海绵窦海绵状血管瘤的诊断及显微手术治疗

Diagnosis and microsurgical treatment of cavernous sinus hemangioma

目的探讨海绵窦海绵状血管瘤的临床诊断及显微手术方法。方法回顾分析12例海绵窦海绵状血管瘤病人的临床资料，对相关文献进行复习。结果12例患者均行显微外科手术治疗，8例经颧弓翼点入路，2例经颅眶颧入路，2例经翼点入路，从中颅底硬膜下暴露并切除病变。肿瘤全切除5例，次全切除4例，部分切除3例，无手术死亡病例。术后视力进步者2例，4例有动眼神经麻痹，6例有面部麻木。结论自中颅底硬膜下暴露并切除肿瘤是一种有效的全切肿瘤的方法。经硬膜下入路，切开海绵窦外侧壁可以近距离达到供血动脉，更有效地减少出血。

Objective To investigate the diagnosis and microsurgical treatment of cavernous sinus hemangioma. Methods The clinical data including pathology, epide- miology, medical imaging, operation procedure, and post-operational complication of 12 cavernous sinus hemangioma patients undergoing operations in Qilu Hospital and Qingdao University Affiliated Hospital from 1999 to 2006 were analyzed. There were 2 males and 10 females. The patients were aged from 28 to 61 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. The common clinical manifestations were visual loss, diplopia, facial numbness and extraocular muscle palsy. The radiological features in all patients were similar with a characteristic pattern of extension and encasement of carotid artery. CT showed the lesion as hypodense to isodense with marked enhancement after contrast administration. Tl-weighted MR imaging showed the lesions as hypointense with marked enhancement after contrast administration. T2-weighted MRI imaging showed the lesions as hyperintense. The maximum size of the lesion was 9 to 57 mm （mean 45mm ）. Basal pterional craniotomy were used for 8 patients. Orbitozygomatic osteotomy were used for 2 patients. Pterional approach were used for 2 patients. The lesions were removed through incising the lateral wall of cavernous sinus. Results The tumor was totally removed in 5 cases, subtotally removed in 4 cases, and partially removed in 2 cases. The main post-operational complications included oculomotor nerve paralysis （4 cases ）, and trigeminal nerve lesions （3 cases）. No postoperative death occurred. Conclusion Operation is the best choice for cavernous sinous hemangioma. It was helpful to control bleeding through intradura and incising lateral wall of cavernous sinus.