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目的探讨海绵窦海绵状血管瘤(cavernous sinus hemangiomas,CSHs)病理与影像的关系及显微外科治疗方法。方法回顾性分析经病理证实的7例CSHs患者的临床资料,所有患者行MRI平扫和增强扫描,其中3例行FLAIR序列检查。所有患者经改良翼点入路开颅伴或不伴眶颧弓切断,其中经硬膜外入路取瘤3例,经硬膜下入路4例。结果 T1WI肿瘤呈均匀或不均匀低信号,T2WI呈均匀或不均匀高信号,增强后A型呈均匀性增强,B型和C型呈现自外向内的渐进性增强信号,但欠均匀,3例FLAIR序列检查呈均匀高信号;肿瘤全切除5例,次全切除1例,大部切除1例。术中失血平均为(3029±3184)mL。主要并发症包括早期动眼神经麻痹5例(3例恢复,2例症状轻微);短暂视神经受累1例,短暂三叉神经受累1例,轻微外展神经麻痹1例,脑积水并偏瘫1例,无手术后死亡病例。结论显微外科手术仍是CSHs比较有效的治疗方法,MRI增强模式可能对CSHs亚型的鉴别起到一定作用。
Objective To investigate the relationship between pathology and imaging of cavernous sinus hemangiomas (CSHs) and the microsurgical treatment. Methods The clinical data of 7 CSHs confirmed by pathology were retrospectively analyzed. All patients underwent MRI plain scan and enhanced scan, of which 3 patients underwent FLAIR sequence examination. All patients with modified pterional approach craniotomy with or without zygomatic zygomatic arch cut, of which 3 cases of tumor by epidural approach, subdural approach in 4 cases. Results The T1WI tumors showed homogeneous or non-uniform low signal, T2WI showed uniform or non-uniform high signal, enhanced type A homogeneity enhanced, type B and type C showed a gradual increase signal from the outside to the inside, but less uniform, 3 cases FLAIR sequence examination showed a uniform high signal; tumor resection in 5 cases, subtotal resection in 1 case, the majority of resection in 1 case. Intraoperative blood loss average (3029 ± 3184) mL. The main complications included 5 cases of early oculomotor nerve paralysis (3 cases recovered, 2 cases of mild symptoms); 1 case of transient optic nerve involvement, 1 case of transient trigeminal nerve involvement, 1 case of slight abduction nerve palsy, 1 case of hydrocephalus and hemiplegia , No case of death after surgery. Conclusion Microsurgery is still an effective treatment for CSHs. MRI enhancement may play a role in the identification of CSHs subtypes.