New onset migraine with a brain stem cavernous angioma

A case of new onset migraine is described following a pontine bleed from a cavernous angioma.     

椎管内海绵状血管瘤手术治疗及其疗效分析

目的 探讨椎管内海绵状血管瘤（CA）的诊断、鉴别诊断、手术治疗及其疗效。方法 回顾性分析本院1993-2001年收治的18例椎管内CA，其中硬脊膜外7例，髓内11例。结果 均行手术治疗，17例行镜下或肉眼全切除术，1例行次全切除。术后随访6-96个月，17例术后神经功能障碍明显改善，其中12例恢复正常工作和学习。5例生活能自理；1例术后神经功能障碍无明显改善，生活需他人照顾。结论 椎管内海绵状血管瘤应早期诊断，早期治疗，应尽可能行肿瘤全切除术，以减少复发。     

儿童颅内海绵状血管瘤并发癫痫的手术治疗

目的明确儿童颅内海绵状血管瘤并发癫痫的手术治疗效果。方法回顾我院从2010年2月至2014年5月经手术治疗27例儿童颅内海绵状血管瘤并发癫痫患儿的病例资料。分析儿童海绵状血管瘤的临床特点,随访患者手术后癫痫缓解情况。手术后癫痫治疗情况用Engle’s分级进行评估,并对手术效果及预后进行分析。结果所有患者均行手术切除。术后1例基底节区病变切除后出现对侧肢体偏瘫,经治疗后到随访时神经功能已恢复至术前状态。1例术后出现颅内感染,经治疗后好转出院。手术后癫痫缓解良好,Engle’s分级1级25例,2级1例,3级1例。患者中无死亡及严重并发症患者。结论儿童颅内海绵状血管瘤并发癫痫手术治疗可有效治疗癫痫,并可避免海绵状血管瘤再次出血而改善患者预后。对多发病变及长期癫痫患者术前需充分评估。     

Surgically resected brain stem cavernous angioma in an infant

An infantile case of surgically resected brain stem cavernous angioma is presented. This 21-month-old boy was admitted to our department after repeated severe pontine hemorrhage. A deeplying lesion with hematoma was successfully removed via the IV ventricle approach. Few infantile cases of this lesion have been presented previously, and the approaches to brain stem cavernous angiomas in infants are discussed.     

Intracranial cavernous angioma]

Cavernous angiomas are vascular malformations that belong to the group of hamartomas. Evidence to support the hypothesis that some intracranial cavernous angiomas are benign vascular tumors is lacking. As they are angiographically occult, cavernous angiomas were largely overlooked and were considered rare before CT scan and MRI became available. Both of these techniques provide a quick and accurate diagnosis in cases of epilepsy, brain hemorrhage or intracranial hypertension. Most of the hemispheric cavernous angiomas are situated subcortically, in the neighborhood of the rolandic fissure. In the brain stem, they can be found mostly in the pons. Cerebellum and spinal cord are seldom involved. Cavernous angiomas may occur in children, as well as in familial forms, or in association with other visceral locations. It is important to know that some cavernous angiomas are able to grow, owing to a variety of mechanisms, which may result in rupture and cerebral hemorrhage. The improvement of both imaging and surgical techniques have reduced the risks of death or heavy sequelae. Some deeply located cavernous angiomas, however, are still inaccessible to surgery.     

脑干海绵状血管畸形的手术治疗

目的 明确脑干海绵状血管畸形(CM)的解剖位置,探讨相应的手术入路和手术技巧.方法 回顾性分析53例脑干CM的病例资料.其中主体位于中脑10例(中脑腹侧1例,中脑背侧2例,中脑侧方7例);主体位于脑桥32例(脑桥侧方28例,脑桥背侧4例);主体位于延髓11例(延髓侧方2例,延髓背侧9例).病变均行手术切除.共使用7种手术入路:额眶颧入路1例、枕下-经小脑幕入路(Poppen入路)2例、颞下-经小脑幕入路27例、颞下-岩前经小脑幕入路6例、枕下-乙状窦后入路2例、枕下后正中入路13例、远外侧入路2例.结果 病变全切除53例(100％).术后随访:症状明显改善18例(34％),症状无变化28例(53％),新增症状7例(13％).结论 对于脑干CM,选择适合的手术入路和精湛的手术技巧,术中配合使用辅助技术,是减少手术损伤、获得良好手术质量及预后的关键.     

幕上海绵状血管瘤伴顽固性癫痫的手术治疗

目的 探讨幕上海绵状血管瘤伴顽同性癫痫的临床特点及手术治疗策略.方法 2000至2008年手术治疗14例幕上脑内海绵状血管瘤患者,术前均行头部MRI检杏,均以顽固性癫痫为主要症状,术后经病理证实并长期随访.结果 所有患者采用多种抗癫痫药物治疗,效果不佳,手术根据病灶数目、位置及与功能区的关系可一期直接完成或分期完成.术后配合药物治疗,经长期随访,癫痫控制良好,无手术导致的功能障碍.结论 MRI诊断海绵状血管瘤有较高的特异性与敏感性,典型表现为T2WI图像上病灶周围有环形低信号区.幕上海绵状血管瘤伴顽固性癫痫的患者应积极手术,且效果较好.具体可根据病灶位置、脑电图表现及临床症状借助颅内电极、立体定向技术制定针对性手术方案.     

显微手术治疗小脑海绵状血管瘤

目的总结小脑海绵状血管瘤的临床表现及手术治疗效果。方法对12例均经手术切除和病理证实的小脑海绵状血管瘤进行回顾性分析。结果11例急性起病,表现为小脑自发性出血。慢性起病1例,表现为渐进性共济失调、行走不稳。头颅MRI平扫与增强多表现为T1高信号,T2高或混杂信号,病灶周围有环形低信号带。磁敏感加权成像序列（SWI）更有助于诊断。12例均采用显微手术治疗,所有病灶均完整切除,疗效满意。结论自发性出血是本病的主要症状,多有共济失调等小脑受损体征。MRI具有较高的诊断特异性,手术是处理小脑海绵状血管瘤安全和有效的首选方法。     

A case of multiple cavernous angioma with dementia]

We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.     

γ-刀治疗脑内海绵状血管瘤

脑内海绵状血管瘤(cavernous angioma, CA)并不少见,但由于其生长缓慢,自然病史不十分清楚,故理想的治疗方法尚未确定.我们分析了北京奥海γ-刀中心1996年11月至2002年12月收治的84例脑内海绵状血管瘤的临床特点和治疗情况,并复习文献,旨在确定γ-刀治疗海绵状血管瘤的疗效和适应证.     

脑海绵状血管瘤选择性治疗

目的观察选择手术切除及伽玛刀治疗脑海绵状血管瘤效果。探讨伽玛刀治疗的适应证。方法回顾1996~2005年手术10例,伽玛刀治疗26例,随访4个月~9年。对癫痫、出血、病灶及局部神经功能障碍控制、变化、改善观察和评估。结果手术10例,8例恢复正常,2例遗留轻度限局神经功能障碍,可做轻工作。CT、MRI复查:9例病灶消失,1例疑有病灶部分残留行伽玛刀治疗,无再出血及癫痫发作病例。伽玛刀治疗26例,随访21例。随访时间4个月~28个月。局部神经功能障碍观察:治疗前4例有锥体束征,治疗后3例恢复,1例无变化。癫痫发作观察:治疗前发作者19例,16例治疗后半年无发作而停药始无发作。3例治疗后偶有发作,服药半年停药,再未发作。CT及MRI复查:治疗后2~28个月,复查1~3次。病灶消失1例,4例无变化,缩小16例,其中2例灶周水肿、1例水肿伴灶内出血症状加重,经治疗逐好转。结论神经外科显微手术切除是首选根治方法。对病灶位于难以手术部位,多发灶难以一次切除,病人难以承受手术或不接受手术症状显著者,伽玛刀是一种安全可选择的治疗方法。对降低出血率、癫痫及病灶控制、改善症状是有效的。对病灶缩小或消失、降低出血率的机制等问题,尚需进一步研究。     

脑干肿瘤的手术治疗

手术治疗6例脑干肿瘤病人,次全切除2例,大部切除1例,部分切除3例.术后临床表现明显改善1例,改善3例.无变化2例,无一例术后死亡.作者认为脑干肿瘤手术治疗成功的关键在于手术适应证的选择.弥漫性脑于肿瘤不适合手术治疗,局限性脑于肿瘤、囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤及背侧外生性脑干肿瘤适合手术治疗.其中囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤、背侧外生性脑干肿瘤常能做到肿瘤的全切除或次全切除.     

Epidural spinal cavernous angioma: case report]

Epidural spinal cavernous angiomas account for approximately 4% of all spinal epidural tumors. More recently the diagnosis has become more frequent due to refinement of imaging modalities. We describe a 50-year-old woman with a spinal epidural cavernous angioma at L1-L2, which was successfully surgical treated. Clinical picture, imaginology and treatment of this entity is reviewed.     

脑干血管畸形的外科治疗

目的探讨脑干血管畸形的外科治疗方法、手术入路和治疗效果.方法对10例脑干血管畸形患者进行回顾性分析,男8例,女2例;平均年龄34.4岁.所有患者均经CT和MRI检查确诊为脑干血管畸形.有6例患者行DSA检查,但无异常发现.病变位于桥脑者6例,桥脑中脑结合部者3例,桥脑延髓结合部者1例.结果10例患者平均在出血后第34 d行开颅手术,其中经后颅窝中线小脑下蚓部第四脑室入路5例,于枕下乙状窦后经小脑外侧入路4例,经颞下切开天幕入路1例.术后病理学检查报告毛细血管扩张症6例、海绵状血管瘤3例、动静脉畸形1例,无手术死亡病例.所有患者术后症状均获改善,有6例患者获得随访,最长随访时间6年,最短1年,无再出血.结论应用显微外科手术治疗脑干血管畸形患者安全有效,通过切除畸形的脑干血管可防止再次出血.     

A case of coexistence with cavernous angioma and focal cortical dysplasia]

There have recently been a number of new pathological findings of specimens from epileptic foci that have become widespread of surgical treatment. We reported a case with seizures resulting from brain lesions which pathologically demonstrated a coexistence with a cavernous angioma and a focal cortical dysplasia. A 24-year-old man was admitted to our hospital because of generalized convulsion from 1 year ago. Brain MRI revealed an enhanced mass lesion, in diameter 1.5 cm, with hemosiderin rim in the left temporal tip. Ictal EEG showed the initiation of the spike from the lateral side of the left temporal lobe. Because the epileptogenic focus was thought to be the lateral side in the left temporal lobe, anterolateral temporal resection was performed and subsequently total removal of the tumor was performed. He had no seizure after surgery. A light microscopic examination was performed on specimens stained with hematoxilin and eosin. We verified to be pathologically coexistent with a cavernous angioma and a focal cortical dysplasia. We also found unusual neurons that were accompanied by perineuronal glial satellitosis in the subcortical white matter, those were occasionally observed in epileptic foci and were thought to be a form of neuronal migration disorders.     

Putaminal cavernous angioma presenting with hemichorea.

We report on a 63-year-old man presenting with hemichorea on his right side. Magnetic resonance imaging revealed a left putaminal cavernoma. To our knowledge this is the first report of such a case caused by contralateral putaminal cavernous angioma.     

Pineal cavernous angioma presenting with Parkinsonism.

Cavernous angioma of the pineal region is rare, as is brain tumour coincident with Parkinsonism. The authors describe the case of a 55 year old woman with a pineal region cavernous angioma, who subsequently developed Parkinsonism after her increased intracranial pressure was relieved. The cause of Parkinsonian syndrome is unclear, but compression of the posterior thalamus and upper mid-brain with congestion of the deep venous system may have caused vascular disturbance of the nigro-striate-pallidal system. Her symptoms gradually improved after total excision of the lesion.     

脑干海绵状血管瘤治疗的研究进展

脑干海绵状血管瘤(brain stem caverous malformation,BSCM)是一种特殊类型的海绵状血管瘤(cavernous malformation,CM).与幕上病灶相比,BSCM具有更明显的出血倾向,引起的临床症状也更严重,手术切除是根治BSCM的唯一方法.近年来,随着神经影像学的进步,神经导航、神经电生理监测的应用以及显微神经外科技术的提高,BSCM的手术效果明显提高.笔者结合自己的临床经验,对BSCM的发病特点、临床治疗和预后等做一综述. 一、发病特点 BSCM的发病率占颅内CM的9％～35％,可发生于任何年龄,多见于20～50岁患者,中脑、桥脑及延髓均可被累及,其中桥脑最多见[1].临床上桥脑病例约占65％以上.