Mori K, Takeuchi J, Ishikawa M, Handa H, Toyama M, Yamaki T
J Neurosurg. 1978 Jul;49(1):22-35. doi: 10.3171/jns.1978.49.1.0022.
Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of Willis by a slowly growing basal tumor, secondary artial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. Cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. Cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of Willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.
本文报告了4例闭塞性动脉病合并脑肿瘤的病例。对这些病例以及文献报道的病例进行临床分析发现，儿童脑底部的闭塞性动脉病常与生长缓慢的脑底部肿瘤相关。这些病例中闭塞性动脉病的可能原因包括：生长缓慢的脑底部肿瘤对 Willis 环的压迫、脑底部肿瘤放射治疗引起的继发性动脉闭塞改变、或与神经皮肤综合征相关的血管病变。突发或发作性症状提示存在闭塞性动脉病而非肿瘤的占位效应。当为排除脑底部肿瘤复发而进行的计算机断层扫描（CT）显示有低密度缺血性病变且无肿瘤占位效应证据时，必须进行脑血管造影。当怀疑儿童患有脑底部肿瘤时，尤其是与神经皮肤综合征和脑底部肿瘤相关的病例，脑血管造影也是必要的。手术时应注意不要损伤脑底部异常的血管网络，因为它被认为起到侧支循环的作用。在治疗儿童良性脑底部肿瘤时，必须考虑放疗对 Willis 环辐射诱导闭塞性改变的潜在危害。即使在成人中，重复大剂量照射也可能导致闭塞性动脉病。
