中枢神经系统海绵状血管瘤诊治的进一步探讨

Further Study of Diagnosis and Treatment of Cavernous Angioma in the Central Nervous System

目的 探讨中枢神经系统海绵状血管瘤(CA)诊治的进展。方法 回顾性分析近5年97例患者(近期组)的资料,并与过去报告的79例(早期组)进行比较。结果 近期组单发CA 86例,多发11例,脑实质内71例,脑外26例。术前CT和MRI拟诊率近期组为28.6％(10/35)和79.5％(58/73),早期组为4.6％(3/65)和72.5％(29/40)。脑内CA全切率和手术死亡率近期组为98.6％(70/71)和0,早期组为93.6％(44/47)和6.4％(3/47)。近期组鞍旁CM经硬膜外或硬膜下入路全切率分别为83％(5/6)和11％(1/9),早期组无1例全切。长期随访优良率近期组为97.5％(78/80),早期组为91.5％(43/47)。结论 提高对CA在MRI表现的识别能力、应用神经导航辅助显微外科技术以及合理地应用手术入路是提高本病诊治水平的重要因素。

Objective To explore further the diagnosis and treatment of cavernous angioma (CA) in the central nervous system. Methods The data of 97 patients with CA (latter group, LG) in the last 5 years were analyzed reslrospectively and compared to those of 79 patients with CA (early group, EG) reported previously by us. Results In LG single CA was found in each of 86 patients, multiple CAs in each of 11 patients. CAs were located within the cerebral parenchyma in 71 patients and out of the cerebral parenchyma 26 patients. Preoperative diagnostic rates by CT and MRI were 28.6% (10/35) and 79.5% (58/73) in LG, and 4.6% (3/65) and 72.5% (29/40) in EG respectively. The rate of total resection of intracereral CAs and the surgical mortality were 98.6% (70/71) and nil in LG. and 73.6% (40/47) and 6.4% (3/47) in EG respectively. The rats of the total removal of parasellar CAs via an extra- and intra-dural surgical approaches were 83% (5/6) and 11% (1/9) respectively in LG and no case of the parasellar CAs was totally removed in EG. There were excellent and good outcomes during long term follow-up periods in 97.5% (78/80) of the patients of LG and 91.5% (43/47) of ones of EG respectively. Conlusion Heightening ability of identification of the CAs features on MRI is key to the exact diagnosis. The neuronavigator-assisted microsurgical technigue and proper surgical approach are essential to improving treatment of CAs.