关键词: 小脑海绵状血管瘤; 发育性静脉畸形; 血管构筑形态; 手术策略; 预后

Abstract:

Objective To investigate safe and effective surgical strategies in treatment to cerebellar cavernous malformations(CCMs) with associated developmental venous anomalies(DVAs). Methods A retrospective analysis of all patients diagnosed as CCMs with associated DVAs admitted in Neurological Depart of Beijing Tiantan Hospital, Capital Medical University between February 2009 and April 2012. Epidemiological data, clinical data, radiographic images and follow up results were analyzed. Results Six male and six female patients were recruited in this study, aged from 12 to 72 years old, the mean age is 31.92 years old. All patients presented with symptomatic intracerebral hemorrhage from the onset. All patients underwent surgery, except for one refusing surgical treatment and then discharged from hospital. DVAs’ architecture is anatomically classified into five modes: (1)The trunks of DVAs passing over CCMs upward and/or forward to end in the straight sinus or Galen’s veins (three cases), suboccipital middle line approach is used. (2)The trunks of DVAs extend laterally from the side of CCMs to end in the superior petrosal sinuses (three cases), retrosigmoid approach is used for resection of the CCMs. (3)The trunks of the DVAs extended upward andentered the proximal transverse sinus (two cases),suboccipital middle line approach are used. (4)The trunks of the DVAs extended forward and laterally to the transverse sinus (two cases). Retrosigmoid approach is applied in surgery. (5)The trunks of the DVAs stride over CCMs ventrally to merge in the subverntricular veins at the fourth ventricle (two cases), suboccipital middle line approach is used. We did not find the trunk of DVAs draining into occipital sinus in any of the studied cases. No patients suffered post-operative cerebral hemorrhage or ischemia, two patients present with transient cerebral edema after surgery, in which 1 patient is gendered immediate suboccipital decompression. All patients have good prognosis and no recurrence of CCMs within a mean follow-up 34.3 months. Conclusion Distal radicles of DVAs always covered the anterior, superior, and medial aspects of CCMs. No trunk of DVAs extend downward. The safe and effective surgical approach included supoccipital midline approach, retrosigmoid approach. These treatment strategy did not cause any intracerebral hemorrhage, ischemia or other complications postoperatively.

Key words: Cerebellar cavernous malformations; Developmental venous anomalies; Angioarchitecture; Surgical strategy; Prognosis