Chongxiao Liu, Wei Shi, Yong Liu, Qiujuan Zhang, Ligui Gao, Ren Zhou, Jianjun Sun, Ruizhi Wang, Zhenyu Guo, Xingmiao Lu
Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Department of Neurosurgery, Xi-Wu Road 157, Xi'an, P.R. China, Xi'an, 710004, China.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.10.2008.1167. Epub 2009 Jul 23.
Angioleiomyomas (ALMs) involving the central nervous system are exceedingly rare, and no ALM involving the parafalx region has ever been clinically reported. We report the first case of ALM involving the parafalx region on its surgical procedure and radiological feature. A 50-year-old man had a 6 month history of frontal headache and occasional seizure attacks. The radiological examination showed a parafalx occupation similar to meningioma. The tumour was very hypointense on T1 weighted magnetic resonance imaging (MRI) and hyperintense on T2 weighted MRI, which enhanced homogeneously with intravenous administration of gadolinium. The tumour was removed totally by sinusoidal transverse scalp incision and bilateral parafalx approach. To our surprise, the tumour was prominently debulked using bipolar shrinkage to coagulate the tumour feeding vessels, resulting in less bleeding during total removal of the tumour.. The lesion was confirmed as ALM by histological examination. The prognosis was good for the patient after surgery during the 18 month follow-up.
累及中枢神经系统的血管平滑肌瘤（ALM）极为罕见，临床上从未有过累及大脑镰旁区域的血管平滑肌瘤的报道。我们报告首例累及大脑镰旁区域的血管平滑肌瘤的手术过程及影像学特征。一名50岁男性有6个月的额部头痛及偶尔癫痫发作病史。影像学检查显示大脑镰旁占位，类似脑膜瘤。该肿瘤在T1加权磁共振成像（MRI）上呈极低信号，在T2加权MRI上呈高信号，静脉注射钆后均匀强化。通过正弦横形头皮切口及双侧大脑镰旁入路将肿瘤完全切除。令我们惊讶的是，使用双极电凝收缩法凝固肿瘤供血血管，使肿瘤显著缩小，从而在肿瘤完全切除过程中减少了出血。经组织学检查，病变被确诊为血管平滑肌瘤。在18个月的随访期内，患者术后预后良好。
