脑干海绵状血管瘤的显微外科治疗

中枢神经系统海绵状血管瘤约占颅内血管畸形的5％．10％，多数发生于幕上，约占75％，脑干海绵状血管瘤约占颅内海绵状血管瘤的20％。目前海绵状血管瘤治疗以手术切除为主，脑干海绵状血管瘤由于部位深在，位于生命中枢，其周围有重要的神经核团和传导束，手术风险大。随着显微外科技术的提高，手术成功率大大提高。我科自2002年至2004年共手术治疗8例脑干海绵状血管瘤，现将结果报道如下。     

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(BSCM)的临床特征及手术治疗的方法与疗效.方法 回顾性分析手术治疗的18例脑干海绵状血管瘤(BSCM)患者,病变位于中脑背侧和背外侧的2例,延髓腹侧和背侧各1例,位于桥脑中脚1例,其余例均位于四脑室底、桥脑背侧.总结影像学特点、手术指征,探讨手术时机、手术入路及手术方法.结果 18例患者均全切除病变,无临床死亡,术前Glasgow Outcom Scale (GOS)评价,5级9例,4级8例,3级1例,无1、2级患者.手术时机多选择于出血后2～4周.手术入路选择:中脑背侧及背外侧者采用经枕下小脑幕切开入路,桥脑中脚选用乙状窦后入路,延髓腹侧病变经远外侧入路,对于四脑室底、桥脑背侧的病变,均采用后颅凹中线入路.术后长期随访按照GOS,显示患者术后恢复5级患者为10例,4级患者7例,3级1例,无2、1级患者.结论 BSCM是可以手术治疗的.严格的掌握手术指征,术前GOS评价,选择合适的手术入路,术中监测和术中精细的手术技巧是手术成功、达到满意疗效的关键.     

显微手术治疗颞叶海绵状血管瘤患者围术期护理

对8例颞叶海绵状血管瘤患者行显微外科手术,均达到良好的治疗效果,未出现癫痫等其他并发症.提出在做好颞叶海绵状血管瘸手术前后常规护理的基础上,进行有针对性的疾病知识健康教育,做好心理护理及特殊检查的护理,术后严密病情观察、药物治疗和不良反应的护理,制订具体、有效、可行的出院后计划,是提高手术成功率,有效控制癫痫症状,减少并发症的重要保证.     

肝脏海绵状血管瘤的外科治疗

肝脏海绵状血管瘤(HCH),肝腺瘤和肝局灶性结节性增生是常见的三大肝脏良性肿瘤。肝腺瘤和肝局灶性结节性增生发病率相对较少,临床治疗方法较统一。肝血管瘤是肝良性肿瘤发生率最高的肿瘤,文献报道大多数HCH随访无变化,对于肝血管瘤的治疗选择上临床争议较大。我院对近10余年手术治疗肝脏海绵状血管瘤114例,现就手术适应证、手术方法等分析报告如下。     

颅内巨大海绵状血管瘤误诊脑膜瘤1例

目的为加深对颅内海绵状血管瘤的认识,增强临床诊断能力,防止类似疾病再次出现误诊误治。方法对临床1例误诊为颅内脑膜瘤的巨大海绵状血管瘤的诊治过程加以分析,并讨论出现误诊的原因,以及对临床救治带来的相应后果。结果因为临床表现不典型,加之急性发病,病情不允许进一步明确诊断,从而导致误诊,并因此造成术中无法将肿瘤全切除。作为急诊手术,治疗已起到缓解颅高压,稳定生命体征作用,为进一步诊治争取了机会。结论临床医生应当充分认识到疾病表现的多样性、复杂性,急诊手术前应尽可能完善各项术前检查,并做好应对术中各种突发情况的准备。     

肝海绵状血管瘤的治疗

文章报告了１９８５￣１９９５年收治的８５例肝海绵状血管瘤患者的治疗经验。其中除１２例因其它合并症未行手术治疗外，余７３例均行手术治疗，并根据肿瘤的不同情况，分别有用不同的手术方式治疗结果满意，其症状，体症均不同程度消失或改善，肿瘤直径缩小，随访０．５￣６年未见再增大。作者体会到，治疗时应根据肿瘤的具体情况，选择相应的手术方式和栓塞材料，文中还阐述了肝海绵状血管瘤治疗的新观念和新进展。     

经皮穿刺射频治疗肝海绵状血管瘤

肝脏海绵状血管瘤是一种较为常见的肝脏良性肿瘤,传统观点认为,手术切除是治疗该症的最好方法。我们应用经皮穿刺多电极射频热损疗法(per-cutaneous multiprobe radiofrequency ablation ther-apy)治疗肝脏海绵状血管瘤,取得良好效果,现报道如下。临床资料1.一般资料:本组病人6例,男1例,女5例,年龄33～56岁,平均42岁,均为 B 超体检发现,病程2～6年,定期检查见病灶皆有不同程度增大趋势,2     

肝脏海绵状血管瘤的外科治疗

目的　探讨肝脏海绵状血管瘤的手术指征和手术方式。方法　回顾性分析手术治疗114例肝脏海绵状血管瘤病人临床资料。结果　 79例采用血管瘤剜除术 (其中 1例合并有Kasabach -Merritt综合症 ) ,2 9例肝叶或肝段切除术 ,5例多发性血管瘤行联合肝段切除术、血管瘤剥离和缝扎术 ,1例采用酒精注射法。结论　对肝脏海绵状血管瘤直径 >6cm并有明显临床症状或患者精神负担较重 ,或合并需手术的其他上腹部外科疾病者选择手术切除 ;直径≥ 10cm随访中有增大或术前与AFP阴性的肝癌鉴别困难者应择期手术     

脊髓海绵状血管瘤的诊断和治疗

目的　探讨脊髓海绵状血管瘤的诊断和治疗方法以指导临床。　方法　回顾分析 2 3例脊髓髓内海绵状血管瘤患者的临床特征、诊断和治疗方法 ,并采用Aminoff&Logue评分标准评价患者术前术后的脊髓功能。　结果　 2例患者拒绝手术而保守治疗 ,2 1例手术治疗 ,术后病理证实为海绵状血管瘤。血管瘤全切除 18例 ,次全切除 3例。术后患者症状好转 15例 ,无变化 4例 ,加重 2例 ,无手术死亡。　结论　MRI对脊髓海绵状血管瘤诊断的特异性高 ,手术治疗效果好 ,有症状者应积极手术。     

Orbital cavernous hemangiomas

Cavernous hemangiomas are the most frequently found primary tumors in the orbital region. They normally appear in adults. Diagnostic features in the majority of cases include protrusio bulbi and orbital enlargement. B-Scan and computed tomography/MRI are the prime diagnostic aids. We recommend surgical removal of these tumors, at least in cases with marked orbital protrusion or significant optic nerve compression. The prognosis is usually good.     

肝门部海绵状血管瘤的动脉栓塞治疗

目的评价经肝动脉栓塞治疗肝门部附近海绵状血管瘤的疗效和价值。方法14例肝门部海绵状血管瘤使用平阳霉素碘化油乳剂+明胶教海绵颗粒经肝动脉栓塞,术后随访3～36月,观察栓塞前、后瘤体的变化,临床症状缓解情况。结果随访期间,14例临床症状明显缓解,瘤体均有不同程度的缩小,在术后12月CT复查时,瘤体直径由术前7.33±1.8cm缩小至3.5±1.7cm(P<0.05),无严重并发症。结论肝动脉栓塞术是治疗肝门部海绵状血管瘤的首选方法。     

Gamma knife radiosurgery for intracranial haemangioblastomas

Summary Background. The results of gamma knife radiosurgery for haemangioblastomas were retrospectively studied to assess the efficacy for tumour growth control and clarify the clinical indications for gamma knife radiosurgery in these tumours. Methods. The medical records of 22 patients with 67 tumours, 12 men and 10 women aged 20–73 years (mean 51.9 years), who underwent gamma knife radiosurgery for haemangioblastomas between January 1993 and January 2006, were retrospectively reviewed. Ten patients with 54 lesions had von Hippel-Lindau disease. The mean tumour volume was 1.69 cm³ (range 0.0097–16.4 cm³). Nineteen patients had undergone 1–4 open surgery procedures (mean 1.5) before gamma knife radiosurgery. Tumours without a cystic component, (the solid type), were found in 54 lesions and tumours associated with cyst, (the mural nodule with cyst type), in 13 lesions. The marginal dose was 8–30 Gy (mean 14.0 Gy). Findings. Follow-up magnetic resonance (MR) imaging was performed at 9–146 months (mean 63 months). The control rate for tumour growth was 83.6%. The only factor affecting tumour growth control was the presence of a cystic component at the time of gamma knife radiosurgery in both univariate and multivariate analysis. No complication such as radiation-induced peritumoural oedema or radiation necrosis occurred. Conclusion. The presence of cystic components at the time of gamma knife radiosurgery was the only factor significantly correlated with unfavourable tumour growth control by gamma knife radiosurgery for haemangioblastomas. Gamma knife radiosurgery is effective for solid type tumours, even if the marginal dose is relatively low. Surgical removal is recommended for mural nodule with cyst type tumours, when possible.     

静脉造影诊断左上肢多发海绵状血管瘤1例

患者女,25岁,以“左上肢掌侧多枚肿块20余年并逐渐长大”为主诉入院。查体：左上肢自腋窝至前臂可见四枚蓝色血管团,隆起于皮肤,     

Response of cavernous sinus hemangioma to radiotherapy: a case report

The author reports a case of a histologically proven cavernous hemangioma of the cavernous sinus and middle fossa, which was treated by radiotherapy. This very rare lesion represents a formidable challenge to the neurosurgeon and its excision has been associated with a considerable mortality rate. The significant reduction in the size of tumor of our patient after radiotherapy and the corresponding improvement in her clinical condition provide further evidence in support of the use of radiotherapy as the first line treatment modality after the histological confirmation of a cavernous sinus hemangioma. Surgery should be reserved for tumors that fail to respond to radiotherapy or recur after an initial good response to radiotherapy.     

肝海绵状血管瘤包膜外剥离术26例临床分析

目的评价包膜外剥离术治疗肝海绵状血管瘤的方法。方法对48例需要手术治疗的肝海绵状血管瘤患者实施了手术,其中包膜外剥离术26例,腹腔镜下肝血管瘤切除7例,开腹肝叶切除术15例。结果实施包膜外剥离术的26例患者肝海绵状血管瘤均被完整剥除,手术平均出血200ml,术后并发症发生率26.9%（7/26）,右侧胸腔积液4例,肝内血肿2例,切口感染1例,经对症治疗后痊愈。结论包膜外剥离术是治疗肝血管瘤的安全有效的方法。     

海绵状血管瘤内压监测指导栓塞及硬化剂注射治疗

为探讨在栓塞硬化海绵状血管瘤中瘤腔内压变化规律及其意义,在29例治疗过程中结合机械性减缓瘤体静脉回流,进行了瘤腔内压连续监测。发现:瘤腔基础内压为0.667～2.0kPa(1kPa=7.5mmHg),颈部最低;回流快者所需栓塞次数多,用量大;瘤腔内压力曲线在栓塞初始为平台波形,提示回流静脉逐一被栓塞;随后出现缓慢下降的钝峰波形,去除瘤体体表浅回流静脉机械性压迫,瘤腔内压不变,提示回流静脉全部栓塞,可注射硬化剂;最后为快速下降的锐峰波形,表明全瘤体已被栓塞硬化。治疗29例,随访半年至3年,26例完全消退,3例复发,未见严重并发症。本法设备操作简便,疗效高,并发症少。     

Gamma knife radiosurgery for tumors involving the cavernous sinus

OBJECTIVE: To study the features of diagnosis and radiosurgery of tumors involving the cavernous sinus. METHODS: From December 1994 to the end of 2000, 175 patients with cavernous sinus lesions were treated by Leksell gamma knife (GK) in our Institute. Ninety patients (51.4%) had had open surgery previously. Our experience of treating cavernous sinus tumors by GK was analyzed retrospectively. RESULTS: A Hundred and forty-four (82.3%) patients were followed from 1 to 84 months (median 32.5 months); total tumor control rate was 94%. Surgery was performed after radiosurgery in 3 patients because of tumor enlargement. Metastatic tumor in the cavernous sinus was highly sensitive to irradiation. These lesions shrunk markedly on MRI 2-3 months after GK surgery. The median survival time was 12.2 months, and patients died of noncavernous sinus lesions. CONCLUSION: With high tumor control rate and few complications, GK surgery could become a main option for small benign or residual tumors involving the cavernous sinus. It is also very useful as part of comprehensive therapy for metastatic tumors in the cavernous sinus.