Ishikawa Takayuki, Takeuchi Kazuhito, Nagata Yuichi, Ito Keishi, Yamamoto Taiki, Kabeya Ryusuke
Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan.
NMC Case Rep J. 2022 Apr 21;9:77-82. doi: 10.2176/jns-nmc.2021-0326. eCollection 2022.
Here we report a rare case of capillary hemangioma (CH) in a 28-year-old woman suffering from gradual worsening diplopia at 28 weeks of pregnancy. Magnetic resonance imaging (MRI) showed a mass lesion (about 3 cm in diameter) in the right parasellar region. We decided to observe as she was pregnant, and had no symptoms other than right abducent nerve palsy. Fortunately, her symptoms did not worsen until delivery. Computed tomography, enhanced MRI, and angiography after delivery revealed that the lesion was highly calcified and vascularized. A dorsum sellae meningioma or highly calcified pituitary adenoma was suspected and the endoscopic transsphenoidal approach was used for tumor removal. The postoperative course was uneventful. The histological diagnosis was CH. Intracranial CHs or CHs of skull are rare vascular tumors. These tumors are reportedly more common in female patients and may change in size in adults according to menstrual cycle and pregnancy. Only six cases, including that of the present study, were diagnosed during the perinatal period. Some of them experienced rapid symptom progression and tumor growth in their course; thus, we should pay further attention to pregnant or peripartum patients with brain tumor, suspected hemangiomas.
在此，我们报告一例罕见的毛细血管血管瘤（CH）病例，患者为一名28岁女性，在怀孕28周时逐渐出现复视加重。磁共振成像（MRI）显示右侧鞍旁区域有一肿块病变（直径约3 cm）。由于患者怀孕且除右侧展神经麻痹外无其他症状，我们决定进行观察。幸运的是，直到分娩她的症状都没有恶化。产后计算机断层扫描、增强MRI和血管造影显示病变高度钙化且血管丰富。怀疑为鞍背脑膜瘤或高度钙化的垂体腺瘤，采用内镜经蝶窦入路切除肿瘤。术后过程顺利。组织学诊断为CH。颅内CH或颅骨CH是罕见的血管肿瘤。据报道，这些肿瘤在女性患者中更常见，在成年人中可能会根据月经周期和怀孕而改变大小。包括本研究病例在内，围产期仅诊断出6例。其中一些病例在病程中经历了症状快速进展和肿瘤生长；因此，我们应进一步关注患有脑肿瘤、疑似血管瘤的孕妇或围产期患者。
