Giant Arachnoid Granulations: Diagnostic Workup and Characterization in Three Symptomatic Adults.
Giant Arachnoid Granulations: Diagnostic Workup and Characterization in Three Symptomatic Adults.
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DOI：
10.3390/ijms241411410
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发表时间：
2023-07-13
影响因子：
5.6
通讯作者：
中科院分区：
文献类型：
--
作者：
巨蛛网膜颗粒（GAG）的研究很少。在这里，我们记录了与五个新的GAG相关的临床发现，并说明了这些结构的解剖组成以及在三个有症状的成年人的诊断考虑。GAG的最大尺寸范围为1.1至3.6 cm（平均2.2 cm），并在中年人中表现出长期存在的脑肿块和/或慢性头痛。在影像学检查中，该组织表现为不规则的肌旁和/或肌周结构，显示内部成分不均匀。GAG沿硬脑膜延伸，穿过颅骨骨髓间隙，并撞击硬脑膜静脉窦，导致其狭窄。从不同个体切除的两个GAG标本的组织学检查显示中央胶原蛋白具有明显的内部血管增生。一个标本还表现出病变内的反应性变化，包括静脉血栓形成，出血和明显的炎症。显著的免疫组分由富含泡沫细胞的浸润物组成，其阻塞了囊下和内部窦状隙GAG空间。在该标本中，还发现脑膜瘤增生。值得注意的是，在结构内还观察到增殖的淋巴管成分，延伸到深层中央胶原区域并吞噬囊下空间中的许多外渗红细胞。在这两个手术治疗的患者，症状完全解决后切除。这份报告是第一个明确描述反应性血管和免疫变化的糖胺酸酯，临床上与头痛。文献中这些脑膜结构内反应性变化的频率尚不清楚，因为很少对GAG进行采样和研究。进一步的系统分析是必要的，以阐明GAG发生的原因和后果及其在生理和疾病状态中的作用。
Giant arachnoid granulations (GAGs) are poorly investigated. Here, we document clinical findings associated with five new GAGs and illustrate the anatomical composition of these structures as well as diagnostic considerations in three symptomatic adults. The GAGs ranged from 1.1 to 3.6 cm (mean, 2.2 cm) in maximum dimension and manifested in middle-aged individuals who presented with long-standing brain mass and/or chronic headache. On imaging examinations, the tissues appeared as irregular parasagittal and/or perisinus structures that demonstrated heterogeneous internal elements. The GAGs abutted dura, extended through calvarial marrow spaces, and impinged on dural venous sinuses, causing their stenosis. The histologic workup of two GAG specimens resected from separate individuals revealed central collagen with pronounced internal vascular proliferation. One specimen additionally exhibited reactive changes within the lesion, including venous thrombosis, hemorrhage, and conspicuous inflammation. The salient immune component consisted of a foam cell-rich infiltrate that obstructed subcapsular and internal sinusoidal GAG spaces. Within this specimen, meningothelial hyperplasia was also appreciated. Notably, proliferated lymphatic vascular elements were additionally observed within the structure, extending into deep central collagen regions and engulfing many extravasated erythrocytes in the subcapsular space. In both surgically treated patients, symptoms resolved completely following resection. This report is the first to definitively depict reactive vascular and immunological changes within GAGs that were clinically associated with headache. The frequency of reactive changes within these meningeal structures is unclear in the literature, as GAGs are rarely sampled and investigated. Further systematic analyses are warranted to elucidate the causes and consequences of GAG genesis and their roles in physiology and disease states.
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影响因子：
4.1
作者：
UPTON, ML;WELLER, RO
通讯作者：
WELLER, RO
DOI：
10.1111/j.1440-1673.2007.01823.x
发表时间：
2007-10-01
期刊：
AUSTRALASIAN RADIOLOGY
影响因子：
--
作者：
Peters, S. A.;Frombach, E.;Heyer, C. M.
通讯作者：
Heyer, C. M.
影响因子：
1.4
作者：
Haybaeck, Johannes;Silye, Rene;Soffer, Dov
通讯作者：
Soffer, Dov
影响因子：
5.9
作者：
Kiroglu, Yilmaz;Yaqci, Baki;Karabulut, Nevzat
通讯作者：
Karabulut, Nevzat
影响因子：
4.1
作者：
KIDA, S;YAMASHIMA, T;YAMAMOTO, S
通讯作者：
YAMAMOTO, S