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颅内海绵状畸形大部分发生在幕上,最常见于皮质下白质内,其次是额、颞叶,畸形位于丘脑者则报道较少,作者遇到一例。男性,50岁,运动性失语,右侧偏瘫1年余。入院后检查仅造有轻度右侧偏瘫。CT示:左侧丘脑后部高密度影,部分钙化,对比增强不明显;左侧颈动脉和椎管造影正常;磁共振成像T_1加权示左侧丘脑后部呈中等高信号强度,周围呈环状低信号强度,T_2加权呈高信号强度,边缘大部分呈低信号强度。取半坐位术式,手术经胼胝体半球间入路,接近左侧丘脑,借助显微镜可见一桑葚状团块,切除后有少量出血。病理检查报告海绵状血管畸形。术后仍有运动性失语和右侧偏瘫;5天后CT示:手术区域和侧脑室的后半部分血液残留,一周后消失。10个月病情逐步好转,只有轻-中度运动性失语及右侧偏瘫,但可独自行走。作者讨论中指出,丘脑海绵状血管畸形的诊断MRI为最佳。根据本例及文献复习,作者认为丘
The majority of intracranial spongiform malformations occur on the epidermis, most commonly in the subcortical white matter, followed by the frontal and temporal lobes, and the malformations are rarely reported in the thalamus. The author encountered one case. Male, 50 years old, apathetic, right hemiplegia for more than 1 year. After admission, only mild right hemiplegia was found. CT showed high density in the posterior thalamus, partial calcification, contrast enhancement was not obvious; left carotid artery and spinal angiography were normal; magnetic resonance imaging T_1 weighted showed that the left posterior thalamus showed moderately high signal intensity, surrounded by a ring Low signal intensity, high signal intensity with T_2 weighting, and low signal intensity at most edges. Take a semi-seat type operation, surgery through the corpus callosum approach, close to the left thalamus, with a microscope visible a mulberry-like mass, a small amount of bleeding after resection. Pathological examination reported cavernous vascular malformations. Postoperatively, there was still athletic aphasia and right hemiplegia; after 5 days, CT showed: blood in the second half of the surgical area and the lateral ventricle disappeared after one week. The condition improved gradually in 10 months. Only mild to moderate apathetic aphasia and right hemiplegia, but walking alone. In the author’s discussion, the diagnostic MRI of thalamic cavernous malformations was the best. According to this example and literature review, the author believes that Qiu