Haciyakupoglu Ersin, Yilmaz Dervis Mansuri, Kinali Burak, Akbas Tugana, Haciyakupoglu Sebahattin
Klinik für Wirbelsaulen Chirurgie und Neurotraumatologie, Zwickau, Germany.
Turk Neurosurg. 2019;29(3):340-348. doi: 10.5137/1019-5149.JTN.22645-18.2.
To analyze the results of stereotactic radiosurgery (SRS) or surgical treatment of 18 cases with cavernous malformation and report 2 cases with unusual localization and size.
We present 11 and 8 patients who underwent surgery and SRS between 2010 and 2018 respectively. The operated group comprised six men and five women (mean age, 33.6 years). SRS was performed in five men and three women (mean age, 33.3 years). All patients were diagnosed and followed-up with magnetic resonance imaging. Stereotactic navigation was not used for lesion localization. The lesion, including the area with hemosiderin, was easily excised using microsurgical approach.
Except for recurrent headache, all symptoms of patients who underwent surgery resolved rapidly. Hemorrhage developed in two of our patients after SRS. One of them refused to undergo surgery and recovered completely with steroid therapy, whereas the other underwent surgery after detection of cavernous malformation at the posterior fossa, with a dimension of 26.8x26.2 mm and occluding the fourth ventricle.
In patients without significant preoperative morbidity risk, surgical excision is the gold standard of treatment. SRS is performed in surgically inaccessible, deeply located, multiple cavernous malformations in the brain stem and eloquent area. Of note, giant aneurysm is defined as an aneurysm with a diameter of at least 25 mm; however, there is no dimension threshold defined for giant CM, and the size of giant aneurysm can be accepted as a valid criterion for giant CM. Our 2 cases had giant CM and up to our knowledge the case with giant CM at the posterior fossa is the first giant CM at the posterior fossa in the English literature.
分析18例海绵状血管畸形的立体定向放射外科治疗（SRS）或手术治疗结果，并报告2例位置和大小异常的病例。
我们分别介绍了2010年至2018年间接受手术和SRS治疗的11例和8例患者。手术组包括6名男性和5名女性（平均年龄33.6岁）。SRS治疗的患者有5名男性和3名女性（平均年龄33.3岁）。所有患者均通过磁共振成像进行诊断和随访。病变定位未使用立体定向导航。使用显微手术方法可轻松切除病变，包括含铁血黄素区域。
除复发性头痛外，接受手术的患者所有症状均迅速缓解。2例接受SRS治疗的患者发生了出血。其中1例拒绝手术，经类固醇治疗后完全康复；而另1例在发现后颅窝海绵状血管畸形后接受了手术，该畸形大小为26.8×26.2 mm，阻塞了第四脑室。
对于术前无显著发病风险的患者，手术切除是治疗的金标准。SRS适用于手术难以到达、位于深部、脑干和功能区的多发性海绵状血管畸形。值得注意的是，巨大动脉瘤定义为直径至少25 mm的动脉瘤；然而，对于巨大海绵状血管畸形没有定义尺寸阈值，巨大动脉瘤的大小可作为巨大海绵状血管畸形的有效标准。我们的2例患者患有巨大海绵状血管畸形，据我们所知，后颅窝巨大海绵状血管畸形病例是英文文献中首例后颅窝巨大海绵状血管畸形。
