囊性脑膜瘤19例诊治分析

目的 对囊性脑膜瘤的临床特点、影像学表现及其成因进行探讨研究.方法 回顾性分析19例颅内囊性脑膜瘤的临床表现、影像学特征及手术经验.结果 囊性脑膜瘤多位于大脑凸面,多数表现为实性肿块伴大小不等的囊样区,其实质部分明显强化.少数表现为囊性,囊内见实质结节,结节明显强化,而囊壁有或无强化.19例患者肿瘤全切除17例,次全切除2例,无手术死亡.结论 囊性脑膜瘤有特殊的影像学表现, CT和MRI在诊断中具有重要价值.手术应在不损伤神经功能区的前提下全切除肿瘤及囊壁以防止复发.     

囊性脑膜瘤

囊性脑膜瘤临床少见。其分型、影像学表现、囊液成因及手术治疗等问题一直存在争议，术前及术中诊断困难。术中囊壁处理是否合理决定了术后的疗效。本文通过对相关文献，尤其是手术治疗和囊液成因方面的争议进行回顾性分析，以进一步加深对该病的认识，为临床诊断和治疗提供参考。     

类胶质细胞瘤的囊性脑膜瘤二例

例1 女性，61岁。患者左半身不完全运动性癫痫3个月。神经系统检查显示左半身不全瘫痪，肌力Ⅳ。余神经系统检查正常。脑CT显示右顶部低密度团伴有周边水肿。强化MRI，T1加权像提示右顶凸面囊性肿瘤伴有环状强化，冠状位和矢状位影像显示一小结节毗邻脑膜。术前诊断转移瘤。术中发现一小的红色结节略附着硬膜，肿瘤为一个含有黄色液体的囊肿，完整切除整个囊壁。病理学和免疫组化检查表明病变为囊性脑膜瘤。术后病人恢复良好。     

与侧脑室相通囊性脑膜瘤1例

1病例资料男性,47岁。因“阵发性头痛,头晕20余天”行CT检查示左额叶蛛网膜囊肿。当地医院诊断为“蛛网膜囊肿”。行MR检查示左额叶侧脑室额角前囊性病变,星形细胞瘤不能排除后入我院,查体未见任何明显阳性体征。全麻下行左额开颅肿瘤切除术。术中在显微镜下见肿瘤位于囊壁内侧(约0.5cm×0.8cm),质韧,灰红色,部分钙化。囊液透明清亮,囊壁呈蛋黄色瘤质改变,后部与侧脑室相通。全切除肿瘤实质及囊壁,明胶海绵覆盖侧脑室相通处。病理报告:脑膜瘤伴大量砂粒体形成。患者术后痊愈出院。2讨论囊性脑膜瘤发病率很低,占全部颅内脑膜瘤的2%～4?rv…     

囊性脑膜瘤的诊治分析

目的 总结囊性脑膜瘤的治疗经验。方法 回顾性分析2007年1月至2018年1月手术治疗的13例囊性脑膜瘤的临床资料。结果 根据Simpson分级，Ⅰ级切除7例，Ⅱ级切除6例。术后病理显示均为脑膜瘤，其中上皮细胞型6例，过渡型3例，纤维型2例，血管型2例。术后随访0.5~11年，平均5.3年；1例复发；1例中残；其余11例均预后良好。结论 对于囊性脑膜瘤，在手术安全前提下，尽量全切肿瘤及囊壁，并根据术后病理，决定是否放疗，多数病人可取得良好预后。     

囊性脑膜瘤(附14例报告)

目的对囊性脑膜瘤的临床特点进行探讨。方法总结１９９６年１月至１９９７年８月收治的１４例颅内囊性脑膜瘤的临床经验。结果１４例患者肿瘤全切除１３例,次全切除１例,无手术死亡。结论脑膜瘤由于急性囊变,引起严重的临床症状,加速了病情发展,往往误诊为其它性质的病变。ＭＲＩ对诊断囊性脑膜瘤很有价值,但不能明确分型。病理变化包括急性出血性坏死和慢性缺血性变化。囊性脑膜瘤手术时在不损伤神经功能区的前提下,不仅切除肿瘤结节,还应彻底切除囊壁以防止复发。     

脑膜瘤复发因素的术前评估及对策

目的 探讨脑膜瘤复发的相关因素，做到术前预测，为选择合适术式提供依据。方法 对125例脑膜瘤患的术前CT／MRI等影像学资料进行回顾性研究，将可能影响脑膜瘤复发的相关因素进行统计学分析，发现其中规律。结果 脑膜瘤的密度、形状与复发密切相关。结论 密度不均匀且较低、界限不清伴瘤周水肿的脑膜瘤及扁平形脑膜瘤明显易复发；肿瘤附着点处硬膜的广泛切除是防止脑膜瘤复发的关键。     

颞叶横纹肌脑膜瘤钙化1例

目的总结横纹肌脑膜瘤的临床病理、影像学特征及手术方法。方法回顾性分析1例经影像学、手术和病理证实的横纹肌脑膜瘤患者的临床、病理资料及术后随访结果。术前CT示右侧颞叶不规则团块状高密度影,其内可见钙化灶,病灶周围可见水肿带。术前MRI示右侧颞叶斑片状稍长T1、短T2信号,增强扫描病灶轻度不均匀强化。结果采取大骨瓣开颅切除肿瘤,肿瘤完全切除。术后病理诊断右颞部横纹肌样脑膜瘤伴变性。结论影像学诊断横纹肌脑膜瘤易出现误诊,确诊需依靠病理学检查。手术设计切口和骨瓣时要足够大,要将钙化全部暴露在骨窗范围内,否则钙化很难完整切除,术中应用磨钻和咬骨钳配合切除肿瘤。     

小脑空洞症一例

患者 男,38岁。头痛伴行走不稳6个月入院。入院检查:言语不流利,呈“暴发式”言语,颅神经无损害,指鼻试验和跟膝胫试验过限。经皮股动脉插管选择性脑血管造影提示右侧小脑半球占位,未见明显肿瘤染色。CT 扫描检查提示右侧小脑半球囊性占位,诊断小脑血管网织细胞瘤。经术前准备后在全麻下开颅探查,术中发现肿物位于小脑半球内,穿刺后抽得15ml淡绿色稍粘稠囊液,切开肿瘤囊壁仔细探查未发现肿瘤结节,囊壁内面光滑,遂将囊壁全切,同时切除部分     

桥脑小脑角囊性脑膜瘤8例报告

目的总结桥脑小脑角(CPA)囊性脑膜瘤的诊治经验。方法回顾性分析8例CPA囊性脑膜瘤的影像学资料、手术方法及治疗效果。结果肿瘤全切除5例,次全切除3例。术后病检显示上皮性脑膜瘤4例,血管型3例,混合型1例。术后均恢复良好,无死亡病例。结论 CPA囊性脑膜瘤的显微手术切除效果好,如何达到全切除以及神经功能的保护仍需进一步的研究。     

Cystic meninigioma.

To study the clinical characteristics of cystic meningiomas, we analyzed retrospectively 21 patients with cystic meningiomas and reviewed the literature with regard to clinical presentation, imaging features, preoperative diagnosis, surgical findings, and histopathological results. The cysts were classified into intratumoral and peritumoral cysts based on their relationship to the tumor, and also according to the classification method described by Nauta. For the 21 patients in our group, there were seven peritumoral cysts and 14 intratumoral cysts. Various pathophysiological mechanisms contribute to the formation of cystic meningiomas. The diagnosis of cystic meningiomas based on CT scan can be problematic, and differentiation from glioma or metastasis may be difficult. MRI scans show low signal intensity areas within the mass on T1-weighted images and high signal intensity areas on T2-weighted images, and the solid parts of tumors are contrast-enhanced after gadolinium administration. MRI with gadolinium enhancement dramatically increases the diagnostic accuracy for cystic meningiomas and provides critical information for their surgical care. Total surgical resection of cystic meningioma is ideal, but special attention should be paid to the cyst walls.     

不同病理类型脑膜瘤的MRI特点及其临床意义

目的 分析不同病理类型脑膜瘤的MRI特点.方法 回顾性分析经手术和病理证实的428例脑膜瘤手术患者的病理类型;病理类型参照WHO 2007年版中枢神经系统肿瘤分型,利用PACS影像系统分析其MRI特点.结果 脑膜皮细胞型多为稍高或等T1、高T2信号,信号均匀;混合型可出现多种信号组合,内部不均匀;纤维型T1、T2多为等或稍低信号,信号均匀;砂粒体型多为低T1、T2信号,有时见到团状或斑块样信号;其他良性脑膜瘤少见,多为低或等T1信号,稍高T2信号;非良性脑膜瘤信号特征类似,多为低或等T1信号,稍高T2信号,内部囊变坏死多见,增强扫描强化不均匀.结论 不同病理类型脑膜瘤在MRI上信号表现有所不同.分析MRI信号特点,对术前判断肿瘤病理类型及术中肿瘤切除方式的选择有意义.

Abstract：

Objective To explore the characters of different types of meningiomas on MRI and the significance for surgical treatment.Methods The clinical data of 428 patients with meningiomas underwent surgery in Southern hospital from January 2000 to January 2010 were analyzed retrospectively.The pathological types of meningiomas were identified according to WHO 2007 edition.The characters of meningiomas on MRI were analyzed by PACS software.Results The MRI images of meningothelial type were slightly high or equal signal on T1 image and high signal on T2 image; the images of transitional( mixed)type on MRI were different and the signals were hybrid.The signals of fibrous type were slightly low or equal on both T1 and T2 and homogeneous.The signals of psammomatous type were low on both T1 and T2, and sometimes cystic degeneration and necrosis were found within tumors.The rest of benign meningiomas were rare and usually showed low or equal signals on T1 image and slightly high signals on T2 image.The signals of non - benign meningiomas were mostly low or equal on T1 image and slightly high on T2 image, and cystic degeneration,necrosis and heterogeneous enhancement were common to be seen.Conclusions Specific characteristics on MRI could be seen in different types of meningiomas.The knowledge of their correlations is helpful for preoperative diagnosis and surgical treatment in patients with meningiomas.     

术前栓塞在巨大脑膜瘤手术中的应用

目的探讨完全以颈外动脉供血或以颈外动脉供血为主的巨大脑膜瘤术前栓塞治疗的临床效果。方法对18例术前经全脑血管造影证实为完全以颈外动脉供血或以颈外动脉供血为主的巨大脑膜瘤,采用明胶海绵栓塞肿瘤供血动脉,栓塞后7d内行手术切除肿瘤。结果栓塞后11例肿瘤染色完全消失,7例肿瘤染色大部分消失。17例栓塞后5～7d顺利实施手术切除肿瘤,1例栓塞后24h内行急诊手术切除肿瘤。术中肿瘤出血减少,所有肿瘤均经手术全切。术后病理观察到肿瘤不同程度的坏死,但有2例栓塞后肿瘤染色消失,而术中肿瘤出血仍较多,且术后病检未发现坏死。术中和术后无严重并发症出现。结论完全以颈外动脉供血或以颈外动脉供血为主巨大脑膜瘤术前栓塞可使术中出血减少,提高手术安全性和肿瘤全切率。     

Intracranial cystic meningiomas: A series of six patients

ObjectiveAlthough meningiomas are the most common primary non-glial intracranial tumors, cystic meningiomas are quite rare. This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas.Patients and methodsSix patients with cystic meningiomas were included in the study. All patients underwent a cranial computed tomography scan and magnetic resonance imaging (MRI) evaluation, pre- and postoperatively.ResultsAll patients presented with long standing headache dating back at least two years. There was no gender predominance in our series. Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region. Two lesions were located at the tuberculum sellae and the foramen magnum. All of the tumors were totally excised (Simpson Grade I or II). Pathology results included meningothelial meningioma in three patients, angiomatous meningioma in two patients, and metaplastic meningioma in one patient. In two patients, the cystic meningiomas were resected with the use of sodium fluorescein (Na-Fl) under a YELLOW 560 nm microscope filter. Na-Fl was found to be very useful in demonstrating the brain–tumor interface, and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas. None of the patients had any complications, and no recurrences were noted in any of the patients within the mean follow-up period of 51 months (range: 16–102 months).ConclusionIt is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions. The use of sodium fluorescein (Na-Fl) under a YELLOW 560 nm microscope filter is a useful tool to differentiate the brain-tumor interface, as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results.     

颅内共存肿瘤的诊治分析（附4例报道并文献复习）

目的 探讨颅内共存肿瘤的诊断、治疗及预后。方法 回顾性分析4例颅内共存肿瘤的临床资料,并复习相关文献。结果 3例行手术治疗,病理证实为脑膜瘤合并垂体腺瘤、颅咽管瘤、胶质瘤各1例,均与术前影像诊断一致,术后正常生活;1例术前考虑为脑膜瘤合并胶质瘤,未行手术治疗。结论 颅内共存肿瘤需进行充分的术前评估,大多可明确诊断,设计合理的手术方案,可获得良好的治疗效果,其预后主要取决于病变性质     

超选择性栓塞联合显微手术治疗巨大脑膜瘤

目的 探讨巨大脑膜瘤术前栓塞方法、效果及联合显微手术治疗的优势。方法 自2013年11月至2014年12月收治颅内巨大脑膜瘤9例,术前应用超选性栓塞肿瘤供血动脉,栓塞术后3 d内显微手术切除脑膜瘤。结果 9例巨大脑膜瘤中,术前达到完全栓塞4例,大部分栓塞5例,无误栓等并发症;Simpson 1级切除5例,2级切除4例。术中出血均在500 ml以内,术中均未输血。术后1 d复查MRI示肿瘤完全切除。结论 颅内巨大脑膜瘤血供丰富,术前超选择性栓塞联合显微手术治疗,可显著减少术中出血,提高肿瘤切除率,减少并发症,显著降低围手术期风险。     

Intracerebral cyst associated with meningioma

A 27-year-old male had experienced an episode of severe headache and nausea, sometimes accompanied by an inability to name objects. Magnetic resonance imaging showed a huge cyst within the left temporal lobe and a high degree of brain shift by it. A small round mass, which appeared to be a mural nodule, was located in the tip of left middle fossa. It was highly enhancing together with its attached dura mater, but the cyst wall was not enhanced. Sphenoid ridge meningioma with an associated intracerebral cyst or cystic glioma invading the dura mater was suspected. During surgery the small tumor was found to be arising from the sphenoid ridge and evaginating into the tip of the temporal lobe. The intracerebral cyst had a smooth surface and the tumor was visible outside the cyst through its wall. The tumor was totally removed, but the cyst wall was left without excision. Postoperatively he had no symptoms. Histological examination showed a microcystic meningioma. It is stressed that differentiations of cystic meningiomas from other cystic tumors and, of intratumoral from extratumoral cystic meningiomas using radiological, operative or histological findings are important.     

前颅底及颅鼻眶沟通脑膜瘤切除及颅底重建探讨

目的探讨显微手术切除前颅底脑膜瘤的手术入路选择以及颅底重建的适应证。方法经头颅CT或MRI扫描确诊,据肿瘤大小、部位选择不同的入路,显微镜下切除肿瘤并行颅底修复重建。本组颅底脑膜瘤110例,经额颞眶颧联合入路切除35例,经额鼻筛眶入路38例,经翼点入路切除4例,经冠状开颅切除33例。结果镜下全切除肿瘤88例,次全切除17例,大部分切除5例。临床痊愈85例,好转23例,死亡2例。随访79例,肿瘤复发5例,行第二次手术切除,死亡5例,余恢复良好。结论根据肿瘤的大小、部位选择不同的手术入路,显微镜下切除前颅底脑膜瘤及必要时颅底修复重建是一种安全、有效的治疗方法。     

Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors

In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.