Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
World Neurosurg. 2019 Jun;126:120-123. doi: 10.1016/j.wneu.2019.02.168. Epub 2019 Mar 9.
Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare.
A 72-year-old woman visited our hospital with gait disorder and progressive consciousness disturbance approximately 3 months after a minor head injury. Initially, on reviewing the results of imaging studies, she was diagnosed with traumatic chronic SDH. Despite repeated operations thereafter, including the embolization of the middle meningeal artery, her general condition progressively worsened, and computed tomography of head repeatedly showed the recurrence of SDH. Based on histopathologic and intraoperative findings, she was finally diagnosed with angiosarcoma originating from the skull. She died shortly thereafter because of aggressive recurrent intracranial SDH caused by leptomeningeal dissemination.
In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.
血管肉瘤通常发生在头皮和面部的皮肤疾病中;然而,伴发血管肉瘤的硬脑膜下血肿(SDH)极其罕见。
一位 72 岁女性,在轻微头部外伤后约 3 个月出现步态障碍和进行性意识障碍,来我院就诊。最初,在对影像学研究结果进行评估时,她被诊断为创伤性慢性 SDH。尽管此后进行了多次手术,包括脑膜中动脉栓塞,但她的一般状况逐渐恶化,头部 CT 反复显示 SDH 复发。根据组织病理学和术中发现,她最终被诊断为源自颅骨的血管肉瘤。此后不久,由于脑膜播散导致的侵袭性复发性颅内 SDH,她去世了。
除了转移到颅骨或硬脑膜的癌症外,对于反复出现 SDH 和骨缺损的患者,应将血管肉瘤纳入鉴别诊断。对于预后不良的伴有 SDH 的血管肉瘤,尚未确立有效的治疗方法;然而,早期诊断可能有助于新的治疗方法。