颅骨海绵状血管瘤手术治疗临床分析
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摘要
目的探讨原发性颅骨海绵状血管瘤的临床表现、影像学特征、病理学特点及治疗措施。方法回顾分析6例原发性颅骨海绵状血管瘤患者的临床资料;并结合文献对其临床表现、影像学特点、治疗方法进行分析。结果本组患者的原发性颅骨海绵状血管瘤为单发,临床症状各异。头颅CT表现为肿瘤呈"日光放射征"改变,周边骨质硬化。头颅MRI示,肿瘤呈T_1WI不均匀中-高信号,T_2WI不均匀高信号,增强扫描不均匀强化。手术切除包括肿瘤在内的颅骨及周边硬化颅骨后,患者的临床症状均消失,预后良好。术后病理检查示,病变表现为蜂窝状肿块,由充填有多量血细胞的囊状血管组成。结论原发性颅骨海绵状血管瘤较为罕见,手术治疗效果确实可靠;术后病理检查为其最终确诊的有效手段。
Objective To explore the clinical manifestation,imaging characteristic,pathological feature and treatment of primary cavernous hemangiomas of the skull. Method The clinical data of 6 patients with the primary cavernous hemangioma was analyzed retrospectively. Combined with the relevant literatures,the clinical manifestation,imaging characteristic and therapeutic method were also anzlyzed. Results Primary cranial cavernous hemangiomas were rare and tend to be solitary lesions. The clinical findings were variable. CT image showed a sunburst sign in the center and reactive sclerosis at the margins. MRI demonstrated a inhomogeneous enhancement mass. T_1-weighted sequences gave heterogeneous medium to high intensity signals,and T_2-weighted image showed heterogeneous high signals. After craniectomy with total resection,the clinical presentations were disappeared and got good prognosis. On histopathology,they were alveolate masses and composed of sinusoidal blood vessels. Conclusions Primary cavernous hemangiomas of the skull are rare,and the effect of surgical procedures are reliable,which can provide the final diagnosis by the pathological features of surgical specimens.
Objective To explore the clinical manifestation,imaging characteristic,pathological feature and treatment of primary cavernous hemangiomas of the skull. Method The clinical data of 6 patients with the primary cavernous hemangioma was analyzed retrospectively. Combined with the relevant literatures,the clinical manifestation,imaging characteristic and therapeutic method were also anzlyzed. Results Primary cranial cavernous hemangiomas were rare and tend to be solitary lesions. The clinical findings were variable. CT image showed a sunburst sign in the center and reactive sclerosis at the margins. MRI demonstrated a inhomogeneous enhancement mass. T_1-weighted sequences gave heterogeneous medium to high intensity signals,and T_2-weighted image showed heterogeneous high signals. After craniectomy with total resection,the clinical presentations were disappeared and got good prognosis. On histopathology,they were alveolate masses and composed of sinusoidal blood vessels. Conclusions Primary cavernous hemangiomas of the skull are rare,and the effect of surgical procedures are reliable,which can provide the final diagnosis by the pathological features of surgical specimens.
引文
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[7]Vural M,Acikalin MF,Adapinar B,et al. Congenital cavernous hemangioma of the calvaria. Case report[J]. J Neurosurg Pediatr,2009,3:41.
[8]刘佳,刘仁忠,陈谦学,等.颅骨海绵状血管瘤九例临床分析[J].中华外科杂志,2014,52:797.
[9]Buhl R,Barth H,D9rner L,et al. De novo development of intraosseous cavernous hemangioma[J]. J Clin Neurosci,2007,14:289.
[10]Yucel E,Akkaya H,Gurkanlar D,et al. Congenital cavernous hemangioma of the skull[J]. Turk Neurosurg 2011,21:645.
[11]Koulouris G,Rao P. Multiple congenital cranial hemangiomas[J].Skeletal Radiol,2005,34:485.
[12]Woertler K. Benign bone tumors and tumor-like lesions:value of cross-sectional imaging[J]. Eur Radiol,2003,13:1820.
[13]Gottfried ON,Wm G,Schmidt MH. Cavernous hemangioma of the skull presenting with subdural hematoma. Case report[J].Neurosurg Focus,2004,17:1.
[14]Nasrallah IM,Hayek R,Duhaime A,et al. Cavernous hemangioma of the skull:surgical treatment without craniectomy. Case report[J]. J Neurosurg Pediatr,2009,4:575.
[15]Ramdasi R,Mahore A,Thorve S,et al. Intradiploic cavernous hemangioma presenting as multiple craters on skull[J]. Acta Neurochir(Wien),2016,158:729.
[2]Salunke P,Sinha R,Khandelwal NK,et al. Primary intraosseus cavernous hemangioma of the skull base[J]. Br J Neurosurg,2010,24:84.
[3]Politi M,Romeike BF,Papadagiotou P,et al. Intraosseous hemangioma of the skull with dural tail sign:Radiologic features with pathologic correlation[J]. Am J Neuroradiol,2005,26:2049.
[4]Brackup AH,Haller ML,Danber MM. Hemangioma of the bony orbit[J]. Am J Ophthalmol,1980,90:258.
[5]Heckl S,Aschoff A,Kunze S. Cavernomas of the skull:review of the literature 1975—2000[J]. Neurosurg Rev,2002,25:56;discussion 66.
[6]吴海涛,王立兴.多发颅骨海绵状血管瘤1例[J].中国中西医结合影像学杂志,2015,13:114.
[7]Vural M,Acikalin MF,Adapinar B,et al. Congenital cavernous hemangioma of the calvaria. Case report[J]. J Neurosurg Pediatr,2009,3:41.
[8]刘佳,刘仁忠,陈谦学,等.颅骨海绵状血管瘤九例临床分析[J].中华外科杂志,2014,52:797.
[9]Buhl R,Barth H,D9rner L,et al. De novo development of intraosseous cavernous hemangioma[J]. J Clin Neurosci,2007,14:289.
[10]Yucel E,Akkaya H,Gurkanlar D,et al. Congenital cavernous hemangioma of the skull[J]. Turk Neurosurg 2011,21:645.
[11]Koulouris G,Rao P. Multiple congenital cranial hemangiomas[J].Skeletal Radiol,2005,34:485.
[12]Woertler K. Benign bone tumors and tumor-like lesions:value of cross-sectional imaging[J]. Eur Radiol,2003,13:1820.
[13]Gottfried ON,Wm G,Schmidt MH. Cavernous hemangioma of the skull presenting with subdural hematoma. Case report[J].Neurosurg Focus,2004,17:1.
[14]Nasrallah IM,Hayek R,Duhaime A,et al. Cavernous hemangioma of the skull:surgical treatment without craniectomy. Case report[J]. J Neurosurg Pediatr,2009,4:575.
[15]Ramdasi R,Mahore A,Thorve S,et al. Intradiploic cavernous hemangioma presenting as multiple craters on skull[J]. Acta Neurochir(Wien),2016,158:729.