血管瘤型脑膜瘤的诊断和手术治疗

The diagnosis and microsurgical treatment of angiomatous meningioma

目的探讨血管瘤型脑膜瘤的特征及手术治疗。方法回顾性分析22例血管瘤型脑膜瘤的病例资料,均采取手术治疗。总结临床和影像学特点、手术技巧及预后。结果血管瘤型脑膜瘤MRI扫描T1WI呈稍低信号或等信号,T2WI多呈高信号,多伴明显瘤周水肿,肿瘤内常可见粗细不等的血管流空影,增强后可见脑膜尾征,并呈显著明亮均匀强化。术中见肿瘤富含血管,血供极其丰富,除硬膜动脉供血外,常有脑表面分支动脉参与供血。本组SimpsonⅠ级切除16例,Ⅱ级切除6例。术后6个月～2年随访复查,无肿瘤复发。结论血管瘤型脑膜瘤以血管化生为主,富含血管，具有特征性的影像学表现，肿瘤血供极其丰富，术中易出血，手术全切除肿瘤后复发率低。

Objective To explore the characteristics and microsurgical treatment of angiomatous meningioma. Methods The clinical data of 22 patients with angiomatous meningioma undergoing microsurgical treatment were analyzed retrospectively. The clinical feature, imaging feature, microsurgical skill and prognosis were summarized. Results The TIWI MRI imaging of angiomatous meningioma demonstrated isointensity or slightly hypointensity and T2WI MRI imaging mostly demonstrated hyperintensity and showed obvious peritumoral edema and vascular flow voids. All the 22 cases demonstrated dural tail sign and extremely obvious enhancement at post-contrast imaging. The tumor was rich in blood vessels and had a rich blood supply which is from both dural arteries and cortical branch arteries. Simpson Ⅰ resection was achieved in 16 patients and Simpson Ⅱ in 6. There was no recurrence during follow-up period from 6 months to 2 years. Conclusions The angiomatous meningioma is dominated by vascular metaplasia and riches in blood vessels, thus demonstrating characteristic imaging findings. The tumor is extremely rich in blood supply. After totally surgical removal, the relapse rate is low.