脑结核瘤的诊断及治疗(附17例报告)

目的探讨脑结核瘤的临床特点、诊断及治疗效果。方法回顾分析2001年1月至2011年6月17例脑结核瘤的临床表现、影像学表现、实验室检查及治疗。结果依据结核病史或身体其他部位结核病灶,颅内压增高、癫痫和/或伴有脑膜刺激征等临床表现,头颅CT或MR呈现"靶征"样表现者,结合脑脊液等检查,12得以明确诊断,5例术前误诊为其他病变术后病理证实为结核瘤。17例患者中手术切除病灶11例,其中6例术前得以明确诊断;另6例采用药物治疗,病灶多可在1～3个月内缩小,3～12个月内消失。所有患者行规律抗结核治疗,无死亡病例,随访3个月至1.5年未见复发。结论脑结核瘤的诊断应根据临床表现、影像学特点、实验室检查和抗结核疗效进行综合分析。手术结合抗痨药物治疗效果良好。     

脑结核瘤的临床分析及文献回顾

目的 :分析脑结核瘤的临床特点 ,提高临床诊断准确率及治疗效果。方法 :结合文献对 1例多发性脑结核瘤患者的临床特点、影像学表现及治疗效果进行回顾性分析。结果 :该例脑内结核瘤粟粒样分布 ,病灶多达 15个以上 ,同时累及大脑、小脑及脑干 ,抗结核治疗后病灶缩小 ,数目明显减少。结论 :脑结核瘤的诊断需结合临床特点、影像学表现及抗痨效果综合判定。药物治疗是有效的 ,但需长程、规则。     

小脑海绵状血管瘤（18例分析）

目的 :研究小脑海绵状血管瘤的临床。方法 :回顾性分析经手术病理证实的小脑ICCA 18例。结果 :18例共 19个病灶 ,单发17例 ,多发 1例 2个病灶。 11例表现为小脑自发性出血 ,7例表现为颅高压及小脑症状。 15例行头颅CT检查 ,诊断小脑ICCA 2例 ,2个病灶 ;头颅MRI检查 16例 ,诊断小脑ICCA 15例 ,16个病灶。 3个病灶为囊性变。 18例均行手术治疗 ,其中 2例急诊手术清除血肿并全切除病灶。手术无死亡 ,疗效满意。结论 :自发性出血是本病的主要症状。MRI具有较高的诊断价值。首选手术切除病灶。囊性小脑ICCA可能为实质性ICCA内部慢性出血的结果。     

脑结核瘤的诊断和手术治疗

目的提高脑结核瘤的诊断和手术治疗水平.方法回顾性分析14例脑结核瘤的临床表现、诊断方式和手术疗效.结果13例全切除,1例全切加减压,术后均予正规的抗结核药物治疗.除1例死亡外,其余全部治愈出院.结论脑结核瘤的诊断应结合临床表现、影像学特点、实验室检查和抗结核疗效进行综合分析.在严格掌握适应证的情况下,手术治疗效果良好.     

中枢神经系统结核瘤的手术治疗

目的分析中枢神经系统结核瘤的临床特点,探讨中枢神经系统结核瘤的诊断和手术治疗水平。方法回顾性分析11例中枢神经系统结核瘤的临床表现、影像学特点及手术疗效。结果11例结核瘤均通过手术全切除,病理检查证实为结核瘤,术前误诊为脑脓肿2例,脑胶质瘤1例。术后均予正规抗结核药物治疗。除1例死亡外,其余10例治愈出院。10例随访2年,遗有偏瘫3例,癫痫发作1例,其他病例可正常生活。结论中枢神经系统结核瘤临床上常缺乏特征性表现,对于诊断不明确的病例,应积极手术治疗。手术一般能完整切除瘤体,效果满意。     

不伴脑膜炎的脑结核瘤临床诊治分析(附1例报告及文献复习)

目的:为提高对脑结核瘤的诊断和治疗水平。方法:回顾性分析1例多发性脑结核瘤患者的临床特点、影像学表现及治疗效果。结果:该例患者脑内结核瘤呈粟粒样分布,累及大脑、小脑和脑干。抗结核治疗后病灶缩小、数目明显减少。结论:结核瘤的诊断应结合临床表现、影像学特点、实验室检查及抗结核疗效进行综合判定。药物治疗需正规、长疗程。     

脑结核瘤28例诊治分析

目的　为了提高对脑结核瘤的诊断和治疗水平。方法　回顾性分析 2 8例脑结核瘤的临床表现、影像、诊断治疗经过和预后。结果　所有病例均确诊为脑结核瘤 ,其中 9例术前误诊为脑肿瘤。手术治疗 2 2例 ,术前、术后均正规抗结核药物治疗 ,并动态监测头部影像 ;预后良好 2 0例、遗留不同程度神经功能障碍 6例、死亡 2例。结论　脑结核瘤的诊断应结合临床表现、影像特点、实验室检查、抗结核疗效进行综合分析 ,对于可疑病例 ,可试行强化抗结核治疗后 ,采取手术或活检明确诊断。治疗上首先正规抗结核药物治疗 ,必要时手术     

显微手术治疗脑干海绵状血管瘤的临床分析

目的 探讨脑干海绵状血管瘤的显微手术治疗方法及其疗效。方法 回顾性分析2011年10月至2015年9月显微手术治疗的19例脑干海绵状血管瘤的临床资料,其中桥脑12例,中脑4例,延髓2例,桥脑延髓交界区1例。经坐位枕下后正中小脑延髓裂入路12例,坐位乙状窦后入路4例,坐位后正中幕下小脑上入路2例,翼点入路1例。结果 病灶全切除17例,次全切除2例。术后症状改善16例,无明显变化3例,无手术死亡病例。术后随访14~58个月,次全切除2例均复发并行二次手术;术前KPS评分为（75±6）分,术后KPS评分为（84±8）分,随访1年KPS评分为（90±5）分。结论 应根据术前影像学检查以及术者经验及习惯选择手术方式,坐位可以作为大部分脑干海绵状血管瘤的常规手术体位;显微手术治疗脑干海绵状血管瘤应在保证安全的前提下做到全切除,使患者获得良好预后。     

中枢神经系统结核的CT改变

CT能使颅内并发症易于识别因而有助于细菌性脑膜炎的处理。然而,CT对结核性脑膜炎(TBM)诊断和随访较全面的报告则较少。本文报告14例TBM及2例脑结核瘤的CT改变。作者对16例已证实的颅内结核患者作了CT检查。其中14例诊断为TBM,2例脑结核瘤术后病理检查确诊,两例均无脑膜受累证据。除1例拟诊为病毒性脑膜炎患者入院后第6天死亡外,余均在10天内予以抗结核药物治疗。该例尸检证实为肺结核并有TBM。12例在入院时作CT检查,其中6例有轻至重度的脑内积水其程度与临床症状无明显关系,3例有严重的脑积水且发展迅速,2例死于入院后两周,1例昏迷后经脑室引流和长期抗结核治疗后治愈。3例CT显示不规则局部病灶,其中1例注射对比剂后病灶有增强。所有病例几个月后复查病灶均消失,仅2例TBM病例注射对比剂后基     

原发灶来源不明的脑转移瘤的临床特点及治疗

目的 探讨原发灶来源不明的脑转移瘤（BMUP）的临床特点及治疗方法。方法 回顾性分析26例BMUP患者的临床资料。结果 病灶位于额叶8例、顶叶13例、枕叶1例、小脑3例、基底节区1例。19例单发转移灶全切除,7例多发灶者行症状侧病灶全切除术。术后均接受普通放疗,其中3例多发转移瘤加行替莫唑胺辅助化疗。术后随访6~78个月,平均28个月;复发7例（单发灶2例,多发灶5例）,再次手术治疗2例,化疗3例,2例因颅内播散、恶性颅内压增高死亡。结论 BMUP影像学及病理学具有一定特征,治疗主要采取以手术为主的综合治疗,术后常规放化治疗可延缓肿瘤生长,提高患者生存率。     

颅内神经内分泌癌的诊治分析（附15例报道）

目的 探讨颅内神经内分泌癌的临床特征、治疗方法及预后。方法 回顾性分析2013年9月至2018年9月手术治疗的15例颅内神经内分泌癌的临床资料。结果 15例中,单发病灶3例。多发病灶12例。3例单发病灶术中显微镜下全切除,其余12例仅切除引起明显颅内压增高、短期威胁病人生命的病灶;术后病理显示小细胞神经内分泌癌9例,大细胞神经内分泌癌6例。术后仅行放疗8例,同时行放化疗4例,拒绝放化疗1例。术后随访1~12个月,死亡14例,平均生存时间为8个月;1例随访12个月生活基本自理。结论 颅内神经内分泌癌是一类罕见的恶性脑肿瘤,预后差,临床症状和影像学表现缺乏特异性,诊断依靠术后病理学检查,治疗仍然以手术切除为主,辅以放、化疗的综合治疗。     

Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas

Introduction

Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. It presents as meningitis or tuberculoma. Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm radiologically, so usually a biopsy is performed.

Material and results

Our study consisted of 23 pathologically proven cases of tuberculomas between 1988 and 2003. Patients were discussed clinically, radiologically and histologically. Headache, fever, weight loss and weakness are the most common clinical manifestations. Our patient's ages vary from 3 to 67 years with a mean of 31.8 years. Ninety-five percent of patients had bad social, economic and nutritional conditions. None of them were infected by human immunodeficiency virus (HIV). All patients had similar contrast-enhancing lesions radiologically. The majority of tuberculomas were located supratentorially. Only one patient presented two foci of (cerebral and cerebellar) tuberculomas. Nineteen tuberculomas were intracerebral; two were located in the cerebellum and one was intramedullary. Among those lesions, one cavernous sinus tuberculoma and one sellar tuberculoma were identified. Only two patients underwent stereotactic biopsy and 21 patients underwent surgical excision. Histopathologic examination revealed granulomatous inflammation with central caseous necrosis in all patients.

Discussion

Diagnosis of tuberculoma can be difficult, and in most of our cases, the clinical diagnosis was ‘neoplasm’. For this reason, clinicians must always be aware of it and consider it in the differential diagnosis of central nervous system mass lesions.     

Tumor of the conus medullaris treated with antituberculous therapy

This case report concerns a 21-year-old man developing left leg paresis. Evaluation with magnetic resonance imaging (MRI) showed an intramedullary tumor in the conus region. He was planned for surgery but preoperative investigation indicated he had tuberculosis and the tumor was presumed to be a tuberculoma. Antituberculous therapy was started and the patient improved neurologically. The patient was followed clinically and with consecutive MRI during 2 years and the last MRI showed that the lesion had disappeared completely. Intramedullary tuberculomas are rare but important differential diagnosis in patients with spinal cord mass lesions. The role of medical and surgical treatment of intramedullary tuberculomas is discussed.     

超声引导下脑沟入路手术治疗大脑中央区病变14例

目的探讨超声引导下脑沟入路手术在治疗大脑中央区病变的应用。方法选择14例大脑中央区病变病人,术中采用超声定位,结合脑沟入路的手术方式切除病变。结果病变全切除10例,近全切除4例。术后病理证实:星形胶质细胞瘤7例,胶质增生1例,海绵状血管瘤4例,转移瘤1例,恶性淋巴瘤1例。原有神经功能障碍8例,术后均有改善。新发神经功能障碍2例,均为运动障碍,出院时完全恢复。未发生术后感染及超声相关的脑损伤。所有病例于术后6个月随访,均无迟发性神经功能障碍。头颅MRI复查9例,未见肿瘤复发。结论超声引导下脑沟入路治疗大脑中央区病变可明显提高手术全切除率,降低术后运动、感觉及语言功能并发症的发生率。     

Isolated sellar tuberculoma presenting with panhypopitutarism: clinical,diagnostic considerations and literature review

Tuberculosis, a common cause for chronic intracranial infections can mimic varied intracranial pathologies including tumours. Pituitary tuberculomas are rare lesions and are often diagnosed pre-operatively as pituitary tumours. We report a case of a 31-year-old lady with a sellar-suprasellar lesion who presented with panhypopituitarism. The patient underwent a trans-nasal, trans-sphenoidal surgical decompression of the lesion. Histopathology revealed a tuberculous lesion in the pituitary. The characteristic radiological features of sellar tuberculomas are discussed along with a review of literature. Atypical sellar radiology in the presence of a thickened pituitary stalk could point to pathology other than pituitary adenoma, possibly a chronic inflammatory condition like tuberculoma.     

Cerebral tuberculoma mimicking high grade glial tumor

Tuberculosis has been an important public health problem in both developing and develop nations. Tuberculosis of the central nervous system is rare. Tuberculosis meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas may be solitary or multiple. Solitary tuberculomas may be indistinguishable from cranial abscess or primary brain tumor. It is necessary to rule out tuberculoma in patients with intracranial mass lesions. We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy.     

经眶入路神经内镜手术治疗颅中窝底病变的疗效分析（附17例报道）

目的 探讨神经内镜下经眶入路（ETOA）手术治疗颅中窝底肿瘤的疗效。方法回顾性分析2017年6月至2021年3月ETOA手术治疗的17例颅中窝底病变的临床资料。结果术后病理显示脑膜瘤9例，胶质瘤3例，神经鞘瘤2例，淋巴瘤1例，海绵状血管瘤1例，血管外皮细胞瘤1例。肿瘤全切除11例，次全切除5例，部分切除1例。术后出现脑脊液漏2例、短暂性动眼神经麻痹3例、脑梗死1例、颅内大出血1例（再次手术）。出院后随访6~24个月，无死亡病例；1例次全切除胶质瘤术后12个月出现进展，二次手术；其余病例未见复发或进展。术后6个月，改良Rankin量表评分0~2分14例，3分3例。结论ETOA手术是治疗颅中窝底病变的有效方法，可达到令人满意的切除程度，并有效地减少并发症。     

Central nervous system tuberculoma

The aim of this study was to outline the clinicoradiological features of central nervous system (CNS) tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3 years (range=17-43 years), and the average disease duration at presentation was six months (range=1-19 months). The tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with headache and consciousness disturbance, and two patients had a history of pulmonary Koch's disease. Five patients had a history of tuberculous meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received conservative treatment; all patients received anti-tuberculosis therapy for 18 months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90-100). Patients presenting at an advanced disease stage had a poorer outcome. CNS tuberculoma is a benign condition with a good prognosis and effective therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early surgical decompression is recommended for intramedullary tuberculoma. Craniotomy is indicated for patients with intracranial hypertension, while more conservative therapy is appropriate for patients who have intracranial tuberculomas without intracranial hypertension.     

Anhelation due to formation of tuberculomas at the medulla oblongata during chemotherapy of tuberculous meningitis

Formation of tuberculoma is a rare response of neurotuberculosis in patients regularly and adequately treated with anti-tuberculous drugs. We report a 13-year-old girl with two tuberculomas which formed in the dorsal part of the medulla oblongata during chemotherapy for tuberculous meningitis. The tuberculomas were both removed via a suboccipital midline approach and were demonstrated by pathological findings but the girl died of cardiac arrest that was thought to be caused by postoperative medulla oblongata oedema. In combination with a literature review, we discuss the clinical features and treatment options of brainstem tuberculomas.     

Intrasellar tuberculoma--an enigmatic pituitary infection: a series of 18 cases

OBJECTIVE: Intrasellar tuberculomas are rare and only few case reports have been described in the literature. We report a series of 18 cases of histologically proven intrasellar tuberculomas, which, to the best of our knowledge, is the largest series in the English literature. METHODS: A total of 1143 pituitary lesions, between 1984 and June 1999, were operated for various reasons in our institute. Of these, 18 cases were histopathologically proven intrasellar tuberculomas. The clinical profile was reviewed in detail. Radiological data and histopathological slides were also reviewed. RESULTS: The age ranged from 8 to 43 years (average 23.6 years) with a female preponderance. The duration of symptoms varied from 15 days to 2 years (average 4 months), the most common symptoms being headache followed by decrease or loss of vision. Five patients had features of pan-hypopituitarism whereas three had raised prolactin (PRL) levels. In six patients, both sella as well as sphenoid sinus were involved. In one patient the lesion was extending from the sella over the clivus. Clinically as well as radiologically, these lesions were mistaken for pituitary adenomas except for one case where tuberculoma was suspected on imaging. In three patients, there was past history of pulmonary tuberculosis, in one patient of tuberculous meningitis, and in one patient, of spondilytis of the spine. In one patient there was cervical lymphadenopathy along with features of acromegaly (also proved by high levels of serum growth hormone) and radiology revealed a pituitary pathology. Microscopic examination of the excised lesion revealed a composite lesion consisting of a pituitary adenoma and tuberculoma, which has not been documented in literature to date. One patient died during the hospital stay. All the other patients were put on antitubercular chemotherapy following surgery and had good outcomes. CONCLUSION: Intrasellar tuberculomas are rare. These may be suspected in female patients especially if radiological imaging shows involvement of paranasal sinuses and pituitary fossa along with thickening of pituitary stalk. Simultaneous involvement of clivus may also be an additional feature. The incidence of pituitary tuberculosis is likely to increase with a rise in the incidence of AIDS.