Zhou Wei, Zhu Yue-ming, Su Zhong-zhou, Pan Feng
Department of Radiology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China.
Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2013 Dec;35(6):677-82. doi: 10.3881/j.issn.1000-503X.2013.06.017.
To summarize the magnetic resonance imaging(MRI)features and microsurgical treatment of cavernous sinus hemangiomas(CSH).
Twenty-three patients with surgically and pathologically verified CSH were reviewed. All patients underwent computed tomography(CT)and MR scan, 19 cases underwent MR diffusion-weighted imaging(DWI)and 7 underwent single voxel (1)H magnetic resonance spectroscopy((1)HMRS)before operation. The microsurgery through modified pterional approach was performed in 11 cases and 12 cases removal was achieved in combined fronto-temporal preauricular subtemporal approach. Nineteen cases with large tumors were treated by Leksell Gamma knife(LGK)before operation.
CSHs were single, large, and spherical/lie gourd-shaped tumors across the inside and outside the sella. CSH showed equal or slightly low signal on T1WI, high signal on T2WI and FLAIR, homogeneous or heterogeneous great enhancement on MR enhancement scan 19 cases showed equal or slightly low signal on DWI, 7 cases showed no NAA, Cr, and Cho peak, and 6 cases showed Lip peak on (1)HMRS. In 23 cases, the tumors were totally removed in 18, subtotally removed in 3, and partially removed in 2. No perioperative death was reported. The postoperative symptoms were improved in 17 cases but remained unchanged in 4 cases two patients suffered from new nervous symptoms after the surgery, which were improved or cured after three weeks of treatment. In 5 patients who had received subtotal or partial removal of the lesions, LGK was performed postoperatively, which resulted in smaller residual tumors in 4 cases and unchanged tumor in one patient. CONCLUSIONS CSH has some unique MRI features, and therefore MRI is helpful to improve the preoperative localization and qualitative diagnosis. The microsurgery through modified pterional approach combined with fronto-temporal preauricular subtemporal approach is an effective procedure for CSH.
总结海绵窦血管瘤（CSH）的磁共振成像（MRI）特征及显微外科治疗方法。
回顾性分析23例经手术及病理证实的CSH患者。所有患者均行计算机断层扫描（CT）及磁共振成像（MR）检查，其中19例术前接受了磁共振扩散加权成像（DWI）检查，7例接受了单体素氢质子磁共振波谱成像（1HMRS）检查。11例行改良翼点入路显微手术，12例行额颞耳前颞下入路联合手术切除肿瘤。19例肿瘤较大者术前接受了Leksell伽玛刀（LGK）治疗。
CSH为鞍内、鞍外的单发、较大、类圆形或葫芦形肿瘤。T1WI呈等或稍低信号，T2WI及液体衰减反转恢复序列（FLAIR）呈高信号，MR增强扫描呈均匀或不均匀明显强化。19例DWI呈等或稍低信号，7例1HMRS未显示N-乙酰天门冬氨酸（NAA）、肌酸（Cr）及胆碱（Cho）峰，6例显示脂质峰。23例中，肿瘤全切除18例，次全切除3例，部分切除2例。无围手术期死亡病例。术后17例症状改善，4例症状无变化。2例术后出现新的神经症状，经3周治疗后好转或治愈。5例肿瘤次全或部分切除患者术后行LGK治疗，4例残余肿瘤缩小，1例肿瘤无变化。结论CSH具有一些独特的MRI特征，MRI有助于提高术前定位及定性诊断。改良翼点入路联合额颞耳前颞下入路显微手术是治疗CSH的有效方法。
