Seiki Y, Terao H, Shibata I, Tsukahara K, Tsutsumi S, Kudo M
No Shinkei Geka. 1984 May;12(6):761-5.
Subarachnoid hemorrhage attributable to brain tumor, particularly due to benign tumor, is not common. A case of subependymoma in the lateral ventricle, which manifested itself with an episode of subarachnoid hemorrhage was reported. A 33-year-old woman was admitted to our hospital because of severe headache and transient loss of consciousness, but neurological examination revealed no abnormality except for slight disturbance of consciousness and nuchal rigidity. Lumbar puncture showed an opening pressure over 350mmH2O and grossly bloody CSF. CT scan revealed an enhanced mass occupying the left ventricular trigone. Angiography, however, demonstrated no tumor stain or other vascular abnormality. Preoperative diagnosis was an intraventricular tumor of benign nature. A soft tumor arose from the lateral wall of the trigone was removed subtotally by paramedian parieto-occipital approach. Histology of the tumor was of typical subependymoma with scanty vascularity. Intraventricular or subarachnoid hemorrhage from cerebral neoplasm reported so far, is mostly due to a highly vascularized tumor. Subependymoma is of benign nature with poor vascularity, and therefore, intraventricular hemorrhage from the subependymoma was rarely reported in the literature. On the basis of the findings of angiography, serial CT scans and histological examination, it is reasonable to assume that intraventricular bleeding in our case is not attributed to the tumor per se, but to tearing of subependymal or ependymal veins extremely extended by the tumor growth.
由脑肿瘤引起的蛛网膜下腔出血并不常见，尤其是由良性肿瘤引起的。本文报告了一例侧脑室室管膜下瘤，该病例以蛛网膜下腔出血发作为临床表现。一名33岁女性因剧烈头痛和短暂意识丧失入院，但神经系统检查除轻微意识障碍和颈项强直外未发现异常。腰椎穿刺显示初压超过350mmH2O，脑脊液呈肉眼血性。CT扫描显示左心室三角区有一强化肿块。然而，血管造影未显示肿瘤染色或其他血管异常。术前诊断为良性脑室内肿瘤。经顶枕旁正中入路，部分切除了起源于三角区侧壁的软性肿瘤。肿瘤组织学为典型的室管膜下瘤，血管稀少。迄今为止报道的脑肿瘤引起的脑室内或蛛网膜下腔出血，大多是由于肿瘤血管丰富。室管膜下瘤为良性，血管较少，因此，文献中很少报道室管膜下瘤引起的脑室内出血。根据血管造影、系列CT扫描和组织学检查结果，有理由认为本例脑室内出血并非肿瘤本身所致，而是肿瘤生长使室管膜下或室管膜静脉极度伸展而撕裂所致。
