Rapacki T F, Brantley M J, Furlow T W, Geyer C A, Toro V E, George E D
Neurosurgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
J Comput Assist Tomogr. 1990 Jan-Feb;14(1):18-25. doi: 10.1097/00004728-199001000-00003.
The cavernous hemangioma (cavernoma) is increasingly recognized as a vascular malformation of the brain that may present with seizures, hemorrhage, or progressive neurological deficit. Since 1985 we have identified 13 cases of presumed cavernoma of the brain based on the findings on CT, selective angiography, and magnetic resonance (MR) imaging. In each case CT showed a high density lesion that was "occult" or "cryptic" on angiography. However, within all lesions MR revealed a complex internal structure consisting of reticulated patches of high and low intensity signal surrounded by a hypointense rim on T1- and T2-weighted pulse sequences. Of the nine operated cases, five resected specimens were compatible with pure arteriovenous malformations (AVMs), and the other four were mixtures of cavernoma with either AVM or venous angioma. Our experience strongly suggests that the above complex of radiographic findings is not at all specific for the cavernoma. We propose that the major common factor shared by such "cavernomatoid" malformations is low blood flow. We believe low flow lesions follow a relatively benign clinical course, and they readily lend themselves to surgical resection.
海绵状血管瘤(海绵瘤)越来越被认为是一种脑部血管畸形,可表现为癫痫发作、出血或进行性神经功能缺损。自1985年以来,我们根据CT、选择性血管造影和磁共振(MR)成像的结果,确定了13例疑似脑海绵瘤病例。在每例病例中,CT均显示出高密度病变,而血管造影显示该病变为“隐匿性”或“隐匿性”。然而,在所有病变中,MR均显示出一种复杂的内部结构,在T1加权和T2加权脉冲序列上,由高、低强度信号的网状斑块组成,周围有一个低信号边缘。在9例手术病例中,5例切除标本符合单纯动静脉畸形(AVM),另外4例为海绵瘤与AVM或静脉血管瘤的混合。我们的经验强烈表明,上述影像学表现的组合对海绵瘤而言根本不具有特异性。我们提出,此类“海绵状样”畸形的主要共同因素是低血流量。我们认为低流量病变的临床病程相对良性,并且它们很容易进行手术切除。