脑膜瘤自发性出血的临床特征和治疗

Clinical features and treatment of meningiomas with spontaneous hemorrhage

目的探讨脑膜瘤自发性出血的临床表现、影像学特征、治疗方法以及预后。方法回顾性分析宁波市医疗中心李惠利医院神经外科2008年3月至2017年3月连续收治并行手术治疗的497例脑膜瘤患者的临床资料,其中脑膜瘤自发性出血患者共15例(占3.0%),总结其临床表现、影像学特征、治疗方法以及预后。结果15例患者的临床症状为慢性头痛、一侧肢体乏力、视力下降或癫痫等前期症状突然加重(6例),亦可表现为突发剧烈头痛、偏瘫、癫痫发作等类似卒中发作表现(9例)。头颅CT和MRI上显示为血肿、肿瘤占位和瘤周水肿征象。根据肿瘤与血肿的位置关系,脑膜瘤自发性出血可分为单纯瘤内出血型(7例)、单纯瘤周出血型(6例)和瘤内外混合性出血型(2例)3个类型。所有患者同期行肿瘤切除和血肿清除。肿瘤切除程度达SimpsonⅠ级9例,Ⅱ级2例,Ⅲ级3例,Ⅳ级1例。15例患者术后随访48个月,3例术后存在神经功能后遗症,余12例均无明显的神经功能障碍。影像学随访结果提示,15例患者中,2例肿瘤进展或复发;余13例未见肿瘤复发。结论脑膜瘤自发性出血的发生率较低,其临床表现与卒中急症相似。通过术前头颅CT结合MRI检查可明确诊断,根据出血的影像学特征可分为单纯瘤内出血型、单纯瘤周出血型和瘤内外混合性出血型。基于患者的临床特征选择相应的治疗策略,患者多可获得良好的预后。

Objective To explore the clinical manifestations,imaging features,treatment methods and prognosis of spontaneous hemorrhage of intracranial meningiomas.Methods A retrospective analysis was conducted on the clinical data of 497 patients with meningioma who were consecutively admitted and underwent surgical treatment from March 2008 to March 2017 at the Department of Neurosurgery,Li Hui Li Hospital of Ningbo Medical Center,including 15 patients with spontaneous hemorrhage of meningioma(accounting for 3.0%).We summarized the patients′clinical manifestations,imaging features,treatment methods and outcomes.Results The clinical symptoms of 15 patients included the sudden worsening of chronic headache,weakness of one limb,decreased vision or epileptic seizure and other preexisting symptoms(6 cases),and they could also be manifested as sudden severe headache,hemiplegia,seizures and other stroke-like symptoms(9 cases).Head CT and MRI showed signs of hematoma,space-occupying tumor and peritumoral edema.According to the positional relationship between tumor and hematoma,spontaneous hemorrhage of meningioma could be divided into three types:merely intratumoral hemorrhage(7 cases),merely peritumoral hemorrhage(6 cases)and combined intratumoral and peritumoral hemorrhage(2 cases).All patients underwent tumor resection and hematoma removal at the same time.The degree of tumor resection reached Simpson gradeⅠin 9 cases,gradeⅡin 2 cases,gradeⅢin 3 cases,and gradeⅣin 1 case.Fifteen patients were followed up for 48 months after operation.Three patients had neurological sequelae,and the remaining 12 patients had no obvious neurological dysfunction.The results of imaging follow-up showed that,of the 15 patients,2 had tumor progression or recurrence;the remaining 13 had no tumor recurrence.Conclusions The incidence of spontaneous bleeding in meningioma is low,and its clinical manifestations are similar to stroke emergencies.Meningioma with hemorrhage can be diagnosed by preoperative CT combined with MRI.According to the imaging characteristics of hemorrhage,it can be divided into merely intratumoral hemorrhage,merely peritumoral hemorrhage and combined intratumoral and peritumoral hemorrhage.The corresponding treatment strategy should be chosen based on the patient′s clinical characteristics,and most patients could achieve a favorable outcome.