颅内多发性海绵状血管瘤15例

目的总结儿童颅内多发性海绵状血管瘤(CA)的临床特点与治疗策略。方法选取2003年1月-2011年5月临床诊断为儿童颅内CA患儿15例。对其临床表现、头颅影像学特征及预后进行回顾性分析。结果 15例患儿颅内CA中脑内型14例,脑外型1例。14例脑内型患儿临床表现为头痛8例,呕吐5例,癫发作4例,意识障碍3例,头晕、偏瘫各2例,肢体感觉障碍1例;1例脑外型患儿临床表现为单侧眼睑下垂,伴头痛、呕吐、复视。14例脑内型患儿CT检查发现30个病灶;MRI检查发现35个病灶,病灶周围一圈低信号30个,呈环状或半环状;颅脑血管磁共振成像检查结果阴性;2例数字减影脑血管造影检查阴性。14例患儿行手术治疗,其中3例因急性头痛、呕吐伴意识障碍于病程10 d内手术;11例病情呈间歇性发作,于病程0.5～12.0 a择期手术。结论儿童颅内CA以脑内型多见,临床表现缺乏特异性,主要表现为头痛、呕吐等颅高压症状,其次为癫发作等症状。头颅MRI检查是目前临床术前确诊颅内CA的最佳方法。外科手术是治疗颅内CA的主要方法,无症状或症状轻微的患儿可临床随访观察,如出现难治性局灶性癫、严重头痛、局部神经功能障碍应及时手术治疗。

Clinical Analysis of Intracranial Cavernous Hemangioma in 15 Children

Objective To summarize the clinical characteristics and therapeutic strategy of intracranial cavernous hemangioma(CA) in children. Methods Fifteen children with clinical diagnosis of intracranial CA from Jan.2003 to May 2011 were chosen.Their clinical presentations,imaging characteristics,prognosis and treatment were analyzed retrospectively. Results Of the 15 cases,14 cases were in intracranial brain while 1 case was outside the brain.Clinical manifestations of these 14 cases and 8 cases with headache,5 cases with vomiting,4 cases with epilepsy,3 cases with awareness of disorder,2 cases with dizziness,2 cases with hemiplegia,and 1 case with sensory disturbance of limbs.Clinical manifestations of 1 case which was outside the brain had unilateral eyelids ptosis,accompanied by headache,vomiting and diplopia.CT examination in 14 cases revealed 29 cerebral lesions;magnetic resonance imaging(MRI) examination found 35 lesions,in which 30 cases were surrounded by low-signal in the form of ring or semi-circular ring;Both magnetic resonance angiography(MRA) and 2 cases of digital subtraction angiography(DSA) were negative.Fourteen cases treated by surgical operation,in which 3 cases underwent operation in 10 d because of acute headache and vomiting and 11 cases with CA received selective operation in 0.5-12.0 years. Conclusions Children with CA are more common in the form of intracranial brain.Clinical manifestations lack specificity,with the main clinical manifestation of intracranial hypertension symptoms such as headache and vomiting followed by seizures,and so on.MRI screening is by far the best clinical method of the diagnosis of CA.Surgery is the primary method of treatment of intracranial CA.Asymptomatic or mild patients need clinical follow-up.If patients have intractable focal seizures,severe headache or local nerve dysfunction,timely surgical treatment is needed.