海绵状血管畸形伴静脉畸形的诊治

目的研究海绵状血管畸形(CM)伴静脉畸形的诊治。方法回顾性分析39例经手术治疗的CM病人的临床资料,术中观察和判断是否伴随静脉畸形,并将病例分为伴静脉畸形组和不伴静脉畸形组,分析两组病人的资料,对CM伴静脉畸形的诊断和外科处理策略提出建议。结果术中显微镜下发现伴静脉畸形14例,术前MRI增强扫描检出伴静脉畸形12例,DSA检出伴静脉畸形1例,MRA未检出伴静脉畸形。伴静脉畸形组和不伴静脉畸形组病灶大小、病变部位、首发症状和预后差异均无统计学意义(P0.05),表明静脉畸形可能是CM病变的一个组成部分。但伴静脉畸形组因术中切断静脉畸形而出现严重脑肿胀2例,其中1例死亡。结论 MRI增强扫描应列为CM的术前常规检查;伴静脉畸形的病例应在设计手术入路时,尽量避开静脉畸形血管,并在术中加以保护。

Diagnosis and surgical strategy of cavernous malformation with venous malformation

Objective To research the diagnosis and surgical treatment of cavernous malformations （CM） accompanied with venous malformation （VM）. Methods Clinical data of 39 patients with CM treated by surgery were analyzed retrospectively. The patients were divided into VM groups and non-VM group based on intraoperative observation and judgment. The clinical data of two groups were analyzed to get suggestions of diagnosis and surgical treatment for CM accompanied with VM. Results VM was found under intraoperative microscope in 14 cases, detected by preoperative contrast-enhance MRI scan in 12, by DSA in 1 and by MRA in 0. There was no statistical significance in lesion size, lesion location, initial symptom and prognosis between the two groups （P〉 0.05）. This suggested that VM might be a part of CM. There were, however, 2 patients undergoing severe brain swell because of cutting off the VM in VM group, and 1 of them died. Conclusions Contrast-enhanced MRI scan should be used as a regular examination for CM, and try to get out of and protect the vessels of VM while designing surgical approach for CM accompanied with VM patients.