酷似高血压脑出血的基底节区血管畸形的显微外科治疗

Microsurgical treatment of vascular malformations in basal ganglia mimicking hypertensive intracerebral hemorrhage

摘要:

目的 探讨基底节区血管畸形出血的诊断及显微外科治疗。方法 回顾性收集2011年2月~2014年12月在我院收治的12例基底节区血管畸形出血患者的临床和影像学资料、手术所见及病理结果。结果 10例行小骨窗开颅术,2例行大骨瓣开颅术,术中见血肿壁异常血管组织,无明显粗大的供血动脉及引流静脉,术后病检结果动静脉畸形8例,海绵状血管瘤4例。结论 对于基底节区脑出血的患者,应警惕血管畸形出血的可能,术前应注意鉴别,该部位血管畸形多较小,无明显粗大的供血动脉及引流静脉,术中应注意在血管畸形周边切除畸形血管团。

Abstract:

Objective To discuss the diagnosis and microsurgical treatment of vascular malformation hemorrhage in the basal ganglia.Methods A retrospective analysis was performed on the clinical data of 12 patients with vascular malformation hemorrhage in the basal ganglia treated in our hospital from February 2011 to December 2014, including clinical and imaging data, operative findings, and pathological results.Results Ten patients underwent small bone window craniotomy, and 2 patients received large bone flap craniotomy. Abnormal vascular tissues were seen on the hematoma walls during the surgery, with no markedly large feeding arteries or draining veins. Postoperative pathological results showed 8 cases of arteriovenous malformations and 4 cases of cavernous hemangioma.Conclusions For patients with basal ganglia hemorrhage, the possibility of vascular malformations should be alerted, and differentiation should be performed before surgery. Most vascular malformations in this region are small, with no markedly large feeding arteries and draining veins. The resection of surrounding vascular mass with malformation needs more attention during surgery.