经硬膜下入路显微手术切除大型海绵窦血管瘤

Microsurgical resection via the subdural approach for large cavernous sinus hemangioma

摘要:

目的 探讨大型海绵窦血管瘤（cavernous sinus hemangiomas，CSH）的影像学表现及治疗方式。方法 对经手术术后病理证实的4例大型CSH的影像学及临床资料进行回顾性分析，并复习相关文献。4例患者均做头颅MRI、头颅CTA扫描，后经硬膜下入路行显微外科手术治疗。结果 病变在头颅MRI上呈等T₁、边缘锐利的短T₂ 表现、FLAIR高信号，增强后快速均匀强化或延迟欠均匀强化（最终达到均匀强化），肿瘤不同程度向中颅窝、鞍区、鞍上生长；头颅CTA显示肿瘤无明显供血动脉，但周边细小血管丰富；4例患者均只做到部分切除。术中平均失血3425 ml，术后3例出现颅神经功能障碍。结论 根据头颅MRI特征性表现基本能诊断CSH，相比显微手术潜在的风险，射波刀放疗效果显著，可能会逐步成为本病的首选治疗方式。

Abstract:

Objective To investigate the imaging findings and treatment modality for large cavernous sinus hemangioma (CSH).Methods A retrospective analysis was performed for the imaging findings and clinical data of four patients with large CSH confirmed by postoperative pathological examination,and related articles were reviewed.All patients underwent head magnetic resonance imaging (MRI) and computed tomography angiography (CTA) scans,followed by microsurgical resection via the subdural approach.Results The lesions had the manifestations of isointensity on T1-weighted image,short T2 signals with a clear boundary,and FLAIR hyperintensity,as well as rapid homogeneous enhancement or delayed homogeneous enhancement;the tumors also grew into the middle cranial fossa,the sellar region,or the suprasellar region.Head CTA showed no marked feeding arteries in tumors,but there were rich small blood vessels around the tumors.All patients underwent partial resection.The mean intraoperative blood loss was 3425 ml,and 3 patients experienced cranial nerve dysfunction.Conclusions A diagnosis of CSH can be made with reference to head MRI findings.Compared with microsurgery which has great risks,cyberknife radiotherapy has a better clinical effect and may gradually become the preferred treatment modality for this disease.