Sakamoto T, Oshio K, Hazama Y, Sekino H, Tadokoro M
Department of Neurosurgery, Machida City Hospital.
No Shinkei Geka. 1997 Jan;25(1):73-7.
A 57-year-old male was admitted to our hospital complaining of a headache with disturbance of consciousness on November 7, 1994. CT scans revealed an intracerebral hematoma of 25ml in volume in the left frontal lobe with adjacent spotty calcification. An arteriovenous malformation (AVM) with a nidus of 2.0 x 2.0cm in size was found to be the cause of the hematoma by cerebral angiography. Since the patient complained of mild right hemiparesis 10 days after the onset, CT scans were taken and a slightly enlarged hematoma with capsule formation was observed. On the 31st day after the onset, the hematoma had liquefied and the surrounding capsule was clearly visible on CT. Since the patient's only symptom was a slight headache, and he displayed no other serious conditions, a palliative operation was planned. The AVM was removed and the capsule was resected 41 days after the onset. The capsule or cyst wall of the liquefied hematoma was composed of three layers: a granulation layer with a neovascular system on the inside, a collagenous layer in the middle, and a reactive brain tissue layer on the outside. The structure of the capsule was the same as the structure of the cyst wall in chronic hematomas that have been reported as cystic AVM or encapsulated expanding hematoma in the literature. We would therefore like to propose that chronic encapsulated expanding hematomas form with time due to intermittent bleeding or exudation form the neovascular system of a cyst wall.
1994年11月7日，一名57岁男性因头痛伴意识障碍入院。CT扫描显示左额叶有一个体积为25毫升的脑内血肿，伴有相邻的斑点状钙化。脑血管造影显示，一个大小为2.0×2.0厘米的动静脉畸形（AVM）是血肿的病因。由于患者发病10天后出现轻度右半身轻瘫，进行了CT扫描，观察到血肿略有增大并形成了包膜。发病后第31天，血肿已液化，CT上可见周围的包膜。由于患者唯一的症状是轻微头痛，且未表现出其他严重情况，因此计划进行姑息性手术。发病41天后切除了AVM并切除了包膜。液化血肿的包膜或囊肿壁由三层组成：内侧为有新生血管系统的肉芽层，中间为胶原层，外侧为反应性脑组织层。该包膜的结构与文献中报道的作为囊性AVM或包膜性扩张血肿的慢性血肿的囊肿壁结构相同。因此，我们认为慢性包膜性扩张血肿是由于囊肿壁新生血管系统的间歇性出血或渗出随着时间的推移而形成的。
