颅内软骨瘤的诊断与治疗(附七例报道)

目的探讨颅内软骨瘤的临床特点及诊断与治疗原则。方法对1979-2004年我科收治的7例颅内软骨瘤患者的临床特点、影像表现及治疗方法与预后情况进行分析。结果7例颅内软骨瘤占本科同期收治的6303例颅内肿瘤的0．11％。本病多见于青壮年，病程2个月至10年。6例肿瘤位于颅底部中线旁硬膜外，并出现1例罕见的额顶部软骨瘤。6例颅底部肿瘤见骨质破坏与钙化，CT呈不均匀混杂密度影，2例有轻度强化；3例MRI显示T1WI呈低或混杂信号、T2WI呈高及混杂信号。肿瘤质地较硬。与重要神经血管相邻．不易全切除。2例病理报告肿瘤生长活跃，均复发。结论颅内软骨瘤发病率低，病程长，多见于颅底部中线旁，多见骨质破坏与钙化。诊断时需要与脑膜瘤、颅咽管瘤及脊索瘤相鉴别。颅内软骨瘤的治疗原则为手术切除，颅底部软骨瘤不易全切除。     

少见部位颅内软骨瘤的影像特点

目的 总结少见部位的颅内软骨瘤的影像学特点.方法 南方医科大学珠江医院和南方医院放射科自2010年2月至2011年4月共收治经手术和病理证实为大脑凸面及大脑镰颅内软骨瘤患者6例,其中大脑凸面3例,大脑镰区3例,回顾性分析其临床表现和影像学资料.结果 患者CT显示肿瘤边缘清楚,5例可见数量不等钙化,相邻骨质受累2例;MRI显示病灶呈混杂信号,其中肿瘤实质部分呈长T1、长T2信号,钙化部分呈长T1、短T2信号,肿瘤出血为长T1、短T2信号;其中3例可见特征性的“皂泡征”;MRI增强扫描显示1例明显强化,3例轻度强化,2例无明显强化.结论 发生于大脑凸面及大脑镰的颅内软骨瘤罕见,术前误诊率高,结合肿瘤体积较大、多发钙化、可见“皂泡征”、增强扫描无或轻度边缘强化等特征,可对其做出影像学诊断,但最终确诊仍需病理检查.     

颅内软骨瘤的显微手术治疗（附8例分析）

1对象与方法1999—2007年,我院收治经术后病理证实的颅内软骨瘤8例,其中男5例,女3例;年龄21-60岁,平均31．7岁。病程5个月～14年,平均5．2年。病人均有不同程度头痛,其中癫痫2例,视力下降1例,一侧肢体无力1例,视野缺损2例,复视1例,     

巨大颅内动脉瘤显微直视手术治疗

巨大颅内动脉瘤显微直视手术治疗李龄，刘绍明，刘承基早在十八世纪末人们就已发现颅内巨大动脉瘤，在对颅内动脉瘤进行外科治疗的早期尝试中很多病例也都与巨大动脉瘤有关。但直到本世纪五十年代，通过国际协作研究才开始把颅内动脉瘤按大小进行分类，把动脉瘤最大直径＞...     

颅内恶性黑色素瘤的显微外科治疗:二例报告及文献复习

颅内原发性恶性黑色素瘤是中枢神经系统罕见肿瘤,而颅内继发性恶性黑色素瘤则是临床常见的居第3位的颅内转移瘤,恶性程度高,患者预后不良,其诊断和治疗一直是神经外科领域的难点。本文回顾分析经显微外科手术治疗的2例颅内恶性黑色素瘤患者的临床特点、影像学表现、病理学特征及预后等情况,并结合文献对其诊断和治疗策略进行阐述。     

成人丘脑肿瘤的临床特点及显微手术治疗

目的探讨丘脑肿瘤的临床特点及显微外科治疗。方法总结48例丘脑肿瘤的临床特点。对其中35例分别采用侧脑室前角入路、侧脑室后部和三角区人路、颞后皮质人路及经胼胝体侧脑室入路手术切除肿瘤，5例行脑室一腹腔分流术，1例行外减压术，余7例拒绝手术。41例手术病人术后除1例海绵状血管瘤病人外，40例行放疗，总剂量40～50Gy。结果35例选择显微手术切除的病人中肿瘤全切25例（71．4％）。近全切7例（20．0％），大部分切除2例（5．7％），部分切除1例（2，8％）。肿瘤切除术后短期症状和神经功能明显改善10例（28．6％）。改善12例（34．3％），无变化10例（28．6％），恶化2例（5，7％），死亡1例（2．8％）。结论丘脑肿瘤以儿童及青年人发病为主。性别差异不明显，病程相对较长，多为恶性肿瘤，部分病例进展较快。临床表现以颅高压及丘脑局限性损害症状为主。丘脑肿瘤治疗首选手术切除．术后应辅以必要的放疗和化疗。     

神经外科导航系统辅助切除颅内微小占位病变

目的 探讨神经外科显微镜导航系统对切除颅内微小病变，提高手术疗效及降低并发症的作用。方法 1996年10月－2000年10月应用神经导航系统手术治疗62例颅内微小病变患，其中病变位于感觉、运动、语言重要功能区23例，额叶11例，顶叶10例，颞叶9例，枕叶3例，后颅窝、丘脑各2例，鞍上和多发性占位占1例。病变直径0．5－1.8cm，＜1cm55例；＞1cm7例，病变均位于皮导下。施行神经外科显微镜导航手术。结果 62例（包括功能区23例）患均在神经导航系统引导下施行病灶切除手术，导航误差＜2mm。术后患恢复良好，无一例发生偏瘫，失语等并发症。结论 应用导航系统可促进神经外科手术的微创化，准确指示颅内微小病变的位置和切除范围，降低手术并发症和保护神经系统功能。     

颅骨骨瘤临床分类和手术方法的探讨

本文对1995年至今在我院手术治疗后诊断为颅骨骨瘤的病人的临床表现和治疗结果进行归纳，并结合国内外的有关报道，探讨颅骨骨瘤临床分类和手术方法，以增加对该疾病的认识，结果如下。     

老年人颅内动脉瘤治疗特点

目的:探讨老年颅内动脉瘤治疗特点。方法:回顾分析62例65岁以上老年人颅内动脉瘤的临床资料,包括手术、栓塞优缺点、脑血管痉挛及电解质紊乱的防治。结果:62例老年人颅内动脉瘤手术和/或栓塞的死亡率为4.8％,单纯手术27例,单纯栓塞33例,栓塞后再手术2例,1例巨大动脉瘤行颈内外动脉搭桥手术。结论:老年人颅内动脉瘤手术危险性大,首选栓塞治疗,尤其对于体弱、多病、颅内多发动脉瘤,必要时手术治疗或手术和栓塞联合治疗。     

显微外科治疗丘脑肿瘤32例临床分析

目的探讨显微外科治疗丘脑肿瘤的疗效,并总结其临床特点。方法我院2009-01-2010-11收治32例丘脑肿瘤患者,采用显微外科治疗,探讨其治疗特点及疗效,总结显微外科治疗丘脑肿瘤的临床应用价值。结果 15例患者（46.9%）行肿瘤全切术,12例（37.5%）行大部分切除术,5例（15.6%）行部分切除术。行显微外科治疗后,患者的短期症状及神经功能明显改善9例（28.1%）,改善11例（34.3%）,无改善9例（28.1%）,转为恶化2例（6.2%）,死亡1例（3.1%）。结论丘脑肿瘤具有病程长的特点,多为恶性肿瘤,儿童与青年患病较为常见,且肿瘤位于脑深部,手术较为困难,故此采取显微外科治疗,临床疗效较显著,值得推广应用。     

Intracranial dural based chondroma

Intracranial chondromas are benign, slow-growing, cartilaginous tumors, which comprise only about 0.2% of all intracranial tumors. The majority of these lesions occur at the base of the skull, where they are thought to arise from residual embryonic chondrogenic cells along the basal synchondrosis. Very rarely, they may also originate from the convexity dura, falx cerebri, or the brain parenchyma. We present a patient with a dural based chondroma to highlight the technical considerations of surgical resection. The recent literature on intracranial chondromas regarding incidence, pathophysiologic origin, clinical symptoms, imaging, histopathology and prognosis is reviewed.     

Microsurgical treatment of intracranial chondroma

Intracranial chondromas are rare benign tumors. Little data are available on the diagnosis and treatment of these tumors. Thus, we aimed to describe a large series of patients with intracranial chondroma and to analyze and discuss the clinical features and microsurgical treatment of these patients. We retrospectively analyzed the clinical data of 30 patients (12 males and 18 females; mean age 35.4 years; age range 16-60 years) who had pathologically confirmed intracranial chondroma treated at our hospital from September 1996 to June 2008. Surgery was performed on all 30 patients: five patients underwent postoperative radiotherapy; 26 patients were followed up postoperatively for a mean duration of 45.8 months. The surgical approach was selected according to tumor location. Total resection was achieved in 11 patients, subtotal resection in 13, and partial resection in nine (three patients had recurrent chondroma). Follow-up showed that 21 patients recovered without recurrences, three had recurrence, and two patients died. The clinical manifestations included headache and multiple cranial nerve lesions. Imaging usually showed a well-demarcated extramedullary tumor, centrally located, without surrounding brain edema, partially calcified (73.3%) and with minimal vascularity, often accompanied by erosion and destruction of surrounding bone (56.7%). It is difficult to totally remove an intracranial chondroma, and it is not possible to differentiate a chondroma from a myxoma or chordoma at the cranial base on the basis of clinical manifestations and neuroradiological findings. Selection of the appropriate surgical approach is important for resection of the tumor.     

Intracranial falx chondroma: literature review and a case report

Intracranial chondromas are benign tumors that represent approximately 0.5% of all intracranial tumors. They usually occur at the base of the skull but on rare occasions might present as intra-parenchymal or intra-ventricular space-occupying lesions, most likely originating from heterotopic chondrocytes or metaplastic fibroblasts of the falx, the convexity dura, or the ventricular ependyma. Chondromas are slow-growing tumors, which remain clinically silent for a prolonged period of time in the majority of cases. Their clinical presentation is non-specific and their radiographic appearance usually does not differentiate them from their more common counterparts, such as meningiomas and glial tumors. As a result, their diagnosis has remained a histopathologic one. In our current study, we present a case of a falcine intracranial chondroma. This case provided the opportunity to extensively review the pertinent literature.     

儿童颅内未成熟畸胎瘤(附30例报告)

目的 探讨儿童颅内未成熟畸胎瘤的临床特征、治疗策略和预后.方法 回顾性分析30例经手术及病理证实的未成熟畸胎瘤患儿的临床资料,26例获得随访.结果 19例术前行血和(或)脑脊液肿瘤标记物(AFP,B-HCG)检测,12例阳性.初次手术肿瘤全切15例,近全切7例,大部切除6例,部分切除2例.随访患儿中,23例行辅助治疗.患儿半年、1年及2年的生存率分别为80%、69%、60%,患儿的存活时间与肿瘤的切除程度筹异有统计学意义(P<0.05).结论 肿瘤标记物的检测有助于诊断.手术是首选的治疗措施,应尽量做到全切.术后应辅以放、化疗.     

伴发颅内肿瘤的Maffucci综合征二例报告及文献复习

目的 报告2例伴有颅内病变的Maffucci综合征病例并文献回顾.方法 通过全身体检进行诊断,进行手术治疗切除颅内病变.结果 结合多发海绵状血管瘤和软骨瘤等全身表现,符合Maffucci综合征临床诊断.结论 我们首次报告了中国人群中伴有颅内病变的Maffucci综合征病例,对Maffucci综合征相关基因及临床表现仍待进一步研究.     

岩斜区肿瘤显微外科手术治疗43例体会

目的通过对43例岩斜区肿瘤显微外科治疗的分析，探讨岩斜区肿瘤的显微外科手术治疗方法，提高岩斜区肿瘤的全切率，减少并发症，改善手术效果。方法总结43例岩斜区肿瘤的临床表现、神经影像学特征及显微手术方法和术后处理。结果肿瘤全切除28例，次全切除9例，大部切除6例，死亡2例。全切率为65．1％，手术并发症率为51．2％。结论采用颅底手术人路和显微外科手术技术可以提高岩斜区肿瘤的全切除率，降低死亡率及并发症，大多数病人能达到治愈目的。     

颅底中线和旁中线部肿瘤的显微外科治疗

目的探索改良手术入路和显微外科手术技巧,以提高颅底中线和旁中线部肿瘤的手术疗效。方法回顾性分析1991年1月-2001年12月施行手术治疗的168例颅底中线和旁中线部肿瘤患者的临床资料,其中肿瘤位于前颅底者64例、中颅底23例以及后颅底81例;中型(2～4cm)91例、大型(>4cm)77例。采用扩大前颅底入路、单侧额下入路、额下眶上匙孔入路、翼点入路、眶颧入路、眶颧颞极入路、岩骨联合入路、远外侧枕下入路及口-咽入路等9种不同手术入路方法施行手术。结果168例颅底部肿瘤患者,138例(82.1%)全切除,其中脑膜瘤全切除率为88.8%(79/89)、神经鞘瘤83.3%(35/42)、脊索瘤31.3%(5/16)、斜坡胆脂瘤93.3%(14/15)以及其他肿瘤83.3%(5/6)。手术后恢复良好者153例(91.1%),中度致残包括手术后失明或持久性精神症状者11例,重残3例,死亡1例(0.6%)。手术后新产生脑神经功能障碍25例(14.9%),与入路有关的并发症4例(2.4%)。结论合适的颅底手术入路、精良的手术技巧和正确的手术策略可以改善手术显露,扩大手术适应证,提高肿瘤全切除率,降低手术死亡率,减少手术并发症,提高患者的生存质量。     

颅内镜像动脉瘤17例临床分析

目的 探讨颅内镜像动脉瘤的临床特征和手术方法.方法 解放军第二五一医院神经外科自2006年1月至2010年6月行显微外科手术治疗颅内镜像动脉瘤患者17例,回顾性分析患者的临床资料和疗效.结果 本组动脉瘤直接夹闭35个,未作处理1个,患者行一期手术9例,夹闭动脉瘤20个.二期手术7例,第一次手术夹闭动脉瘤7个,第二次手术夹闭动脉瘤7个.1例患者行一侧动脉瘤夹闭后对侧动脉瘤未处理;11例患者术后行CTA复查,夹闭的23个动脉瘤中2例瘤颈残留,余动脉瘤均消失,载瘤动脉通畅.GOS评分显示恢复优良12例,轻残4例,重残1例.结论 显微外科手术治疗颅内镜像动脉瘤效果显著.正确判断责任动脉瘤并首先处理,根据动脉瘤的部位、Hunt-Hess临床分级及患者周身状况等选择一期、分期手术可达到良好效果.

Abstract：

Objective To study the clinical characteristics and microsurgical skills of intracranial mirror-image aneurysm. Methods The clinical data and post-operative outcomes of 17 patients with 36 intracranial mirror-image aneurysms who underwent microsurgical operation were analyzed retrospectively. Results Thirty-five aneurysms were clipped directly and 1 did not give any treatment. One-time surgery was performed in 9 patients and 20 aneurysms were clipped. Two-stage operation was performed in the other 7 patients: 7 aneurysms were clipped in the first surgery and 7 in the second one. One patient received aneurysm clipping only in one side of the brain. CTA was performed again on 11 patients, noting that residual aneurysm neck of the 2 aneurysms existed in 23 clipped aneurysms, that the other aneurysms disappeared, and that the parent arteries were clear. GOS indicated that good surgical outcomes were achieved in 12 patients, light disability in 4 and severe disability in 1.Conclusion The surgical outcomes of intracranial mirror-image aneurysm performed microsurgical operation are predominance. Criminal aneurysms should be determined correctly and clipped firstly; and according to the sites and grades of the aneurysms and the patient's condition, good outcomes can be achieved by choosing one-time operation or two-stage operation.     

儿童颅内单发小炎性肉芽肿

目的 总结儿童颅内单发小炎性肉芽肿的临床特点和治疗经验。方法 自1997年1月～2001年6月手术治疗颅内单发小炎性肉芽肿患儿24例,占同期全年龄组颅内炎性肉芽肿总病例数的47.06％(24/51),平均年龄10.67岁,男女之比为2.4:1。症状以癫痫发作最为常见,占79.17％(19/24)。病灶分布以顶枕叶多见(50.00％),额叶次之(29.17％)。结果 非特异性肉芽肿14例,占58.33％,寄生虫性肉芽肿10例,占41.67％,二者周围组织水肿程度有所不同。病灶均经手术全切除,随访15例患儿均临床痊愈。结论 “小环形”强化病灶是颅内炎性肉芽肿的特征性表现,符合手术指征者,显微外科手术全切除是最佳的治疗选择。