儿童颅骨膜血窦27例的诊断与治疗

Diagnostic and Therapeutic Considerations of Sinus Pericranii in 27 Children

目的探讨儿童颅骨膜血窦的临床特点,影像学诊断、治疗与疗效。方法回顾性分析本科2007年7月-2011年7月收治的27例颅骨膜血窦病例的临床资料。本组病例术前均行头颅CT三维成像或头颅CT血管造影三维成像,清楚显示病灶内异常血管团与颅内静脉窦相通,病灶下方存在不同程度的骨质缺损。治疗方法以手术为主,目的在于切除异常血管团,离断交通静脉,封堵缺损骨孔。结果本组病例共手术治疗23例,切除病灶25处,手术均获成功,未出现术中大出血、颅内静脉栓塞等并发症。术后21例症状消失,2例好转。术后随访6个月～3 a,无复发,复查CT大部分骨孔愈合。结论颅骨膜血窦是一种少见的静脉异常,是沟通颅外静脉和颅内静脉的无肌层静脉血管团,多见于儿童。临床常表现为与体位改变有关的非搏动性可回复的头皮软组织肿块。诊断主要依靠CT或头颅CT血管造影三维成像。治疗以手术切除为主,亦可血管内栓塞。术后效果满意。

Objective To discuss the clinical features,imaging diagnosis,therapeusis and efficacy of sinus pericranii（SP） in children. Methods Twenty-seven pediatric cases of SP in Nanjing Children′s Hospital from Jul.2007 to Jul.2011 were analyzed retrospectively.They underwent three-dimensional CT（3D-CT） or three-dimensional CT angiography,the abnormal blood vessels within the mass connected with the intracranial venous sinus and the tiny holes under the mass could be shown clearly.Surgery had been the common choice of treatment.The aim was to remove abnormal vascular groups,close traffic veins,and block the hole. Results Twenty-three cases underwent surgery for SP,and 25 lesions were removed. All operations were successful,and didn′t have bleeding,intracranial venous thrombosis or other complications.The symptoms disappeared in 21 cases of the patients after surgery while 2 cases improved.Children recovered well after surgery,follow-up of 6 months to 3 years,without recurrence.CT scans showed that most of the bone holes healed well. Conclusions SP is a rare vascular group for the communication of extracranial and intracranial veins.It′s more common in children.It usually presents with clinical position on the non-pulsatile scalp soft tissue mass.The diagnosis of SP depends on CT or CT angiography three-dimensional imaging.Surgery is an important treatment.The postoperative results are satisfactory.