颅内血管母细胞瘤影像学分型与手术策略的探讨

目的探讨颅内血管母细胞瘤的诊断和治疗。方法回顾性分析58例血管母细胞瘤病人的临床资料，根据MRI检查将肿瘤分为4型：单囊伴单瘤结节型40例，实质型8例，囊实型6例，多发结节型4例。采用后正中、旁正中或枕下人路手术。结果肿瘤全切除56例，大部分切除2例。术后脑肿胀1例，再出血1例，予再次手术。无死亡病例。术后随访1～5年，肿瘤复发2例。结论影像学分型对于指导手术是必要的，应根据瘤结节位置，合理选择手术人路。实质型和囊实型肿瘤手术时间长，手术风险大，术前可行造影检查，必要时栓塞治疗。

Imaging classification and surgical strategy of intracranial hemangioblastomas

Objective To investigate the diagnosis and treatment of intracranial hemangioblastomas. Methods Fifty-eight patients with intracranial hemangioblastoma were analyzed retrospectively. The intracranial hemangioblastomas in the 58 patients could be classified as four types by MRI, the first type was single tumor nodules and single capsule in 40 patients, the second type was solid tumor nodules in 8, the third type was solid-cystic tumor nodules in 6, the forth type was multiple tumor nodules in 4. The posterior midline approach, paramedian approach or suboccipital approach was adopted in resection of intracranial hemangioblastomas. Results The tumor was totally removed in 56 cases, and subtotally removed in 2 cases. Reoperation was performed for rebleeding or postoperative brain swelling occurred in 1 patient respectively. No patient died. All the patients were followed up for 1 to 5 years, intracranial hemangioblastomas recurred in 2 cases. Conclusions Imaging classification is necessary and important in preoperative preparation of hemangioblastoma patients. Surgical approach should be selected according to the position of the tumor nodule. Surgical procedures for solid or solid-cystic hemangioblastoma need more time with a high risk, therefore preoperative DSA is useful for solid or solid-cystic hemangioblastomas, if necessary, embolization treatment should be conducted.