颅内结核瘤的临床特点与外科治疗

The clinical features of intracranial tuberculoma and surgical treatment

目的探讨颅内结核瘤的临床特点、诊断和外科治疗效果。方法回顾性分析首都医科大学附属北京地坛医院神经外科2013年8月至2016年4月收治的8例颅内结核瘤的临床表现、手术方式及治疗效果。结果8例颅内结核瘤中4例合并人类免疫缺陷病毒（HIV）感染，3例合并其他系统结核。其中5例病变位于幕上，3例位于幕下。8例中7例行开颅手术切除病灶，1例行立体定向活检术。术后病理均确诊为颅内结核瘤，抗酸染色均为阳性。术后予以正规的抗结核药物治疗。1例术后1年因HIV相关并发症而死亡，其余患者恢复良好。结论颅内结核瘤临床特点多变，幕上病变多以癫痫、头痛等症状为主，幕下多表现为脑积水所致的颅高压症状。该病诊断应结合临床表现、影像学特点、实验室检查和抗结核疗效综合分析。在严格掌握适应证的情况下，手术治疗效果良好。

Objective To investigate the clinical characteristics of intracranial tuberculoma and its diagnosis and outcomes of surgical treatment. Methods In this retrospective study, clinical data including manifestations, imaging, laboratory tests and surgical outcomes of 8 adults were analyzed who were consecutively identified with intracranial tuberculoma from August 2013 to April 2016 at Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University. Results Among the 8 patients with intracranial tuberculoma, the human immunodeficiency virus （HIV） infection was identified in 4 cases and tuberculosis （TB） involving other systems was found in 3 cases. Out of the 8 patients, lesions were supratentorial in 5 cases and located in posterior fossa of the remaining 3 cases. Seven cases underwent total resection and stereotactic biopsy was performed in 1 case. Pathological acid-fast stain demonstrated positive results and confirmed the diagnosis of tuberculoma. All the patients were regularly treated with anti- tubereulosis drugs. One case died from HIV-related complications 1 year post operation and the rest recovered well. Conclusions The clinical characteristics of intracranial tuberculoma vary depending on its location. The supratentorial tuberculoma commonly caused epilepsy and headache and the subtentorial lesion often presented with symptoms related to high intracranial pressure due to hydrocephalus. The diagnosis should be based on a combination of clinical manifestations, imaging features, laboratory examination and anti- tuberculosis efficacy. With strict following of its indications, surgical treatment might be effective.