化。CT平扫为斑片状不规则形高密度区。增强后有轻度强化或无强化。结论应用MRI诊断脑内海绵状血管瘤,其敏感性高,特异性强。对脑内海绵状血管瘤的显示MRI明显优于CT。     

Intracranial extra-axial cavernous (HEM) angiomas: tumors or vascular malformations?

INTRODUCTION: Extra-axial cavernous hemangiomas or angiomas [(hem)angiomas] are relatively rare lesions. They usually arise in relation to the dura mater intracranially or at the spinal level. Most of these lesions have been described in the middle cranial fossa at level of the cavernous sinus. Controversy still exists regarding the exact nature of these extra-axial cavernous angiomas: vascular tumor versus vascular malformation similar to intra-axial cavernomas. It has been suggested that they could represent an adult form of the hemangioma of infancy. Extra-axial cavernous (hem)angiomas often mimic meningiomas and their clinical behavior and imaging appearance are quite different than those of intra-axial cavernous angiomas. SUBJECTS AND METHODS: Five patients ranging in age from 24 to 63 years with a histologically proven dural cavernous angioma were retrospectively included. The lesions were located at level of the cavernous sinus (4 cases) and falx. CT and MR scans were performed in all cases and angiography in three patients. Four patients underwent surgery and a biopsy was performed in one case. One lesion was embolized before biopsy. Histology was available in all patients. RESULTS: In the operated patients, the lesion was totally resected in 2 cases and partially in the other 2. No postsurgical complication was noted. Histology revealed a vascular malformation composed of large vascular channels lined by flat endothelium and separated by fibroconnective tissue stroma. The pathological diagnosis was cavernous angioma. CONCLUSION: On the basis of the analysis of the literature and of our cases, intra-cranial extra-cerebral so-called cavernous (hem)angiomas present findings suggesting that they are vascular malformative lesions, analogous to the intra-axial cavernous angioma. A relationship with the hemangiomas of infancy seems unlikely. Correct terms for extra-cerebral cavernous (hem)angiomas are cavernoma, cavernous angioma, or venous vascular malformation of cavernous type . The term hemangioma should be avoided and reserved for the common vascular tumor of infancy.     

MRI diagnosis of brainstem cavernous angiomas presenting as tumours.

We report experience with 11 patients misdiagnosed for years, on the basis of computed tomography (CT) and angiography, as harbouring brainstem tumours in whom magnetic resonance imaging (MRI) demonstrated cavernous angiomas. Seven had undergone external irradiation, 2 had a ventriculo-peritoneal shunt, 2 developed aseptic femur necrosis following corticosteroid treatment, 1 had undergone a biopsy with a pathological diagnosis of glioma. CT had depicted ill-defined, hyperdense, faintly enhancing lesions. Angiography was normal, or showed an avascular mass or subtle venous pooling. MRI delineated discrete lesions, typical of cavernous angiomas, with a mixed hyperintense, reticulated, central core surrounded by a hypointense rim. Six patients subsequently underwent stereotactic radiosurgery without changes in clinical status or lesion. Although hemorrhagic neoplasms may mimic the clinical course and MRI appearance of cavernous angiomas, MRI is useful in the diagnosis of brainstem cavernous angiomas and should be performed in patients with suspected brainstem tumours.     

Management of cerebral cavernous angiomas in children presenting with seizures

Until recently intracranial cavernous angiomas were thought to be rare vascular malformations that usually presented in adulthood as an intracerebral hemorrhage, an expanding mass lesion, or with the new onset of seizures. Prior to the advent of computed tomography (CT), and more recently magnetic resonance imaging (MRI), their diagnosis in childhood was extremely rare. However, the CT and MRI features of cavernous angioma are quite distinctive and allow early diagnosis and treatment. Advances in surgical techniques permit successful removal of these potentially devastating lesions and amelioration of the associated seizure disorder. Seven children with cerebral cavernous angiomas have been treated at the Children's Hospital Medical Center since 1980. Six children presented with seizures and one with an intracerebral hemorrhage. All had characteristic findings on CT and/or MRI and underwent surgical excision of symptomatic lesions. Intraoperative sonography, electrocorticography, and cortical mapping were used when indicated and were found to be helpful in the surgical management of these patients. Our experience suggests that symptomatic cerebral cavernous angiomas in children are not as rare as previously thought and that surgical treatment using modern neurosurgical techniques is both safe and appropriate and can be helpful in the management of associated seizures.     

Intracerebral cavernous angiomas

We studied 31 patients with histologically verified intracerebral cavernous angiomas. Twenty-two patients were symptomatic; nine were asymptomatic. All 22 symptomatic patients had seizures, three had intracranial hemorrhage, and one had signs of a space-occupying lesion. Twenty-seven lesions were located in the neocortex, three in the brainstem, and one in the cerebellum; all exhibited characteristic gross and microscopic features of cavernous angiomas. CT identified the location and extent of the lesion in 16 of 27 cases. Six of seven lesions demonstrated contrast enhancement, and ten of 27 scans harbored densities consistent with intracerebral calcium. Angiography was performed in 17 cases and was completely normal in eight. MRI revealed mixed signal intensity centrally with a ring of decreased signal intensity peripherally on T2-weighted images and was diagnostic in five cases. Surgical treatment offers an excellent prognosis for seizure control in patients with such lesions.     

Cavernomas of the central nervous system: clinical and neuroimaging manifestations in 47 patients.

Forty seven cases of central nervous system cavernous angioma (21 males and 26 females) are described. The main clinical signs were epilepsy and brainstem syndromes. Digital subtraction intra-arterial angiography, when used, failed to reveal cavernoma. CT detected many of the lesions, but the most successful supplementary diagnostic procedure was MRI which produces highly characteristic images of cavernous angioma. The diagnosis of cavernous angioma was confirmed in the 18 cases in which the tumour was removed surgically.     

脑内海绵状血管瘤的CT及MRI诊断

目的探讨CT及MRI对脑内海绵状血管瘤(cavernous angiomas,CA)的表现和诊断价值。方法收集资料完整经手术病理证实的36例脑内CA患者的CT及MRI资料,重点分析其影像表现特征。结果 CA可位于脑内任何部位,单发病灶多见,周围无或轻度水肿,无占位效应,CT平扫为稍高密度影,钙化占68.7%,增强扫描大都无强化;MRI表现为桑椹状混杂高信号,周围有云絮状低信号环,增强后病灶大都无强化。结论脑内海绵状血管瘤的MRI表现有特异性,MRI对脑实质内CA的检出率优于CT,特别是MRI的T2WI像有助于明确诊断。     

Cavernous and Venous Angiomas of the Central Nervous System,Neuroimaging and Clinical Controversies; Neuroimaging and Clinical Controversies

Cavernous and venous angiomas of the brain are often incidental findings on computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients with unrelated signs and symptoms. Cavernous angiomas can cause hemorrhage or seizures. The venous angioma itself is a developmental anomaly and as such has only a slight predisposition to rupture. Cavernous and venous angiomas have distinct CT and MRI characteristics, which facilitate their diagnosis. No therapy is usually indicated for venous angiomas. On the other hand, extirpation of cavernous angiomas is the usual treatment of choice.     

A case of multiple cavernous angioma with dementia]

We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.