科研之友
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摘要
Objective: To explore the clinical manifestations, imaging features, treatment methods and prognosis of spontaneous hemorrhage of intracranial meningiomas. Methods: A retrospective analysis was conducted on the clinical data of 497 patients with meningioma who were consecutively admitted and underwent surgical treatment from March 2008 to March 2017 at the Department of Neurosurgery, Li Hui Li Hospital of Ningbo Medical Center, including 15 patients with spontaneous hemorrhage of meningioma (accounting for 3.0%). We summarized the patients' clinical manifestations, imaging features, treatment methods and outcomes. Results: The clinical symptoms of 15 patients included the sudden worsening of chronic headache, weakness of one limb, decreased vision or epileptic seizure and other preexisting symptoms (6 cases), and they could also be manifested as sudden severe headache, hemiplegia, seizures and other stroke-like symptoms (9 cases). Head CT and MRI showed signs of hematoma, space-occupying tumor and peritumoral edema. According to the positional relationship between tumor and hematoma, spontaneous hemorrhage of meningioma could be divided into three types: merely intratumoral hemorrhage (7 cases), merely peritumoral hemorrhage (6 cases) and combined intratumoral and peritumoral hemorrhage (2 cases). All patients underwent tumor resection and hematoma removal at the same time. The degree of tumor resection reached Simpson grade Ⅰ in 9 cases, grade Ⅱ in 2 cases, grade Ⅲ in 3 cases, and grade Ⅳ in 1 case. Fifteen patients were followed up for 48 months after operation. Three patients had neurological sequelae, and the remaining 12 patients had no obvious neurological dysfunction. The results of imaging follow-up showed that, of the 15 patients, 2 had tumor progression or recurrence; the remaining 13 had no tumor recurrence. Conclusions: The incidence of spontaneous bleeding in meningioma is low, and its clinical manifestations are similar to stroke emergencies. Meningioma with hemorrhage can be diagnosed by preoperative CT combined with MRI. According to the imaging characteristics of hemorrhage, it can be divided into merely intratumoral hemorrhage, merely peritumoral hemorrhage and combined intratumoral and peritumoral hemorrhage. The corresponding treatment strategy should be chosen based on the patient's clinical characteristics, and most patients could achieve a favorable outcome.
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