颅内血管母细胞瘤的诊断和显微手术治疗

目的探讨颅内血管母细胞瘤诊断方法和手术治疗策略。方法回顾性分析28例经手术和病理证实的血管母细胞瘤的临床资料，并从影像学诊断方法、特点及显微手术治疗中注意事项予以分析。结果本组血管母细胞瘤好发年龄为20-45岁，肿瘤位于小脑半球20例，位于中线蚓部、Ⅳ脑室内累及延髓背侧7例，幕上1例。除3例多发外，余均为单发。显微镜下手术全切除23例，次全切除3例，部分切除2例。未全切除病例术后加行放射治疗。本组手术无死亡。随访期内3例患者复发。结论外科治疗应在不加重神经功能障碍的前提下尽量全切除肿瘤。显微手术技术、CTA的应用、肿瘤术前栓塞以及立体定向放射外科等可提高手术疗效。

Diagnosis and microsurgical treatment of intracranial hemangioblastoma

Objective To summarize our experince of diagnosis and microsurgical treatment of intracranial hemangioblastoma. Methods Twenty-eight cases of intracranial hemangioblastoma were analyzed retrospectively in terms of clinical manifestations, imaging studies, diagnosis, microsurgical treatment and follow-up results. Result The tumors occurred mainly in patients between 20 to 45 years of age, most tumors were in hemisphere of cerebellum ;7 tumors were located in midline, cerebellar vermis, IV ventricle and attached to caudal part of medulla. Only one case was grown supratentorially. Three cases were multiple lesions, others were single lesions. 23 received total removal, 3 subtotal and 2 part removal of the tumors. No patients died of the operation. 3 cases recurrent during the follow-up. Conclusion Hemangioblastomas are histologically benign lesions of the central nervous system. Total removal of lesions is recommended under the circumstances of preserving neurological function. A combined strategy of microsurgical technique, application of CTA, preoperative embolization and stereotaxic radiosurgery are helpful for decreasing morbidity and mortality.