颅内海绵状血管瘤的诊断与显微外科治疗

目的探讨颅内海绵状血管瘤的诊断与显微手术治疗效果。方法分析32例（34个病灶）颅内海绵状血管瘤病人的临床表现、影像学特征、手术治疗及预后。病人术前均行头颅M刚和（或）CT检查，单发病灶30例，多发病灶2例。主要临床表现为头痛、癫痫及神经功能障碍。均行最微外科手术。结果全切除33个病灶，部分切除1个病灶，术前诊断均与病理相符。15例伴癫痫者术中均予皮质脑电监测，根据术中发现行扩大切除5例，皮质热灼3例；术后达EngelI级14例，EngelⅡ级1例，术后无新发癫痫病例。24例随访3—26个月，均未发现复发病例。结论影像技术的进步使颅内海绵状血管瘤的术前诊断率大大提高。颅内海绵状血管瘤可通过显微手术切除获得良好疗效。伴有癫痫者需行术中皮质脑电监测并根据术中发现决定手术策略。

Diagnosis and microsurgical management for intracerebral cavernous angiomas

Objective To explore the diagnosis and microsurgical outcomes for intracerebral cavernous angioma. Methods Clinical and neuroimaging features, microsurgical procedures and prognosis of 32 patients （34 lesions） with intracranial cavernous angioma were analyzed retrospectively. MRI and/or CT examination were performed in all the patients before operation, including 30 single lesions and 2 multiple lesions. The main clinical manifestations were headache, epilepsy and neurological defects. Microsurgery was performed in all the patients. Results Total tumor resection was achieved in 31 lesions and partial resection in 1. The pathologic results agreed with the preoperative diagnosis in all the patients. Intraoperative electrocorticography （ECoG） was routinely used in 15 patients accompanied with epilepsy, and extended resection was applied in 5 patients and cortex thermocoagulation in 3 according to ECoG findings. Engel I grade was achieved in 14 patients and Engel 11 grade in 1, and no new onset of epilepsy occurred postoperatively. Conclusions Preoperative diagnosis for intracerebral cavernous angioma is considerately accurate with the advanced imaging techniques currently. Microsurgery is well effective for resection of intracerebral cavernous angioma. For intracerebral cavernous angioma with epilepsy, intraoperative ECoG should be used to guide the surgical strategies accordi＇ng to the ECoG findings.