婴幼儿颅内海绵状血管瘤的临床特点与治疗

Intracranial cavernous angioma in infants: clinical characteristics and therapy

目的 探讨婴幼儿颅内海绵状血管瘤（intracranial cavernous angioma,ICA）的临床特点,治疗和预后.方法 回顾我科2008年6月至2011年6月收治的13例3岁以下婴幼儿ICA的临床资料,分析病变的大小、分布及临床表现、治疗预后等.结果 13例患儿均在手术显微镜下行手术治疗（部分采用神经导航下手术）,共切除病变13个,多发病变者仅切除责任病灶,病灶平均大小21.6 mm,大脑半球发生率最高（8/13,61.5％）;术后全组患儿无死亡及严重并发症病例,原有癫痫发作、神经功能障碍等临床症状除1例复视未改善外,均明显改善.随访2～5年,无复发病例,未出现新的临床症状.结论 婴幼儿ICA的临床特点与成人不同,手术是唯一有效的治疗方式,微创手术可有效改善神经功能障碍,取得满意的临床疗效.

Objective The clinical characteristics, therapy and outcome of intracranial cavernous angioma （ICA） in infants are discussed. Methods Clinical data of thirteen infants diagnosed as ICA from Jan 2008 to Jun 2011 were reviewed. Clinical manifestations, therapy, and outcome of the patients were analyzed. Results All of thirteen patients received microsurgery, while some were guided by neuronavigation. Thirteen lesions were successfully removed, while only responsible lesions were resected in 2 patients with multiple ICA. Majority of lesions located in cerebral hemisphere （8/13, 61.5% ）. The diameter of lesions ranged from 5 mm to 48 mm （ mean was 21.6 mm）. There was no mortality or severe complications. Seizures of four patients were controlled after operations. Neurological deficits （ including limps dyskinesia, headache, and intracranial hypertension） significantly improved in the other 9 cases. Only the symptom of diplopia in one infant got no improvement. There was no recurrence or re-hemorrhage during the 2 ~ 5 years＇ follow-up. Conclusion There are many differences of ICA between infants and adults. Microsurgery is the optimal choice for infants with ICA, while favorable outcomes can be achieved in most patients.