上颌窦海绵状血管瘤的影像学诊断与治疗

Radiologic diagnosis and endoscopic surgery for cavernous hemangioma in maxillary sinus

目的探讨上颌窦海绵状血管瘤影像学检查的诊断价值,总结鼻内镜下切除上颌窦海绵状血管瘤的可行性。方法回顾性分析经病理确诊的11例海绵状血管瘤患者的影像学资料,对上颌窦海绵状血管瘤的内镜手术疗效进行随访并复习相关文献。结果影像学检查示CT主要表现为受累鼻窦膨大,骨质不同程度吸收。MRI检查9例患者T1WI呈中等信号,10例患者T2WI呈高信号;其中8例动态增强扫描均呈渐进性强化及蜂窝状或斑驳状表现。结合临床均能提示上颌窦海绵状血管瘤的诊断。11例上颌窦海绵状血管瘤均在鼻内镜下顺利完整切除,随访1年无复发。结论影像学检查对上颌窦海绵状血管瘤的术前诊断有特征性意义,绝大多数病例在不进行颌内动脉栓塞或颈外动脉血管结扎的情况下,可在鼻内镜下完整切除肿瘤。

Objective To investigate the diagnostic value of radiological examinations for cavernous hemangioma in maxillary sinus, and to evaluate the feasibility of endoscopic surgical removal of this tumor. Methods Radiological data （CT and MRI findings ） of 1 1 cases suffering from pathologically-confirmed cavernous hemangioma in maxillary sinus was analyzed retrospectively. All the patients received transnasal endoscopic surgical removal of cavernous hemangioma. The therapeutic effect was evaluated with postoperative follow-up, and related literature was reviewed. Results In all cases, MRI showed isointense lesions in 9 cases on T1WI and hyperintense lesions in 10 on T2WI. Dynamic contrast MRI imaging demonstrated marked progressive enhancement, honeycomb- like or variegated appearance in all these cases. All 1 1 cases received endoscopic removal of cavernous hemangioma without relapse in one year postoperatively. Conclusions The radiological characteristics can provide accurate information about the diagnosis of cavernous hemangioma in the maxillary sinus. In most of the patients, the tumor can be completely resected endoscopically without internal maxillary artery embolization or ligation of external carotid artery.