鞍旁海绵状血管瘤12例临床诊断及显微外科治疗分析

Clinicai diagnosis and microsurgery of 12 patients with parasellar cavernous hemangiomas

目的探讨鞍旁海绵状血管瘤的临床特点及显微外科手术治疗的效果。方法对12例鞍旁海绵状血管瘤患者的临床资料和显微外科手术治疗效果进行回顾性分析。鞍旁海绵状血管瘤的MRI-T1WI呈稍低信号，T2WI呈高信号，增强扫描病变呈显著强化。结果9例肿瘤全切除，3例次全切除，无手术死亡病例发生。术后颅内高压症状均得到缓解；6例有视力、视野障碍者，改善5例，无变化1例；5例术前眼球活动障碍者，改善3例，无变化2例；4例术前有垂体内分泌功能障碍者，改善2例，无变化2例；术后早期并发尿崩症和电解质代谢紊乱3例，同侧动眼神经功能障碍2例。术后随访（30．51±2．57）个月，3例尿崩症和电解质代谢紊乱均痊愈，动眼神经功能障碍恢复1例。12例患者均未见肿瘤复发或增大。结论MRI检查有助于术前对鞍旁海绵状血管瘤做出正确的诊断；显微外科手术是治疗鞍旁海绵状血管瘤的首选治疗方法。

Objective To investigate the clinical features and microsurgical outcomes of patients with paraseUar cavernous hemangiomas. Methods The clinical data and prognosis of 12 patients with parasellar cavernous hemangiomas treated with microsurgery were retrospectively analyzed. Magnetic resonance imaging showed that cavemous hemangiomas appeared slight hypointensity on TIWI, hyperintense on T2WI, and significant contrast on enhancing. Results Total resection and sub-total resection was achieved in 9 and 3 patients. No death occurred postoperatively. After operation, all patients were released from intracranial hypertension. In 6 patients who had visual disorder, 5 patients improved and 1 patient had no change. In 5 patients who had eyeball motor disorder, 3 patients improved and 2 patients had no change. In 4 patients who had pituitary gland dyshormonism, 2 patients improved and 2 patients had no change. At postoperative early stage, diabetes insipidus and serum electrolyte disorder occurred in 3 patients, 2 patients developed oculomotor paralysis. Patients were followed up （30.51 ± 2.57） months. Three patients recovered from diabetes insipidus and serum electrolyte disorder, and 1 patient recovered from oculomotor paralysis. No patient suffered tumor recurrence or regrowth. Conclusions The correct diagnosis of parasellar cavernous hemangiomas can be achieved according to the preoperative MRI. Microsurgery is the first-line therapy for parasellar cavernous hemangiomas.