颅内海绵状血管畸形合并静脉性血管畸形切除术的临床分析

Clinical analysis of the resection of intracranial cavernous malformation complicated with venous malformation

目的初步探讨颅内海绵状血管畸形合并静脉性血管畸形患者的手术方法。方法回顾性分析首都医科大学附属北京天坛医院神经外科2007年1月至2014年12月手术治疗的13例颅内海绵状血管畸形合并静脉性血管畸形患者的临床资料和术后随访结果。结果13例患者中，7例颅内海绵状血管畸形合并静脉性血管畸形均达到全切除，其术后均发生严重的脑组织水肿，其中幕上4例采取加强脱水治疗后预后良好，幕下1例死亡，2例遗留后遗症；切除异常扩张髓静脉、保留主要引流静脉的4例患者和保留静脉性血管畸形的2例患者术后病情均平稳，预后良好。结论在切除颅内海绵状血管畸形合并静脉性血管畸形的手术中，全切除海绵状血管畸形的同时切除异常扩张的髓静脉，并保留主要引流静脉，更有利于患者的康复。

Objective To preliminarily discuss the operation strategy in patients with intracranial cavernous hemangioma complicated with venous malformation. Methods The clinical data and postoperative follow-up results of 13 patients with intracranial cavernous hemangioma complicated with venous malformation operated at the Department of Neurosurgery, Beijing Tiantau Hospital, Capital Medical University fi＇om Janual3~ 2007 to December 2014 were analyzed retrospectively. Results In the 13 patients, intracranial cavernous malformation complicated with venous malformation achieved total resection in 7 patients. They all developed severe cerebral edema after procedure. Four of them were in the supratentorial region, their prognoses were good after strengthening dehydration treatment, and 1 in the supratentorial region died, and 2 left sequelae. The postoperative condition was stable and the prognosis was good in 4 patients whose abnormal expansion of medullary veins were resected, the main drainage veins were retained and in 2 patients whose venous vascular malformations were retained. Conclusion In the operation of resection of intracranial cavernous malformation complicated with venous malformation, the resection of abnormally dilated medullary veins and retaining main draining veins at the same time of the total resection of cavernous malformation are more conducive to the rehabilitation of patients.