Sakakibara Yohtaro, Taguchi Yoshio, Nakamura Homare, Matsumori Takashi, Wakui Daisuke, Kono Takao, Aida Yoshio
Division of Neurosurgery, St. Marianna University Yokohama City Seibu Hospital.
No Shinkei Geka. 2015 May;43(5):429-34. doi: 10.11477/mf.1436203042.
Here, we report a case of dural cavernous angioma. A 54-year-old man presented with headache in his right frontal area for the previous few weeks. Computed tomography (CT) and magnetic resonance imaging revealed a well-demarcated extramedullary mass, 3 x 2.5cm in size, within the subdural space at the right frontal region. The mass was not enhanced on a contrast-enhanced CT scan, and heterogeneously enhanced after administration of Gd-DTPA on magnetic resonance images. Cerebral angiography revealed an avascular mass. Right frontal craniotomy was performed. On surgery, the mass was found to be mainly extramedullar, and partially intramedullar. No adhesion between the mass and the overlying dura was observed. It was removed in an en bloc fashion. The pathological diagnosis was cavernous angioma. The patient's headache was resolved soon after surgery. Cavernous angiomas are usually intramedullar in the subcortical white matter of the cerebral hemispheres;extramedullary cavernous angiomas are rare. Extramedullary dural cavernous angiomas located in the subdural space at the cerebral convexity are extremely rare. They usually present with headache or mass signs, and resemble meningioma radiologically. During surgery they are easily resected with minimal blood loss. Dural cavernous angiomas should be considered in the differential diagnosis of intradural extramedullary mass at the cerebral convexity.
在此,我们报告一例硬脑膜海绵状血管瘤病例。一名54岁男性在过去几周出现右侧额部头痛。计算机断层扫描(CT)和磁共振成像显示在右侧额部硬膜下间隙有一个边界清晰的髓外肿块,大小为3×2.5厘米。在增强CT扫描中该肿块无强化,在磁共振成像上给予钆喷酸葡胺(Gd-DTPA)后呈不均匀强化。脑血管造影显示为无血管肿块。进行了右侧额部开颅手术。手术中发现肿块主要位于髓外,部分位于髓内。未观察到肿块与覆盖的硬脑膜之间有粘连。将其整块切除。病理诊断为海绵状血管瘤。患者术后头痛很快缓解。海绵状血管瘤通常位于大脑半球皮质下白质的髓内;髓外海绵状血管瘤罕见。位于脑凸面硬膜下间隙的髓外硬脑膜海绵状血管瘤极为罕见。它们通常表现为头痛或肿块体征,在影像学上类似脑膜瘤。手术中它们易于切除,失血极少。在脑凸面硬膜内髓外肿块的鉴别诊断中应考虑硬脑膜海绵状血管瘤。