脑干海绵状血管瘤的影像学诊断和显微外科治疗

Radiological diagnosis of brainstem cavernous malformations and their micro-neurosurgical treatment outcomes

目的探讨脑干海绵状血管瘤的影像学特点与显微外科治疗效果。方法第四军医大学唐都医院全军微创神经外科中心自2006年5月至2011年9月共行显微外科手术切除术治疗脑干海绵状血管瘤患者15例，回顾性分析患者的影像学资料和治疗效果。结果脑干海绵状血管瘤在MRI上有特征性的表现，可见“桑椹状”或“网格状”结构，肿瘤周边可见低信号环，以T2WI像更为明显，提示有含铁血黄素沉积的陈旧性出血。本组肿瘤全切14例，1例次全切。术后1周。12例较术前症状有明显改善，2例无明显变化，l例延髓病变者出现饮水呛咳加重。术后3月，随访13例症状较术前明显改善，2例无明显改善。术后12月，随访12例，11例症状较术前明显改善，1例无明显改善。结论MRI及其增强显影可准确地显示海绵状血管瘤的大小位置，显微外科手术治疗是有效的治疗脑干海绵状血管瘤的方法。

Objective To investigate the radiological characteristics of brain stem cavernous malformations and their micro-neurosurgical treatment outcomes. Methods A retrospective analysis of radiological characteristics and micro-neurosurgical treatment outcome of 15 patients with brain stem cavernous malformations, admitted to our hospital from May 2006 to September 201 I, was performed. Results Distinctive features of patients with brain stem cavernous malformations were noted under MRI, showing mulberry-like or Lattice-shaped structures; low signal ring was noted around the tumors; T2WI enjoyed the most obvious signal, indicating remote hemorrhage resulted from hemosiderin deposition. All patients underwent entire resection ofbrainstem cavernous malformations except for one patient sub-entire resection. One week after the operation, the neurological status was improved in 12 patients, remained unchanged in 2 patients, and aggravated in 1 patient. Three months after the operation, the neurological status was improved in 13 patients and remained unchanged in 2 patients. Among the 12 patients undergone follow-up 12 months after operation, the neurological status was improved in 11 patients and remained unchanged in 1 patient. Conclusion MRI is reliable in the diagnosis of brainstem cavernous malformations; the position and size of cavernous hemangioma could be displayed clearly; miero-neurosurgical treatment can provide good outcome for patients with symptoms.