海绵窦区海绵状血管瘤的临床特征及显微外科治疗

Clinical characteristics and microsurgical treatment of cavernous hemangiomas in cavernous sinus regions (a report of 6 cases)

目的探讨海绵窦区海绵状血管瘤的临床特征及显微外科治疗方法。方法回顾性分析2001年至2009年收治的6例海绵窦区海绵状血管瘤患者的临床资料。患者的主要临床表现为头痛、视力下降、复视、面部麻木等。CT示海绵窦低或等密度病变,增强扫描时病变明显而均匀增强。头颅MRI示T1WI等信号或略低信号,T2WI高信号,增强后显著均匀强化。6例患者均经改良翼点入路或眶颧翼点入路行显微手术治疗,其中经硬脑膜外入路4例,经硬脑膜下入路2例。结果海绵状血管瘤完全切除3例,次全切除3例。无死亡病例,4例术后出现同侧第Ⅲ、Ⅳ、Ⅴ及Ⅵ颅神经麻痹,1例偏瘫,2例患者术后视力较术前有明显改善。结论海绵窦区海绵状血管瘤有一定的临床特征和影像学表现,有助于术前诊断。经颅底开颅和硬脑膜外入路手术切除海绵窦区海绵状血管瘤是有效的治疗方法,术中应严格按界限整块切除;对血管瘤较小者或术后残留者可辅以放射治疗。

Objective To investigate the clinical characteristics and microsurgical treatment of cavernous hemangiomas in the cavernous sinus region. Methods The clinical data of 6 patients with cavernous hemangiomas in the cavernous sinus regions undergoing surgery in our hospital from 2001 to 2009 were analyzed retrospectively. The literature related to the cavernous hemangiomas were reviewed. The common clinical manifestations included headache, visual loss, diplopia, facial numbness and extraocular muscle palsy in the patients with cavernous hemangiomas in the cavernous sinus regions. CT showed that there were hypodensity or isodensity lesions with marked and homogeneous enhancement after contrast administration in the cavernous sinus regions. The cavernous hemangiomas manifested isointensity hypointensity with marked and homogeneous enhancement after contrast administration on MRI T1WI, and hyperintensity with marked and homogeneous enhancement on MRI T2WI. The microsurgery through modified pterional approach or orbitozygomatie pterional approach was performed in all the patients. Results Of 6 patients with cavernous hemangiomas, 3 received total removal of the hemangiomas and 3 subtotal. The main postoperative complications included palsy of the cerebral nerves Ⅲ, Ⅳ, Ⅴ, Ⅵ in 4 patients and hemiparalysis in 1 patient. The visual sight was significantly improved after the operation compared to that before the operation in 2 patients. Conclusions The cavernous hemangiomas in the cavernous sinus regions has some clinical and imaging characteristics which are helpful to its diagnosis. The curative effects of total resection of hemangiomas by surgery on the cavernous hemangiomas is good. Radiosurgery should be performed in patients with residual hemangiomas.