中枢神经系统血管母细胞瘤的诊断及显微外科治疗

Diagnosis and microsurgical treatment of central nervous system hemangioblastoma

摘要:

目的 探讨中枢神经系统血管母细胞瘤的临床特点、手术技巧和疗效。方法 回顾性分析我院2009年06月至2014年06月17例中枢神经系统血管母细胞瘤显微手术患者的临床数据、影像学特征、手术效果和随访资料。结果 主要症状包括头痛、共济失调和肢体功能障碍。17例行MRI检查, 6例行CT检查, 3例行DSA检查, 1例行MRA检查, 大囊小结节型 10例, 均为单发, 实质性7例, 6例多发。13例显微镜下一期全切, 1例显微镜下二期全切, 3例显微镜下切除大的病变, 小的病变随访。无手术死亡病例。随访3月-5年, 神经功能改善15例, 无明显变化2例, 肿瘤全切者无肿瘤复发, 3例未切除的小的病变随访未增大。结论 MRI对中枢神经系统血管母细胞瘤具有重要的诊断价值, 显微外科治疗中枢神经系统血管母细胞瘤安全有效, 术后并发症少。

Abstract:

Objective To investigate the clinical characteristics, surgical techniques, and treatment outcomes in patients with central nervous system hemangioblastoma (CNS HB).Methods We conducted a retrospective analysis on the clinical data, imaging characteristics, surgical effect, and follow-up data for 17 cases of CNS HB from June 2009 to June 2014.Results The major clinical symptoms of CNS HB included headache, ataxia, and limb dysfunction. All the 17 patients had magnetic resonance imaging (MRI) scan. Computed tomography was performed in 6 patients. Three patients had digital subtraction angiography. Magnetic resonance angiography was performed in 1 patient. Totally 10 cases were identified as solitary cystic-nodule type. There were 7 cases with parenchymal lesions and 6 cases with multiple lesions. Under the microscope, a total of 13 cases had the tumor completely removed at stage I and 1 case had the tumor completely removed at stage II; the large lesions in the other 3 cases were removed and the small lesions were followed up. No intraoperative death was observed. After 3 months to 5 years of follow-up treatment, there were 15 cases of neurological function improvement and 2 cases of no obvious changes. No tumor recurrence was observed in all completely removed cases. The small lesions in the 3 cases were not found to become larger.Conclusions MRI has great diagnostic value for CNS HB. In addition, microsurgical treatment for CNS HB is safe and effective with few postoperative complications.