小脑血管母细胞瘤的临床特点及显微手术治疗效果分析

Clinical features and microsurgical treatment of cerebellar hemangioblastoma

目的探讨小脑血管母细胞瘤的临床特点、诊断及显微手术治疗效果。方法回顾性分析东部战区总医院神经外科2008年8月—2018年12月,行显微手术治疗的67例小脑血管母细胞瘤患者的临床资料。患者均经术前影像学检查诊断及术后病理组织学检查证实。于患者入院及出院时采用Kamofsky功能状态(KPS)评分评估患者的健康状况和生活质量。术后定期进行随访及影像学检查。结果本组患者的临床表现为头痛、头晕者52例、共济失调12例、肢体无力或麻木3例。手术采用枕下正中入路者35例、枕下旁正中入路19例、枕下远外侧入路13例。病灶位于左侧小脑半球20例、右侧小脑半球24例、小脑蚓部23例。肿瘤为小型者43例、大型17例、巨型7例;实体型28例、囊肿型39例。术后复查头部CT均未出现术区出血;复查头部MRI示,肿瘤全切除者66例,部分切除者1例。术后12例患者出现并发症。本组患者术前的KPS评分为(60±13)分,术后KPS评分为(74±12)分,治疗前后KPS评分比较,差异有统计学意义(t=11.002,P<0.01)。术后完成随访的患者41例,其中3例患者肿瘤复发,再次行手术治疗,病灶全切除。结论小脑血管母细胞瘤的临床表现无特异性,以颅高压症和小脑损害症状多见;显微手术治疗可以获得较好的效果,能明显改善患者的健康状况和生活质量。

Objective To analyze the clinical characteristics,diagnosis and microsurgical treatment of cerebellar hemangioblastoma.Methods The clinical data of 67 patients with cerebellar hemangioblastoma underwent microsurgical treatment in the neurosurgery department of Jinling Hospital from August 2008 to December 2018,were analyzed retrospectively.All patients were diagnosed by imaging data before operation,and further confirmed by pathology after operation.The patients'health status and quality of life were assessed by Karnofsky performance scale(KPS)score in admission and when discharged.Clinical and radiological follow-up were carried out regularly after operation.Results(1)Of 67 patients,the clinical features of 52 were headache and dizziness,12 were ataxia,3 were weakness or numbness of limbs.(2)Of 67 patients,35 were treated with suboccipital median approach,19 were treated with suboccipital paramedian approach and 13 were treated with suboccipital far lateral approach.The lesions of 20 cases located in left cerebellar hemisphere,24 located in right cerebellar hemisphere and 23 located in cerebellar vermis.43 cases were small size,17 were large size and 7 were giant size.28 cases were solid type and 39 were cystic type.(3)The 67 patients had no hemorrhage in the operative region as showed in head CT immediately after operation and the lesions were totally removed in 66 cases and partly removed in 1 case as showed in head MRI.After operation,12 cases had complications.The preoperative and postoperative KPS of 67 patients was(60±13)points and(74±12)points,respectively.There was significant difference before and after treatment(t=11.002,P<0.01).Of 67 patients,41 were followed up,3 recurred and underwent re-operation,the lesions were totally resected.Conclusions The clinical features of cerebellar hemangioblastoma are nonspecific,intracranial hypertension and cerebellar damage are common.Microsurgical treatment can achieve good results,which is important for the improvement of cerebellar hemangioblastoma patients'health status and quality of life.