[Preoperative Embolization for Solid Cerebellar Hemangioblastoma on the Day of Surgery:Two Case Reports].
[Preoperative Embolization for Solid Cerebellar Hemangioblastoma on the Day of Surgery:Two Case Reports].
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实性小脑血管母细胞瘤手术当天术前栓塞二例报告
DOI：
10.11477/mf.1436203560
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
I. Date
中科院分区：
文献类型：
--
作者：
K. Kuwahara;T. Ichikawa;J. Haruma;T. Hishikawa;M. Hiramatsu;K. Sugiu;I. Date
由于小脑血管母细胞瘤的血供丰富且瘤腔狭窄，手术切除是一个挑战。我们报告两例实性小脑血管母细胞瘤，在手术当天通过手术切除并辅以术前血管内栓塞治疗。病例1：一名36岁女性，有两个月的头痛和呕吐病史。磁共振成像（MRI）显示右侧小脑实性肿块，轻度脑积水和明显的瘤周水肿。血管造影显示一个高度血管化的肿块，三条供血动脉来自小脑上级动脉（SCA），一条扩张的静脉流入汇合处。我们在术前用15%的正丁基-2-氰基丙烯酸酯（NBCA）栓塞了三个供血动脉。最终血管造影显示无肿瘤染色。在同一天进行了肿瘤切除术，实现了大体全切除，无并发症。病例2：一名36岁男性，有4个月的头痛和左上肢麻木病史。MRI显示右侧小脑实性肿块伴瘤周水肿。血管造影显示一个高度血管化的肿块，两条供血动脉来自右侧SCA，一条来自左侧小脑后下动脉（PICA），一条扩张的静脉流入汇合处。术前使用15% NBCA进行栓塞，并实现完全断流。在同一天进行了肿瘤切除术，实现了大体全切除，无并发症。总之，手术当天使用NBCA进行术前栓塞是一种安全有效的实体性小脑血管母细胞瘤的持续治疗方法。
Surgical resection of solid cerebellar hemangioblastomas can be challenging because of the profuse blood supply and tight space. We report two cases of solid cerebellar hemangioblastomas treated via surgical resection with the aid of preoperative endovascular embolization on the day of surgery. Case 1: A 36-year-old woman presented with a two-month history of headache and vomiting. Magnetic resonance imaging(MRI)revealed a right cerebellar solid mass, mild hydrocephalus, and apparent peritumoral edema. Angiogram showed a highly vascularized mass, three feeding arteries from the superior cerebellar artery(SCA), and a dilated vein draining into the confluence. We performed preoperative embolization of the three feeders with 15% n-butyl-2-cyanoacrylate(NBCA). Final angiogram showed an absence of tumor staining. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. Case 2: A 36-year-old man presented with a four-month history of headache and numbness in the left upper extremity. MRI revealed a right cerebellar solid mass with peritumoral edema. Angiogram showed a highly vascularized mass with two feeding arteries from the right SCA, one from the left posterior inferior cerebellar artery(PICA), and a dilated vein draining into the confluence. Preoperative embolization was performed with 15% NBCA, and complete devascularization was achieved. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. In conclusion, preoperative embolization with NBCA on the day of surgery is a safe and effective adjunctive treatment for solid cerebellar hemangioblastoma.