背景:切除仍然是血管母细胞瘤的最佳治疗方法,通常位于小脑或脊髓的高度血管性肿瘤。术前栓塞可谨慎使用,以减少术中失血量,促进全切,同时降低神经系统发病率。
方法:作者报告了一例44岁男性,表现为头晕恶化,步态失衡,和复视。影像学显示大血管小脑肿块伴脑干受压和脑积水,关于血管母细胞瘤。患者术前栓塞右小脑上动脉的主动脉供血,使肿瘤断流并减少早期静脉分流,然后是肿瘤的总切除。术前栓塞有助于促进安全的显微外科手术切除,因为这种主要动脉供应深入到计划的手术方法,Onyx石膏是背中脑和剩余动脉供应的标志。这导致最小的术中失血。在2年的随访中,患者的复视和眩晕已经解决,他的步态继续改善。
结论:尽管术前栓塞用于血管母细胞瘤切除术存在争议,作者强调其在切除大型小脑血管母细胞瘤时的安全性和实用性.Onyx栓塞在减少肿瘤血液供应和作为术中视觉指导方面均具有优势。
BACKGROUND: Resection remains the optimal treatment for hemangioblastomas, highly vascular tumors commonly located in the cerebellum or spinal cord. Preoperative embolization can be used with caution to reduce intraoperative blood loss and promote gross-total resection while reducing neurological morbidity.
METHODS: The authors report a case of a 44-year-old male who presented with worsening dizziness, gait imbalance, and diplopia. Imaging revealed a large vascular cerebellar mass with brainstem compression and hydrocephalus, concerning for hemangioblastoma. The patient underwent preoperative embolization of the main arterial supply from the right superior cerebellar artery, which devascularized the tumor and reduced the early venous shunting, followed by gross-total resection of the tumor. Preoperative embolization helped to facilitate safe microsurgical resection because this main arterial supply was deep to the planned surgical approach, and the Onyx cast served as a landmark of the dorsal midbrain and remaining arterial supply. This resulted in minimal intraoperative blood loss. At 2-year follow-up, the patient\'s diplopia and vertigo had resolved, and his gait continues to improve.
CONCLUSIONS: Despite controversy regarding the use of preoperative embolization for hemangioblastoma resection, the authors emphasize its safety and utility during resection of a large cerebellar hemangioblastoma. Onyx embolization provided benefit in both reducing the tumor blood supply and serving as intraoperative visual guidance.