Motomochi M, Makita Y, Nabeshima S, Itagaki T, Tei T, Keyaki A
No Shinkei Geka. 1982 Mar;10(3):329-34.
A 32-year-old male, who had had temporal lobe seizure for the past 10 years, was admitted to the neurosurgical institute of Tenri Hospital on March 10, 1981. Physical examination on admission revealed some memory disturbance, neuroasthenic tendency and a purplish nevus in the left foot. Plain x-ray series of the skull showed several nodular calcified lesions in the medial aspect of the left temporal lobe. Electroencephalography showed sporadic negative spikes and irregular slow waves dominant in the left anterior quadrant of the head. CT scan showed a high-density area in the left hippocampal gyrus with slight enhancement by contrast medium. Under stereotactic consideration, a left temporal osteoplastic craniotomy and total removal of the mass were performed on March 20, 1981. The histological examination proved it to be calcified cavernous hemangioma or hemangioma calcificans after Penfield and Ward (1948). Postoperative course was uneventful; even 4 weeks after surgery, electroencephalogram became normalized, and memory and anxiety scores became better. At present, in spite of decreased anticonvulsant, the patient has had no more seizure since surgery, and has returned to his business without any complaint. The authors have emphasized the necessity of active operation for hemangioma calcificans even for the one located in the depth of the dominant cerebral hemisphere. Stereotactic consideration can make the surgical risk minimize. CT scan especially with its contour plot of the images is helpful precisely to locate the lesion. For the nevus in the left foot, the biopsy was refused by the patient, which might have connection with the intracerebral cavernous angioma.
一名32岁男性,过去10年患有颞叶癫痫,于1981年3月10日入住天理医院神经外科研究所。入院时体格检查发现有一些记忆障碍、神经衰弱倾向以及左脚有一紫色痣。头颅X线平片显示左颞叶内侧有几个结节状钙化病灶。脑电图显示散在的负性尖波和不规则慢波,以头部左前象限为主。CT扫描显示左侧海马回有一高密度区,注射造影剂后有轻度强化。在立体定向考虑下,于1981年3月20日进行了左颞骨成形开颅术并将肿物完全切除。组织学检查证实其为Penfield和Ward(1948年)描述的钙化性海绵状血管瘤或钙化性血管瘤。术后过程顺利;即使在术后4周,脑电图也恢复正常,记忆和焦虑评分也有所改善。目前,尽管抗惊厥药物用量减少,但患者自手术以来未再发作,已恢复工作且无任何不适。作者强调,即使对于位于优势大脑半球深部的钙化性血管瘤,也有必要积极手术。立体定向考虑可使手术风险降至最低。CT扫描尤其是其图像轮廓图有助于精确确定病变位置。对于左脚的痣,患者拒绝活检,这可能与脑内海绵状血管瘤有关。