Intracerebral cavernous tumor resection

Cavernous malformation, a cavernous hemangioma, also known as cavernoma, is a mismatched tissue and is not a true tumor. It is classified as a vascular malformation according to the WHO pathological classification. Intracranial spongy malformations occur mostly in the brain, and some also occur outside the brain, such as the cavernous sinus of the middle cranial fossa, but the histology is consistent. The distribution in the brain is more in the shallow or general parts of the cerebral hemisphere, while the deep brain, important functional areas of the brain and brainstem are also seen. Clinical symptoms are mainly epileptic, hemorrhagic and focal symptoms, and some are asymptomatically found in physical examinations and other examinations. CT examination showed a clear, nodular, high-density lesion with calcified plaques. MRI examination: T1 image is mixed signal, bleeding around the lesion, red blood cell destruction, hemosiderin deposition, showing a circular low signal, commonly known as "black ring"; T2 like a lesion around the ring is also a low signal, which is the characteristics of this disease Seen by sex. Multiple lesions account for about 20%. There are many countermeasures for the treatment of this disease: non-surgical treatment for patients with accidentally discovered non-clinical symptoms; for patients with neurological symptoms, the lesions are located in the general brain area and advocate surgical resection; for deep brain, functional areas, brainstem and Catheter sinus lesions, surgery is damaging and quite difficult. The advantages and disadvantages of surgery should be weighed according to the specific situation, or combined with radiotherapy and surgery. Treatment of diseases: intracranial cavernous hemangioma Indication 1. There are symptoms of epilepsy, hemorrhage or neurological dysfunction, and the lesion is located in the easily resected area. 2. Acute bleeding has symptoms of intracranial hypertension. 3. Deep brain, functional area, brain stem or cavernous sinus area, etc., surgery does not cause serious complications. Contraindications 1. Old, infirm, unable to tolerate surgery. 2. Occasionally found lesions, but no clinical symptoms. 3. The lesion is huge and located in an important functional area, which may lead to severe disability after surgery. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. 5. The lesion of the cavernous sinus should be removed and adequate blood should be prepared. Surgical procedure 1. Craniotomy as usual. 2. After the dura mater is cut to determine the lesion, if the lesion partially exposes the cerebral surface, it can be completely removed according to its boundary line. If the surface does not see the lesion, the cerebral cortex is opened by avoiding the functional area according to the position determined by CT or MRI. After the lesion is reached, the gelatinous layer along the boundary of the brain is gradually stripped of electrocoagulation to stop bleeding until it is completely removed. The general superficial lesions of the brain, like the removal of benign tumors in the brain, are not as complicated as the removal of cerebral arteriovenous malformations. For deep brain, brain function area or brain stem lesions, the surgical approach should be selected, carefully operated under the operating microscope, and the damage should be reduced to a minimum to be fully cut. For extracranial cavernous sinus lesions, the operation is very difficult, find the patient interface separation of the lesions, do not do block resection, reduce a large number of blood loss, protect the 3rd, 4th, 5th, 6th cranial nerve and internal carotid artery. If the bleeding is turbulent, it is difficult to stop bleeding, and the surgery should be adequate. Shi Jixin et al (1999) reported 10 cases of surgery, of which 4 cases were completely cut, only 1 case had no complications; Hashimoto et al (2000) reported that 1 case was treated with an adhesive injection in the lesion and was completely cut in case of less bleeding. Prompt surgery experience has yet to be accumulated. 3. After the complete hemostasis, routinely close the skull. complication 1. The postoperative symptoms are aggravated, and the lesions in the general site are temporary; while the recovery rate of deep brain and brain stem lesions is lower. 2. The cavernous sinus cavernous malformation in the middle cranial fossa is easy to be complicated by cranial nerve injury, eye muscle paralysis and facial numbness.

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