中枢神经系统海绵状血管畸形的新分类

A new classification of cavernous malformation in the central nervous system

目的基于术前MRI影像和术中病理形态特征,提出中枢神经系统海绵状血管畸形的新分类。方法回顾性分析经显微手术切除的97例海绵状血管畸形的临床资料。根据术前MRI表现和术中病理形态特征,将病变分为团块型、假包膜型、混合型和巨大型,并统计分析。结果团块型47例(48.5%),假包膜型33例(34.0%),混合型14例(14.4%),巨大型3例(3.1%)。不同类型海绵状血管畸形病人的就诊年龄、首发症状构成比有显著性差异(均P<0.05),但分布部位、病程无差别(均P>0.05)。巨大型病人平均就诊年龄最小,为17.7岁。假包膜型的首发症状以神经功能障碍(48.5%)和头痛(27.3%)居多,团块型以癫疒间(46.8%)和神经功能障碍(25.5%)居多,混合型以癫疒间(42.9%)和头痛(35.7%)居多。除巨大型,其他类型病灶大小有显著性差异(P<0.05),混合型最大,团块型最小。结论不同类型的海绵状血管畸形各有临床特点,区分不同类型病变有助于精细手术。

Objective To propose a new classification of cavernous malformation in the central nervous system based on preoperative MR/and intraoperative pathomorphologic features. Methods The clinical data of 97 patients with cavernous malformation in the central nervous system were analyzed retrospectively. According to preoperative MR/and intraoperative pathomorphological features, the lesions were divided into lump type, psuedo-capsule type, mixed type and giant type, and were analyzed statistically. Results The lump type was seen in 47 patients （48.5%）, pseudo-capsule type in 33 （34.0%）, mixed type in 14 （14.4%） and giant type in 3 （3.1%）. The differences in visit age and constituent ratio of first symptom between the 4 types of cavernous malformation were significant （all P〈0.05）, while the differences in site and course of disease were insignificant （all P〉0.05）. The visit age of giant type was 17.7 years, which was younger than that of three other types. The first symptoms were mainly neurologic deficits （48.5%） and headache （27.3%） in pseudo-capsule type, epilepsy （46.8%） and headache （25.5%） in lump type, epilepsy （42.9%） and headache （35.7%） in mixed type. The differences in lesion diameter between the 3 types except giant type were obvious （P〈0.05）, and the mixed type was biggest while the lump type was smallest in lesion diameter. Conclusions Different types of cavernous malformation have respective clinical features. The surgery can be performed precisely by distinguishing different types of lesions.