脑(脊髓)内外海绵状血管瘤的影像学特征与显微外科治疗

Imaging features of intra/extra cerebral(spinal)cavernous angioma and its microsurgical treatment

目的探讨脑(脊髓)内外海绵状血管瘤(CA)的影像学特点及治疗方法。方法脑内CA 13例,分别位于脑皮层深部、海马、外侧裂Broca氏区、中央前回、后回、丘脑深部、桥脑及小脑半球；胸髓内CA 3例；位于海绵窦、鞍旁颅中窝的脑(轴)外CA 2例；髓外(T_(12))CA 1例。所有病例均行CT、MRI检查并接受显微外科手术治疗。结果脑(脊髓)内CA在MRI的T1、T2像上,病变周围可有典型的含铁血黄素黑环征；脑(脊髓)外CA的CT、MRI表现不具特征性。所有脑(脊髓)内CA在显微镜下(部分病例使用立体定向配合)获得全切；因轴外CA血供异常丰富,只作部分切除。结论MRI对于脑(脊髓)内CA具有诊断意义,对于反复出血病例宜争取显微手术全切；因轴外CA术中出血凶猛,应慎重决定其治疗方案。

Objective To discuss the imaging features of intra/extra cerebral / spinal cavernous angioma （CA） and its treatment methods. Methods Thirteen intra-cerebral CAs were sited in the deep cerebral cortex, hippocampus, Broca＇s area, anterior/posterior central gyms, deep thalamus, pons, cerebellar hemisphere and 3 intra-spinal CAs were located in thoracic cord. 3 extra-axial （cerebral/spinal） CAs, including 2 extra-cerebral CAs, and 1 extra-spinal CA, were located in cavernous sinus, parasellar region, and T12 level of the spinal cord respectively. All cases underwent CT scan, MRI examination and microsurgical treatment. Results Intra-cerebral/spinal CAs showed the typical change, hemosiderin ring surrounding the CAs, on the T1 and T2-weighted MRI images. Extra-axial CAs showed no characteristic change on CT or MRI. All intra-cerebral/spinal CAs were total removed by microneurosurgical technique and the extra-axial CAs were partly resected because of the especially rich blood supply. Conclusion MRI is the best choice for the diagnosis of intra-cerebral/spinal CA. If the CA appeared repeat hemorrhage, it should be totally removed by microneurosurgical technique. Because of severe intraoperative bleeding, it is should be careful to decide the strategy for extra-axial CA.