以颅内出血首发的脑膜瘤19例临床及影像学分析

Clinical and imaging analysis on meningiomas initially manifesting as intracranial hemorrhage in 19 cases

目的探讨以颅内自发性出血起病的脑膜瘤主要临床特征、影像学特点、诊断及治疗。方法回顾性分析2011年1月至2020年12月汕头大学医学院第一附属医院收治的以颅内自发性出血首发的脑膜瘤患者19例的临床、影像学、治疗及随访资料。结果19例患者中,男6例,女13例;年龄(53±14)岁;起病表现为突发剧烈头痛、呕吐6例,意识障碍渐至昏迷4例,偏瘫9例。脑膜瘤影像学表现:15例肿瘤形态不规则,CT呈混杂高密度,4例呈均匀高密度;18例见瘤周水肿灶;3例见瘤内钙化灶,1例见瘤内液平征。14例T1WI呈中、低信号,T2WI呈中、高信号;5例T1WI呈等、高信号,T2WI呈混杂低、高信号。增强扫描18例呈不均匀强化,15例瘤内见囊变坏死,16例见脑膜尾征。术前影像学误诊4例。患者均行手术切除肿瘤及清除血肿,无手术死亡病例,术后肌力均较术前改善。随访时间为(46.5±28.4)个月,肿瘤复发2例,末次随访时、出院时、术前等Karnofsky功能状态评分(KPS)分别为(73.7±3.4)分、(61.1±5.5)分、(49.5±5.6)分(F=21.06,P<0.01);末次随访时的KPS评分较出院时、术前均有升高(F=13.13,P<0.01)。结论脑膜瘤自发性出血少见,临床起病急骤,术前容易误诊,头颅CT、头颅CT血管成像(CTA)结合MR增强检查可提高术前确诊率,及早行手术切除肿瘤及清除血肿,可取得良好的临床疗效。

Objective To investigate the main clinical characteristics,imaging features,diagnosis,and treatment of meningiomas initially manifesting as spontaneous intracranial hemorrhage.Methods The clinical characteristics,imaging features,treatment,and follow-up data of 19 patients with meningiomas initially manifesting as spontaneous intracranial hemorrhage who received treatment in The First Affiliated Hospital of Shantou University Medical College from January 2011 to December 2020 were retrospectively analyzed.Results Among the 19 patients,there were 6 males and 13 females,with an average age of(53±14)years.The onset manifestations were sudden and severe headache and vomiting in 6 cases,progressive coma in 4 cases,and hemiplegia in 9 cases.Among the 19 patients,15 patients showed irregular tumor shape and mixed hyperintense signal in CT,and 4 patients showed a homogeneous hyperintense signal.Eighteen patients showed peritumoral edema.Three patients showed intratumoral calcification.One patient showed an intratumoral fluid level.Fourteen patients showed isointense to hypointense signals on T1WI images and isointense to hyperintense signals on T2WI images.Five patients showed mixed isointense and hyperintense signals on T1WI images and mixed hypointense and hyperintense signals on T2WI images.Heterogeneous enhancement was found in 18 patients,intratumoral cystic necrosis was found in 15 patients,and the meningeal tail sign was found in 16 patients.Preoperative imaging misdiagnosis occurred in 4 patients.Before surgery,all patients underwent surgery to resect the tumor and remove the hematoma.No patients died because of surgery.After surgery,muscle strength was improved compared with that before surgery.The average follow-up time was(46.5±28.4)months.Tumor recurrence occurred in two patients.The Karnofsky Performance Scale score at the last follow-up,at discharge,and before surgery was(73.7±3.4)points,(61.1±5.5)points,and(49.5±5.6)points,respectively(F=21.06,P<0.01).The Karnofsky Performance Scale score at the last follow-up was significantly increased compared with that at discharge and before surgery(F=13.13,P<0.01).Conclusion Spontaneous hemorrhagic meningioma is rare and has a sudden onset.It is easily misdiagnosed before surgery.Skull CT,skull CT angiography,and enhanced magnetic resonance imaging examination in combination can increase the preoperative diagnosis rate.Early surgical resection of tumors and removal of hematoma can acquire good clinical efficacy.