Kurita H, Sasaki T, Kawamoto S, Taniguchi M, Kitanaka C, Nakaguchi H, Kirino T
Department of Neurosurgery, University of Tokyo Hospital, Japan.
J Neurosurg. 1996 May;84(5):874-8. doi: 10.3171/jns.1996.84.5.0874.
The authors report a rare case of a patient with a chronic encapsulated expanding hematoma and progressive neurological deterioration who presented 2 years after gamma knife radiosurgery for a cerebral arteriovenous malformation (AVM). A tough capsule containing multiple layers of organized hematoma resulting from previous bleeding was confirmed surgically. Histological examination revealed that the capsule consisted of a dense collagenous outer layer and a granulomatous newly vascularized inner layer with marked fibrosis. Hemosiderin deposits were frequently observed in the inner layer, which suggested recurrent minor bleeding from fragile vessels in this layer. An AVM was found in the hematoma, which had degenerated as the result of radiosurgery. A cross-section of the abnormal vessels showed various stages of obliteration due to intimal hypertrophy. The clinical course, radiological features, and histological findings in this case were compatible with those of previously reported chronic encapsulated hematomas. A possible mechanism of hematoma formation and its expansion are discussed.
作者报告了一例罕见病例，患者患有慢性包裹性扩张性血肿且伴有进行性神经功能恶化，该患者在接受脑动静脉畸形（AVM）伽玛刀放射治疗2年后出现症状。手术证实有一个坚韧的包膜，其中包含多层因既往出血形成的机化血肿。组织学检查显示，包膜由致密的外层胶原层和伴有明显纤维化的肉芽肿性新血管化内层组成。在内层经常观察到含铁血黄素沉积，这提示该层脆弱血管反复发生少量出血。在血肿中发现了一个AVM，其已因放射治疗而退化。异常血管的横截面显示由于内膜肥厚而处于不同闭塞阶段。该病例的临床病程、放射学特征和组织学表现与先前报道的慢性包裹性血肿相符。本文讨论了血肿形成及其扩张的可能机制。
