后颅窝实质性血管母细胞瘤的诊断和治疗

目的：探讨后颅窝实质性血管母细胞瘤(PFSH)的诊断和治疗。方法：回顾性分析本科室1998～2003年间经手术和病理证实的10例PFSH临床资料并复习相关献。结果：本组病例平均病程为1个月。术前磁共振成像(MRI)检查肿瘤直径为3．0～5．5cm(平均为3．8cm)。DSA检查发现肿瘤多为小脑后下动脉供血。术前行肿瘤超选择栓塞6例，无栓塞严重并发症。手术全切除8例，次全切除2例。术前栓塞的患中5例获全切除。术中出血量为400～600ml。手术死亡2例，8例存活患术后分别随访6个月至2年，格拉斯哥评分(GOS)5分7例。4分1例。结论：术前MRI和DSA检查是诊断PFSH的重要依据。肿瘤的超选择栓塞可减少术中出血，有助于全切除肿瘤．降低病死率。手术切除是治疗PFSH的最佳方案，全切除肿瘤可获治愈。

Diagnosis and treatment of posterior fossa solid hemangioblastoma

Objective To study the diagnosis and surgical treatment of the posterior fossa solid hemangioblastomas (PFSHs). Methods Ten patients with pathologically confirmed PFSHs admitted from 1998 to 2003 were retrospectively analyzed and relevant literatures were reviewed. Results Of the ten patients, 6 were men and 4 women. Preoperative MRI showed the tumors ranged from 3 to 5.5 cm (average 3.8 cm) in diameter. DSA inspection indicated that the tumors were primarily fed by the posterior inferior cerebellar artery. Six patients underwent preoperative embolization. Total tumor removal was achieved in 8 patients and subtotal in 2. Of the patients underwent preoperative embolization, 5 received complete resection with the intra-operation bleeding ranging from 400 to 600 ml. Two patients died of brain stem dysfunction or infection after operation. Eight patients were followed-up for 6 months to 2 years and the Glasgow outcome scale showed 5 in 7 patients and 4 in 1. Conclusion MRI and DSA are important diagnostic methods for PFSHs. Preoperative embolization may be helpful in operative excision of sensitive neural areas and allow for complete surgical resection of tumors. Microsurgery is the major treatment of choice for PFSHs and the total removal of these tumors still pose a challenge for neurosurgeons.