Li Jiuhong, Zhang Guisheng, Ma Qiang, Li Xiang, He Jiaojiang
Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Neurosurgery, Lhasa People's Hospital, Lhasa, China.
Front Neurol. 2023 Feb 17;14:1105421. doi: 10.3389/fneur.2023.1105421. eCollection 2023.
Intracranial cavernous hemangiomas (CHs) usually originate from the cerebral and cerebellar hemispheres, while the clinical features and optimum treatment of CHs that originate from atypical locations remain unclear.
We conducted a retrospective analysis of CHs that originated from the sellar, suprasellar, or parasellar region, the ventricular system, the cerebral falx, or the meninges in patients who underwent surgery from 2009 to 2019 in our department.
In our study, fourteen patients with pathologically confirmed CHs in uncommon locations (UCHs) were enrolled; 5 were located at the sellar or parasellar region, 3 at the suprasellar region, 3 at the ventricular system, 2 at the cerebral falx, and 1 originated from parietal meninges. The most common symptoms were headache and dizziness (10/14); however, none presented with seizures. All UCHs located in the ventricular systems and 2 of the 3 UCHs located in the suprasellar region manifested as hemorrhagic lesions and shared similar radiological features compared with axial CHs; other locations of UCHs did not have a "popcorn" appearance on T2-weighted image. Nine patients achieved GTR, 2 achieved STR, and 3 achieved PR. Four out of five patients who received incomplete resection underwent adjuvant gamma-knife radiosurgery. During the average follow-up of 71.1 ± 43.3 months, no patient died and one patient encountered recurrence and formation of midbrain CH. Most patients had an excellent KPS score of 90-100 (9 of 14) or a good KPS score of 80 (1 of 14).
We suggest that surgery is the optimum therapeutic method for UCHs located at the ventricular system, dura mater, and cerebral falx. Stereotactic radiosurgery plays an important role in the treatment of UCHs located at the sellar or parasellar region and remnant UCHs. Favorable outcomes and lesion control could be achieved by surgery.
颅内海绵状血管瘤（CHs）通常起源于大脑半球和小脑半球，而起源于非典型部位的CHs的临床特征和最佳治疗方法仍不明确。
我们对2009年至2019年在我科接受手术的起源于鞍区、鞍上区或鞍旁区、脑室系统、大脑镰或脑膜的CHs患者进行了回顾性分析。
在我们的研究中，纳入了14例经病理证实的非典型部位CHs（UCHs）患者；5例位于鞍区或鞍旁区，3例位于鞍上区，3例位于脑室系统，2例位于大脑镰，1例起源于顶叶脑膜。最常见的症状是头痛和头晕（10/14）；然而，无一例出现癫痫发作。所有位于脑室系统的UCHs以及位于鞍上区的3例UCHs中的2例表现为出血性病变，与轴位CHs相比具有相似的放射学特征；UCHs的其他部位在T2加权图像上没有“爆米花”样表现。9例患者实现了全切（GTR），2例实现了次全切（STR），3例实现了部分切除（PR）。5例接受不完全切除的患者中有4例接受了辅助伽玛刀放射治疗。在平均71.1±±43.3个月的随访期间，无患者死亡，1例患者出现复发并形成中脑CH。大多数患者的KPS评分优异，为90 - 100分（14例中的9例）或良好，为80分（14例中的1例）。
我们建议，手术是位于脑室系统、硬脑膜和大脑镰的UCHs的最佳治疗方法。立体定向放射治疗在位于鞍区或鞍旁区的UCHs以及残余UCHs的治疗中起重要作用。通过手术可实现良好的治疗效果和病变控制。
