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目的探讨后颅窝血管母细胞瘤(hemangioblastoma,HB)的磁共振(MRI)特征性表现以及手术治疗方法,提高对该病的诊断和显微外科手术治疗水平。方法回顾性分析我科2010年1月~2013年12月43例开颅经显微镜手术切除及病理证实的后颅窝HB资料。结果 37例囊壁小结节型肿瘤、4例实质型肿瘤、1例囊实型做到全切除,1例多发者靠近延髓HB未切除。术后1周头痛、头晕、恶心或呕吐等神经系统症状消失40例;1例遗有走路不稳;1例合并脑积水者术后第3天行侧脑室穿刺术,7天拔除脑室穿刺管,2周恢复正常出院;1例累及脑干者术后术腔出血,二次手术后第2天死亡。40例术后随访3个月~1年,平均11.5月,38例GOS评分5分(恢复正常生活),1例4分(遗有行走不稳症状),1例术后6个月复发并于术后15个月再次手术治疗。结论 MRI是术前诊断及鉴别诊断后颅窝HB的主要方法,明确诊断后尽早显微外科手术切除是后颅窝HB有效且安全的治疗方法。
Objective To investigate the magnetic resonance imaging (MRI) features of posterior cranial fossa hemangioblastoma (HB) and the surgical treatment methods to improve the diagnosis and the surgical treatment of the disease. Methods Retrospective analysis of 43 patients with craniofacial resection and histopathologic evidence of posterior cranial fossa in our department from January 2010 to December 2013 were retrospectively analyzed. Results 37 cases of small nodular tumor of the wall, 4 cases of parenchymal tumor, 1 case of sac-like resection, 1 case of multiple resection of the proximal medulla oblongata was not removed. One week after surgery, headache, dizziness, nausea or vomiting and other neurological symptoms disappeared in 40 cases; 1 case of walking left unsteady; 1 case with hydrocephalus were 3 days after operation line ventricular puncture, 7 days to remove ventricular puncture Tube, and returned to normal after 2 weeks. One case had intracavitary hemorrhage involving the brain stem and died on the second day after the second operation. 40 cases were followed up for 3 months to 1 year, average 11.5 months, 38 cases of GOS score 5 points (return to normal life), 1 case 4 points (left with walking symptoms), 1 case 6 months after the recurrence and 15 months after surgery again surgery. Conclusion MRI is the main method of preoperative diagnosis and differential diagnosis of posterior cranial fossa. It is an effective and safe treatment for posterior fossa of the posterior fossa by microsurgical resection after definite diagnosis.