CAJ | 학술논문

目的探讨慢性扩张性脑内血肿(CEICH)的诊断依据和处理原则.方法对1987年6月至2012年1月山东省潍坊市人民医院、山东大学第二医院等4家医院神经外科收治的42例CEICH的资料42例CEICH患者的发病过程、临床表现、影像学特点、术中所见、病理结果、术后随访等方面结合文献进行回顾性研究.结果本组患者病程22 d至10年,均为慢性起病,其中23例误诊(54.8％),分别误诊为囊性胶质瘤、脑囊虫病、脑脓肿、肿瘤卒中等.自1997年6月年以来误诊率下降为19.0％.38例患者进行了开颅手术治疗,4例行血肿穿刺引流术.无手术死亡病例,33例恢复良好,9例有不同程度的神经功能障碍.随访1～21年,1例患者于术后10年复发,1例多发性CEICH,未手术处理的2个小病变1个7年后有所增大,另外1个自行消失.结论诊断CEICH的依据:(1)影像学提示脑实质内的囊性占位性病变;(2)病灶周围有圆形或类圆形不规则强化;(3) MRIT1WI呈混杂信号的同心圆板层状结构(“年轮征”);(4)CTA、MRA、DSA显示病灶区异常血管影;(5)缓慢进展的颅内高压症状和临床体征.有占位效应和临床症状的血肿应予手术清除血肿和异常组织,并切除包膜,小血肿(＜2 cm)可随访观察.
목적 탐토만성확장성뇌내혈종(CEICH)적진단의거화처리원칙.방법 대1987년6월지2012년1월산동성유방시인민의원、산동대학제이의원등4가의원신경외과수치적42례CEICH적자료42례CEICH환자적발병과정、림상표현、영상학특점、술중소견、병리결과、술후수방등방면결합문헌진행회고성연구.결과 본조환자병정22 d지10년,균위만성기병,기중23례오진(54.8％),분별오진위낭성효질류、뇌낭충병、뇌농종、종류졸중등.자1997년6월년이래오진솔하강위19.0％.38례환자진행료개로수술치료,4례행혈종천자인류술.무수술사망병례,33례회복량호,9례유불동정도적신경공능장애.수방1～21년,1례환자우술후10년복발,1례다발성CEICH,미수술처리적2개소병변1개7년후유소증대,령외1개자행소실.결론 진단CEICH적의거:(1)영상학제시뇌실질내적낭성점위성병변;(2)병조주위유원형혹류원형불규칙강화;(3) MRIT1WI정혼잡신호적동심원판층상결구(“년륜정”);(4)CTA、MRA、DSA현시병조구이상혈관영;(5)완만진전적로내고압증상화림상체정.유점위효응화림상증상적혈종응여수술청제혈종화이상조직,병절제포막,소혈종(＜2 cm)가수방관찰.
Objective To summarize our own experiences of managing chronic expanding intracerebral hematoma (CEICH) and discuss its diagnosis and treatment.Methods The courses of CEICH,clinical and imaging features,intraoperative findings,pathological examinations and follow-up outcomes were reviewed retrospectively.The relevant literatures were reviewed simultaneously.Results The course of CEICHs ranged from 22 days to 10 years.Twenty-three cases (54.8％ ) were misdiagnosed as cystic gliomas,cystic gliomas,brain cysticercoses,brain abscesses and tumor strokes,etc.The misdiagnostic rate had decreased to 19.0％ since June 1997.Thirty-eight patients underwent surgical operations and 4 had puncture drainage of hematoma.There was no operative death.Thirty-three cases achieved an excellent recovery and 9 cases had varying degrees of nervous dysfunctions.The follow-up period was 1 -21 years.One patient had recurrence after 10 years.Among the cases of multiple CEICH,two lesions underwent no surgical treatment.One increased obviously after 7 years and another disappeared.Conclusion The following five points may be used as the diagnostic criteria of CEICH:( 1 ) intracerebral cystic space-occupying lesions on brain images; (2) circular or circle-like enhancement around lesions; (3)a mixed signal of concentric circular lamellar structures on MRI T1WI; (4) abnormal vascular lesions on CTA,MRA or DSA; (5) clinical signs and symptoms of slow progress of intracranial pressure.CEICHs with clinical symptoms of local mass effect shall be obliterated surgically.The abnormal tissues in cyst wall of hematoma should be resected.Small hematomas ( ＜2 cm) may be followed up.