Licata B, Turazzi S
Department of Neurosurgery, Division II, City Hospital of Verona, Verona, Italy.
J Neurosurg Sci. 2003 Dec;47(4):201-10; discussion 210.
This article discusses the role of intracranial tumors in the etiology of spontaneous intracerebral hematomas, compared to other causes such as hypertension, aneurysm, arteriovenous malformation (AVM) or cavernoma. An analysis of cerebral tumors, with a particular oncological emphasis on intrinsic bleeding during growth and resulting in symptomatic hematoma, is presented.
We analyzed 110 cases of intracranial tumor with symptomatic bleeding, accounting for 1.5% of 7373 intracranial neoplasms and 4.4% of 2514 intracerebral hematomas, surgically treated at the Department of Neurosurgery in Verona, from 1968 to 2000. The bleeding tumors comprised 36 (33%) glioblastomas, 23 (21%) metastases, 14 (13%) anaplastic gliomas, 13 (12%) low-grade gliomas, 13 (12%) meningiomas, 5 (5%) adenomas, 2 (2%) hemangioblastomas, 2 (2%) melanomas, 1 (1%) neuroblastoma and 1 (1%) pinealoblastoma.
Analysis of the data of the 110 cases of tumors with symptomatic hematoma showed that there was a statistically significant correlation between the incidence of bleeding and histological groups according to the World Health Organization classification. A clinical study of these cases indicates that hematoma onset is more frequent in anaplastic gliomas (93%) and meningiomas (62%) than in other pathologies (p=0.008); meningiomas are prevalent on the left side (92%) (p=0.000); favorable bleeding factors correlate with meningioma (62%), (p=0.009). The postoperative short-term results following hematoma evacuation and tumor removal were significantly influenced only by patient age (p=0.000) and preoperative clinical condition (p=0.000).
The analysis of our study population shows that the tumoral etiology of intracerebral hematomas is by no means negligible, accounting for 4.4% of 2514 hematomas operated on, and emphasizes the fact that not all bleeding neoplasms are malignant. Out of a total of 110 hemorrhagic tumors 23 (21%) were benign and 6 (5%) low-grade. The tumoral origin of cerebral hematoma is not always correctly diagnosed by non-contrast-enhanced CT and angiography, and therefore, in the presence of a hematoma with an "atypical" appearance, it is advisable to complete the diagnostic investigations with contrast-enhanced CT or MRI for the purposes of better planning surgical evacuation of hematoma and tumor removal, bearing in mind the high incidence of bleeding in benign and low-grade tumors as well as the optimal short and long-term results obtained with surgery.
本文探讨颅内肿瘤在自发性脑内血肿病因中的作用，并与高血压、动脉瘤、动静脉畸形（AVM）或海绵状血管瘤等其他病因进行比较。本文对脑肿瘤进行了分析，特别从肿瘤生长过程中的内在出血导致有症状血肿这一肿瘤学角度进行了阐述。
我们分析了110例有症状性出血的颅内肿瘤病例，这些病例占1968年至2000年在维罗纳神经外科接受手术治疗的7373例颅内肿瘤的1.5%，以及2514例脑内血肿的4.4%。出血性肿瘤包括36例（33%）胶质母细胞瘤、23例（21%）转移瘤、14例（13%）间变性胶质瘤、13例（12%）低级别胶质瘤、13例（12%）脑膜瘤、5例（5%）腺瘤、2例（2%）血管母细胞瘤、2例（2%）黑色素瘤、1例（1%）神经母细胞瘤和1例（1%）松果体母细胞瘤。
对110例有症状性血肿的肿瘤病例数据的分析表明，根据世界卫生组织分类，出血发生率与组织学类型之间存在统计学上的显著相关性。对这些病例的临床研究表明，间变性胶质瘤（93%）和脑膜瘤（62%）中血肿发作比其他病理类型更常见（p = 0.008）；脑膜瘤在左侧更为常见（92%）（p = 0.000）；有利的出血因素与脑膜瘤相关（62%），（p = 0.009）。血肿清除和肿瘤切除术后的短期结果仅受患者年龄（p = 0.000）和术前临床状况（p = 0.000）的显著影响。
对我们研究人群的分析表明，脑内血肿肿瘤病因绝非微不足道，占2514例接受手术的血肿的4.4%，并强调并非所有出血性肿瘤都是恶性的这一事实。在总共110例出血性肿瘤中，23例（21%）为良性，6例（5%）为低级别。脑血肿的肿瘤起源并非总能通过非增强CT和血管造影正确诊断，因此，在出现“非典型”外观的血肿时，为了更好地规划血肿手术清除和肿瘤切除，建议用增强CT或MRI完成诊断检查，同时要记住良性和低级别肿瘤出血的高发生率以及手术获得的最佳短期和长期结果。
