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目的探讨儿童颅骨骨膜窦的临床特点及治疗。方法回顾性分析并总结我科2000年1月至2010年12月收治的12例颅骨骨膜窦患儿的临床资料,无症状、可复性、中线附近的头皮下肿块为其典型临床表现,其中位于顶部4例,额部3例,枕部3例,颞部2例。所有患儿均行CT、颅骨三维重建、MRI、CTA或MRV检查。手术切除颅骨外血窦,封堵沟通静脉孔或修补颅骨缺损。结果头颅CT显示颅骨外软组织肿块影,增强后可见点片状强化,肿块下方颅骨变薄或缺损。三维重建显示局部颅骨变薄,虫蚀样改变。CTA显示局部异常血管团通过板障静脉/导静脉与硬脑膜静脉窦相通,其血供来源于硬脑膜静脉窦,且最终回流至硬脑膜静脉窦。MRI显示T1加权像呈蜂窝状等信号或低信号改变,T2加权像可见等信号或高信号改变,3例显示病灶穿透颅骨内板与颅内相交通。MRV显示颅外肿块与静脉窦沟通,并有局部硬脑膜静脉窦明显增粗。病理检查结果显示,大量扩张的无肌层血管组成的囊腔,腔壁内衬单层扁平内皮细胞或结缔组织。12例术后肿块消失,头颅外形满意,无颅高压症状,复查CT颅内无血肿形成,随访6个月至5年,均无复发。结论结合大小随颅内压改变的可复性头皮下包块的临床表现和CT、MRI、CTA或MRV等影像学检查,易于诊断儿童颅骨骨膜窦,该病通过手术切除治疗可获得良好效果。
Objective To investigate the clinical features and treatment of children skull periosteal sinus. Methods The clinical data of 12 patients with cranial periosteal sinus treated in our department from January 2000 to December 2010 were retrospectively analyzed and summarized. Asymptomatic and refastenable, the subcutaneous mass near the midline was the typical clinical manifestation, of which In the top 4 cases, 3 cases of forehead, 3 cases of occipital and 2 cases of temporal. All children underwent CT, three-dimensional reconstruction of skull, MRI, CTA or MRV examination. Surgery to remove extracranial sinusoids, blocking communication vein holes or repair skull defects. Results The cranial CT showed the shadow of soft tissue mass outside the skull. After the enhancement, the visible flake strengthened and the skull below the mass became thin or defect. Three-dimensional reconstruction showed partial skull thinning, worm-like changes. CTA showed that local abnormalities of blood vessels connected with the dural venous sinus through the bard vein / guide vein, the blood supply from the dural venous sinus, and eventually back to the dural venous sinus. MRI showed a weighted average of T1 weighted images such as honeycomb signal or low signal changes, T2 weighted images visible signal or high signal changes in 3 cases showed lesions penetrating the skull inner plate and intracranial traffic. MRV showed extracranial mass communicating with the sinus and local dural venous sinus significantly thickening. Pathological examination showed that a large number of expansion of the non-muscular vascular capsule cavity wall lined with flattened endothelial cells or connective tissue. No tumor recurrence occurred in 12 cases after the operation. The tumor disappeared, the shape of the skull was satisfactory, and the symptom of no intracranial hypertension was observed. Conclusions It is easy to diagnose the skull periosteal sinus in children with surgically resected subcutaneous mass whose size changes with the change of intracranial pressure and CT, MRI, CTA or MRV imaging. The surgical treatment of this disease can achieve good results.