颅骨血管瘤6例并文献复习

目的探讨颅骨血管瘤的临床特征、影像学特征、病理特征及治疗方法。方法回顾性分析经手术后病理学证实的6例颅骨血管瘤的临床资料。结果 CT示6例病灶均为单发1例示多发条状骨嵴样结构,部分骨质破坏区突破皮质向邻近头皮软组织内膨隆;其余5例示病灶膨胀性溶骨性骨质破坏。6例病灶全切。术后失访1例,其余5例随访,预后良好。结论颅骨血管瘤临床少见,影像学具有特征性表现,术后病理检查易确诊。手术全切病灶预后良好。     

颅骨海绵状血管瘤手术治疗临床分析

目的探讨原发性颅骨海绵状血管瘤的临床表现、影像学特征、病理学特点及治疗措施。方法回顾分析6例原发性颅骨海绵状血管瘤患者的临床资料;并结合文献对其临床表现、影像学特点、治疗方法进行分析。结果本组患者的原发性颅骨海绵状血管瘤为单发,临床症状各异。头颅CT表现为肿瘤呈"日光放射征"改变,周边骨质硬化。头颅MRI示,肿瘤呈T_1WI不均匀中-高信号,T_2WI不均匀高信号,增强扫描不均匀强化。手术切除包括肿瘤在内的颅骨及周边硬化颅骨后,患者的临床症状均消失,预后良好。术后病理检查示,病变表现为蜂窝状肿块,由充填有多量血细胞的囊状血管组成。结论原发性颅骨海绵状血管瘤较为罕见,手术治疗效果确实可靠;术后病理检查为其最终确诊的有效手段。     

颅骨海绵状血管瘤影像及病理分析

目的探讨颅骨海绵状血管瘤的影像、病理学特点及手术疗效,以提高对该病的诊治。方法回顾性分析10例经病理证实的颅骨海绵状血管瘤的临床及影像学资料及手术疗效,并复习文献。结果 8例位于额骨,顶骨及枕骨各1例,X线平片表现为边界清楚的类圆形低密度影。CT平扫表现为高密度或稍高密度,骨窗位常呈特征性的蜂窝状或日光放射状的溶骨性改变。MRI信号特点复杂,MRI平扫表现为高低信号混杂影为主,增强后不均匀强化。9例患者行病变扩大切除术加钛网修补术,1例行病变扩大切除术。肉眼见病变呈暗红色,突出颅骨表面;镜下见大量囊状扩张的壁薄血管,血管腔内被血细胞填充,组织分化成熟。随访3至24个月无复发。结论颅骨海绵状血管瘤影像学表现具有一定特征性,对于单发病灶,行扩大整块切除加一期颅骨缺损修补术治疗效果满意。     

脊椎血管瘤的影像学诊断15例分析

目的 探讨脊椎血管瘤的影像学表现特征,评价其诊断价值.方法 回顾性分析15例经临床及手术病理证实的脊椎血管瘤的X线、CT及MRI表现,并找出其特点.结果 X线片可见椎体呈典型的“栅栏状”改变;CT可见“网眼状”影像中夹杂着低密度脂肪;MRI T1 WI呈混杂高低信号,T2WI为高信号,并随回波时间延长信号逐渐变亮.CT二维重建及MRI冠、矢状位可更好的显示病变椎体断面的“栅栏状”征象.结论 脊椎血管瘤具有影像学特征性表现,MRI在鉴别诊断方面优于X线、CT.     

脑海绵状血管瘤的影像表现

目的 探讨脑海绵状血管瘤的影像表现。方法 脑海绵状血管瘤58例全都作MRI检查,其25例曾作DSA和48例曾作CT检查。分析脑海绵状血管瘤的影像表现。结果 脑海绵状血管瘤DSA常呈阴性,CT的敏感性和特异性有欠缺,而MRI有较高的敏感性和特异性。结论 MRI对脑海绵状血管瘤有重要的临床诊断价值。     

颅骨硬纤维瘤一例报告并文献复习

目的探讨颅骨硬纤维瘤(desmoplastic fibroma,DF)的临床、病理、放射学特征及治疗方法。方法报告1例颅骨硬纤维瘤病例,结合文献探讨该疾病的临床特点、放射学特征、病理表现、治疗及预后。结果颅骨硬纤维瘤在临床上极为罕见。X线和CT表现为溶骨性破坏,形成均匀一致或泡沫状的软组织包块,MRI T1加权像表现为中等信号或低信号,有明显增强效应,T2加权表现为低信号,局部区域为高信号。病理学特点:胶原纤维构成病灶的主要成分,其中分布有长梭形或圆胖形的纤维细胞,无异形性,没有有丝分裂像,可与其他恶性肿瘤相鉴别。本病有复发和转移倾向,手术应彻底,可配合放射治疗和内分泌治疗。结论颅骨硬纤维瘤是一种局部侵袭性较强的病变,应结合CT、MRI和病理学特点诊断本病,最好的治疗措施为手术全切,根据激素受体水平考虑内分泌治疗,可减少复发。     

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。     

颅骨骨纤维结构不良的诊断和治疗

目的探讨颅骨骨纤维结构不良的诊断和治疗。方法回顾性分析33例经病理证实为颅骨骨纤维结构不良病例的临床资料．探讨其手术原则及其疗效。结果33例颅骨骨纤维结构不良患者中,男13例,女20例;年龄6-58岁,其中小于18岁者15例。该病常见累及额骨、筛骨、蝶骨,其主要临床表现为头痛、局部肿物、眼球突出、视力障碍、面部畸形等。X线平片及CT检查主要表现为局部骨密度增高,出现占位效应。病灶位于颅骨一侧皮质者,边界清楚,可有硬化;而病灶在骨髓腔内者,则多边界不清。CT增强扫描可见病灶明显强化,密度不均匀。MRI检查骨纤维结构不良信号呈多样性,无特异性,因此MRI对其的诊断意义不大。术后随访．33例患者经手术治疗后临床症状均有改善,2例复发。结论该病多见于儿童和青少年,女性较男性多见。外科手术为颅骨骨纤维结构不良的主要治疗手段,早期积极手术可使骨质愈合良好,缓解症状,改善预后。     

颅骨海绵状血管瘤20例分析

目的探讨颅骨海绵状血管瘤影像学像特点、临床表现以及治疗。方法回顾性分析20例经病理证实的颅骨海绵状血管瘤的临床资料,均采用手术治疗。结果 20例术后随访2~24个月,平均15个月。19例痊愈,无手术相关并发症;1例额部病变随访2年,颅脑CT发现原病灶位置肿瘤复发。结论颅骨海绵状血管瘤为良性肿瘤,预后良好;根据病变临床特征和典型的"日光放射"影像学特点可以考虑该诊断,确诊以病理为主。手术为首选治疗方案,术后可复发,应加强随访。     

磁共振血管成像对成年人烟雾病的诊断价值

目的 探讨磁共振血管成像(MRA)对成年人烟雾病的诊断价值.方法 对20例成年人烟雾病患者进行DSA和MRI、MRA检查.结果 DSA检查显示20例患者均有颈内动脉系统末端狭窄或闭塞及脑基底部烟雾状血管网形成.MRI显示11例为缺血性病变,9例为颅内出血性病变.MRA显示20例患者均有脑动脉狭窄或闭塞,16例(80%)见丘脑-基底节区有烟雾状的异常血管网,异常血管网检出率与DSA相比差异无统计学意义.结论 MRA可以显示成年烟雾病患者脑动脉狭窄或闭塞及脑内异常血管网,且无创伤性,对成年人烟雾病有较高的诊断价值.     

A case of calvarial aneurysmal bone cyst: transcranial contrast sonographic examination with pulse inversion harmonic imaging method]

A 31-year-old female came to our hospital complaining of left frontal bulging with pain on 10 August 2000. The head x-p showed a radiolucent lesion and bulging at the same calvarial site. CT scan and MRI showed fluid-fluid levels, diploic cyst, deformity and hypertrophic calvarial change. There was a partial hypervascular part of cyst adjacent to the left frontal base by selective left external carotid angiography. Harmonic image is a contrast specific imaging modality that uses the nonlinear properties of contrast agents by transmitting at the fundamental frequency and receiving at multiples of these frequencies. Pulse inversion harmonic image(PIHI) using pulse inversion to eliminate and strengthen the harmonic frequency is more effective than conventional harmonic imaging. Transcranial sonographic examination showed hyper- and hypoechoic appearances in the cyst around abnormal hyperechoic appearances of the calvarial site. The transcranial contrast sonographic images with PIHI (hereinafter TCIpi) demonstrated an enhanced intracystic lower stratum and nearby the diploic part. That modality facilitates better visualization than the harmonic imaging method, enabling differentiation of vascular from avascular areas. As contrast agents are microbubbles, those are restricted in the vascular canal space. So TCIpi findings proved to be a blood circulation of the tumor, cyst and neighboring tissue. Enhanced areas changed by every minute and disappeared gradually. The findings were probably based on the vascular component of the tumor. We obtained images similar to those with CT and MRI. The patient underwent on 21 August. The tumor was removed along with the surrounding skull component. Fresh and old blood were mixed in the cyst. The clinical and pathological diagnosis was aneurysmal bone cyst. The postoperative course was uneventful and she was discharged on 29 August. Aneurysmal bone cyst is a rare calvarial tumor. An diagnostic finding is fluid-fluid levels that appear in approximately 30% of aneurysmal bone cysts. However, this is not a specific finding and has also been reported to occur in osteosarcoma, malignant fibrous histiocytoma, fibrous dysplasia, synovial sarcoma, hemangioma and simple bone cyst. Therefore, diagnosis of aneurysmal bone cyst is based on a combination of the various imaging applications, clinical and pathological findings. Gometz reported that sonographic examination was superior to any diagnostic imaging studies for aneurysmal bone cyst. Furthermore, the perfusion examination like TCIpi can directly observe blood circulation channels in tissue, so the specific enhancement changes of aneurysmal bone cyst could be observed. TCIpi is a useful method for diagnosis of aneurysmal bone cyst.     

DSA、CT与MRI融合影像对颅内多发假性动脉瘤的诊治价值（附1例报告并文献复习）

目的 报告1例通过DSA、CT与MRI融合影像联合神经导航诊治颅内多发假性动脉瘤患者的手术经验及体会。方法 回顾性分析1例外伤性颅内多发假性动脉瘤患者的临床资料,包括病史、症状、体征、影像学检查、手术过程及病理结果,总结DSA、CT与MRI融合影像对颅内多发假性动脉瘤的诊治价值及临床应用。结果 患者为25岁女性,车祸多发伤入院,经术前DSA检查为左侧大脑前A2段及胼周动脉多发假性动脉瘤,术前经3D-DSA与CT融合影像确定出血责任动脉瘤,经3D-DSA与MRI融合影像解决了精确定位,在神经导航指引下,一期手术完成了两个动脉瘤夹闭并切除。经病理证实为外伤性假性动脉瘤。结论 DSA与CT融合图像可以帮助判定多发动脉瘤中出血的责任动脉瘤,DSA与MRI融合图像输入神经导航为脑深部不能行介入栓塞治疗的颅内动脉瘤开创了新方法。     

Primary intraosseous hemangioma of the orbit: report of two cases

Primary intraosseous hemangioma, though rarely affect the bones of the orbit, should be considered in the differential diagnosis when a patient presents an enlarging mass fixed to the bone in the orbit or signs of progressive painless proptosis. Assessing the exact site and extent of the hemangioma by means of a CT scan and MRI and establishing the vascular origin of the lesion, is critical in the therapeutical planning, since an inadequate management may result in a severe hemorrhage. Progressive proptosis and contour deformity require surgical treatment. Two cases of patients with primary intraosseus hemangioma of the supra-lateral orbital rim are reported. A bony healthy margin excision was performed, followed by immediate reconstruction of the orbit with calvarial bone grafts fixed with resorbable plates. After three-year follow-up there have not been evidence of local recurrence, and the functional and aesthetic results obtained have been very satisfactory.     

Melanotic progonoma of the skull in infancy

Introduction  Melanotic progonoma or melanotic neuroectodermal tumor is a rare tumor in infancy. This lesion has to be considered in the differential diagnosis of benign or malignant lesions of calvarium. Case report  The authors present a case of a 4-month-old infant with left retroauricular mass. The patient had a subcutaneous mass that is fixed to the underlying skull. CT and MRI scans showed left occipitotemporal expansile mass. The tumor was removed by surgery. A tumor, brownish-black in color, was diagnosed as melanotic progonoma. The patient remained symptom-free for the last 2 years after complete surgery. Discussion  Extracranial subcutaneous masses involving the skull are uncommon in infants. Benign or malignant lesions may occur as lumps on calvarium. Physical examination and some laboratory findings are helpful in the assessment of patient. Benign or malignant lesions can be differentiated by craniography, CT, or MRI scans, but exact diagnosis of melanotic progonoma is made by histopathology and immunostaining, as was in the presented case. Cranial vault progonomas have a better outcome by complete surgery. The tumors usually do not recur in long-term period.     

两次DSA阴性的颅内破裂动脉瘤1例报道并文献复习

目的 报告1例经两次全脑、全程血管造影阴性的破裂小脑后下动脉动脉瘤患者诊治经验。方法 回顾性分析1例颅内破裂动脉瘤病人的临床资料,包括症状、体征、影像学检查、手术过程及病理结果,分析其脑血管造影阴性的原因。结果 患者为21岁男性,以突发头痛起病,外院头部CT示蛛网膜下腔出血,但脑血管造影未发现动脉瘤,头部MRI检查怀疑脑干背侧海绵状血管瘤。转入我院后,复查全脑、全程血管造影仍然为阴性,复查头部MRI检查再次怀疑海绵状血管瘤并行开颅手术治疗,术中于小脑延髓裂发现病变为豌豆大小。呈结节状,有供血动脉进入口和输出口,术后病理证实为动脉瘤内血栓形成并机化。术后病人恢复良好。将MRI影像与3D-DSA影融合后,发现病变旁有小脑后下动脉通过,考虑为动脉瘤出血后继发血栓形成而闭塞。结论 脑血管造影虽然是颅内动脉瘤诊断的金标准,但是两次脑血管造影阴性仍然不能完全排除颅内动脉瘤,其中原因之一就是动脉瘤出血后继发血栓形成。     

海绵窦海绵状血管瘤的影像特点

目的 探讨海绵窦海绵状血管瘤(CSCH)的影像学特点.方法 回顾性分析17例经手术病理证实的CSCH的影像表现,其中男3例,女14例,平均47.4岁;均行MRI平扫及增强检查;8例行CT检查,其中3例加做CT增强扫描.结果 17例CSCH的影像表现如下:(1)常见于中年女性,呈"哑铃形"或"葫芦状",边缘清晰,有占位效应,很少出现瘤周水肿、瘤内出血及钙化.(2)T1WI呈低信号,T2WI呈高信号,信号均匀,增强后明显强化;T2WI高信号及出现延迟强化效应为其特征.(3)CT表现为高密度,明显强化.可有临近骨质的压迫性吸收,无骨质增生.(4)DSA显示血管正常或出现静脉期染色.结论 CSCH有比较典型的影像表现特点,结合临床病史,有助于术前诊断.     

Neo-Adjuvant Chemotherapy Followed by Surgery for Extensive Calvarial Metastases of a Neuroblastoma

Neuroblastoma is a common tumor of children. We report a patient with extensive calvarial metastases of a neuroblastoma as an initial presentation. A 2-year-old girl presented with a history of gradually increasing head size and fever. A brain CT showed a multilobulated, large, extra-axial tumor involving both frontotemporoparietal areas with a sunray-spiculated hyperostosis of the skull and marked contrast enhancement. A brain MRI demonstrated extensive calvarial lesions with simultaneous involvement of the orbits. A biopsy was performed and a ganglioneuroblastoma was diagnosed. On systemic evaluation, an enlarged abdominal mass was detected. After neo-adjuvant chemotherapy, most of the tumors disappeared except for a tumor in the left parietal area; there was a corresponding decrease in the circumference of the head. We performed surgery for the remnant mass. Intensive chemotherapy was administered and a bone marrow transplantation was performed. Adequate neo-adjuvant chemotherapy followed by surgery to the neuroblatoma with extensive metastases to the skull and orbit may be helpful.     

Benign Osteoblastoma Located in the Parietal Bone

Benign osteoblastoma is an uncommon primary bone tumor, extremely rare in calvarium. We present a case of a 25-year-old female with an osteoblastoma of parietal bone which was totally resected. The authors discussed the clinical presentation, radiographic finding, differential diagnosis and management of the benign calvarial osteoblastoma with a review of the literature.