您可能打錯了，應該是以下2種可能

1.海綿狀血管瘤-cavernoma,血管不正常增生，長成整個充滿血管網的團塊
2.動脈瘤-aneurysm,動脈中某一段像氣球一樣膨大

小弟畢業滿久了，比較習慣德文拉丁文混合體，還請包涵

您親戚是不是有很長一段時間有頭暈頭痛或是偶爾會想吐，吃藥一開始有效，後來越來越沒用

如果是1.，團塊沒擴散前是手術沒錯，否則就是局部打硬化劑讓血管團萎縮，至於一些血管增生因子抑制劑(沙利邁竇)有沒有效這個就要問專門的腦神經科了

2.的話就是血管移植

小弟不是外科，有在動刀的都是一些小手術，最好請腦神經專科確定

板上的VOLTES大自己承認是外科專科，可以請他在幫李雙全伸張正義之餘也幫您出一點意見

上GOOGLE意外找到的研究報告....不知有沒有幫到忙呢?

http://www.tzuchi.com.tw/tcmj/91-4/9.htm

http://www.stroke.org.tw/guideline.htm

CVA(中風)是乎是免不了

Cavernous Malformation (Cavernoma):


Contents of This Section:

What is a cavernous malformation (cavernoma)?
How common is a cavernous malformation (cavernoma)?
Why does a cavernous malformation (cavernoma) develop?
What are the symptoms of a cavernous malformation (cavernoma)?
More about cavernous malformation (cavernoma) hemorrhage and rehemorrhage.
What are the complications of a cavernous malformation (cavernoma)?
How is a cavernous malformation (cavernoma) detected?
How is a cavernous malformation (cavernoma) treated?
Images of a cavernous malformation (cavernoma).

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1. What is a cavernous malformation (cavernoma)?

A cavernous malformation, also known as a cavernous hemangioma or cavernoma, is an abnormal vascular entity (or "lesion") made up of many small compartments (lobules) like a bunch of small berries, or a mulberry (see section 9., below, for an image). These microcomparments contain blood (hemorrhagic) products in different stages of evolution. The "sinusoidal" compartments are enclosed by abnormally thin and quite fragile endothelialized walls. Unlike an arteriovenous malformation (AVM; take me to the AVM section now), there is no large feeding artery and no large draining vein in a cavernoma. However, there frequently is a venous angioma associated with the cavernoma! ( take me to the Venous Angioma section now ).

Most cavernomas are found in the larger (supratentorial) parts of the brain hemispheres, but up to 1 in 4 or 5 are found in the hindbrain (posterior fossa; infratentorial), especially in the pons region of the brainstem. Much less commonly a cavernoma may be found in the spinal cord (but this may be more likely to occur in patients with a family history of cavernous malformations).

2. How common are cavernous malformations (cavernomas)?

They are not very common. Their prevalence (presence at any given time) in the population is probably somewhere between 0.1 - 0.5%; they are about as common as brain arteriovenous malformations (AVM), and far less common than brain aneurysms.

3. Why do cavernous malformations (cavernomas) develop?

Cavernomas occur sporadically (spontaneously in a noninherited manner) in the majority of cases, but in some cases may demonstrate inheritance (familial; i.e., a positive or strong family history of cavernous malformations). In familial cases, a specific chromosome 7 gene abnormality has been demonstrated, and familial cavernous malformation has been reported to be more common in hispanic (especially Mexican-American) persons. In familial cases, cavernous malformations are more commonly multiple (i.e., two or more cavernomas present at the time of diagnosis), and may certainly also involve the spinal cord.

On chromosome 7, the specific two genes involved are refered to as CCM1 (band 7q11.2-q21; aka KRIT 1 because of its role in creating the KRIT 1 protein, or Krev interaction-trapped 1 protein), and CCM 2 (band 7p15-p13; controls production of the protein malcavernin). A third gene referred to as CCM 3 (on chromosome 3q) has been identified and is being investigated further.

4. What are the symptoms of cavernous malformations (cavernomas)?

Cavernomas may be asymptomatic, or may present with seizures (60%) or with progressive neurological impairment or "deficits" (50%). Some can present with hydrocephalus or raised intracranial pressure (headache, nausea, vomiting, visual disturbance, sleepiness) depending on their size and location. It is uncommon for cavernomas to cause sudden catastrophic or devastating neurological injury, but the progressive brain (or spinal cord) injury associated with cavernomas may be severely disabling as time goes on.

Why do these symptoms occur? The reason is repeated bouts of hemorrhage in the cavernoma. Different cavities of the cavernoma may have different ages of blood products. The walls are fragile, and the growth of micro blood vessels into these lesions results in blood product (hemosiderin) leeching around the cavernoma, and cycles of cavernoma growth through hemorrhage and rehemorrhage. The hemorrhage is rarely a large devastating hemorrhage.

5. More about cavernous malformation (cavernoma) hemorrhage and rehemorrhage.

The risk of hemorrhage from a cavernoma is somewhere between 0.5-1% per year. It may be greater (or at least easier felt symptomatically) in cavernomas located in more "eloquent" brain such as the basal ganglia, thalamus, brainstem, and spinal cord. The rehemorrhage rate varies in the literature, but is probably somewhere between 4-10% per year (some reports indicate an even higher rate in the first year or two following the first diagnosed cavernoma hemorrhage).

6. What are the complications of cavernous malformations (cavernomas)?

The major complications are seizures and progressive neurological impairment, and the type of "deficit" varies according to the size and location of the cavernoma, and the extent and multiplicity of the hemorrhage(s).

7. How are cavernous malformations (cavernomas) detected?

Cavernomas are detected best through MRI. They can enhance with contrast, but frequently do not. They are not detectable on a cerebral angiogram (i.e., are referred to as angiographically occult vascular malformations or AOVMs; however, an associated venous angioma may be detected on the angiogram!). The best two MRI sequences used to detect cavernomas are regular T2 ("popcorn" appearance) and gradient echo (GRE; "India ink" blotch appearance). These are shown below. A CAT scan can also show a cavernoma, but the resolution is better with an MRI.

Note that in familial or multiple cavernoma patients, it is worthwhile screening the cervicothoracic spinal cord via MRI to exclude the presence of an occult cavernoma there.

8. How are cavernous malformations (cavernomas) treated?

The treatment is surgery. There is no effective radiation treatment for cavernomas. The one exception is a possible cavernoma variant that occurs in the venous sinuses (intrasinus cavernoma) which has been reported to be susceptible to radiation (e.g., gamma knife or stereotactic radiosurgery). There is some debate over the precise pathology of this intrasinus cavernoma; i.e., it may be a variant of a cavernoma, or a different vascular lesion altogether!

In general, a cavernoma that is enlarging radiologically and/or symptomatic should be given consideration for surgery. Even ones located in the brainstem or spinal cord or other highly "eloquent" areas should be considered for removal if symptomatic and if relatively safely accessible surgically (i.e., ones that are causing neurological problems and present themselves to the surface of the brain or brain stem or spinal tissue region). The relative risks vs. benefits of surgery should be considered on an individual basis, and discussed comprehensively. Cavernomas in the brainstem and spinal cord and other highly "eloquent" regions require a highly experienced neurosurgeon for safe and effective treatment.

http://www.brain-aneurysm.com/cm.html

您參考一下，現在還有加碼刀能用(好羨慕)，注意第3點，這個有可能會遺傳

大哥!我知道您在開玩笑
可介紹庸醫會害死人的...
而且那個傢伙可能連庸醫的資格都沒有吧?
沒職照的叫密醫...
密醫也是很危險的吧

是第一個...

但醫生從頭開始就說...只有開刀一途而以...沒有別的方案...而且還長在「腦幹」要開那個部位

所以挺令人擔憂的...

血管增生因子抑制劑(沙利邁竇)→這個的拉丁文或英文怎麼說？！

還有一件事情，就是他已經出血兩次了...＠＠

是否出血後就只有開刀一途呢？！



現在幾乎全身癱瘓...躺在加護病房，全身插管

小弟的媽媽小腦長瘤長在小腦壓到腦幹
症狀跟2F的大大說的一樣
大約三個月前開始發生的，期間還去美國玩但因為頭痛在美國作檢查
回台灣時一直看耳鼻喉科，都吃一些止痛薬
發病前一星期，吃東西就立刻吐！本想應是”耳石”＜－－猜的。之類的問題
到了醫院急診時照段層才覺得有問題。當時我人在台中上班趕去林口，（醫生說我一定要到）
住院第二天就開刀了，說是因為小腦長瘤壓到腦幹導至腦水無法向下流
說是頭暈是小腦長瘤引起的！吃東西會吐則是腦積水導至腦壓升高引起的。
醫生說腦積水很危險要立刻作”引流”手術。腦部插一根細管引水到腹部吸收
然後就作了第一次手術。我有問可不可以直接開腦。醫生說因為我媽當時狀況不好（沒吃飯）
不能動大手術。
手術作了之後頭還是會暈但的確可以吃一點流質的東西了。
過了一個星期準備開小腦了，醫生說要完全切除是不可能因為壓到腦幹的地方是不能碰的
只能碰小腦這邊，手術中會先作"冷凍切片"看是什麼樣的細胞(癌)，說準確率有8成，也會送化驗要等一個星期，冷凍切片等結果出來看那個細胞對化學針和放射的效果怎樣。好的話就切少一點(避免接近腦幹)，不好的話能切多少就切多少囉！
目前第二次手術已完成(開了10個小時)，我媽回復狀況我覺的比預期的好！是不是癌細胞還在等結果中。不過醫生有說傷到小腦不可避免會有頭暈和平衡感不好的後遺症。

腦幹是不能動的...＠＠

這裡的醫生則是告訴我，一定要切除

否則再次的出血會有生命危險，而且是要在「腦幹」的部分開刀

生命危險為一成，後遺症無法估計...所謂的後遺症就是開了之後，身體機會會如何很難講

Cavernoma 是 血管畸形四種中的一種
跟 AVM 動靜脈畸形 一樣都是會流血的

如果位置在腦幹中間 或表面 是沒有辦法開刀治療完全切除的
因為對腦幹的傷害太大

如果病灶在診斷時沒有出血太多, 大小也比較小, 是可以考慮用放射線手術治療
放射線手術是用輻射線照射病灶, 將正常組織的傷害減到最少, 使cavernoma血管細胞變性, 最後纖維化, 來達到治療的目的. 需要時間.
要完全讓病灶從MRI 上消失, 需要1.5~3 年的時間.
放射線手術目前發展最久的是 Gamma Knife, 這在慈濟 台北榮總都有, 缺點是要釘頭架在病人頭上定位, 只能照一次.
台灣有比較新的機器叫 Cyberknife, 中文是電腦刀, 這跟 Gamma knife 比起來, 最大的好處是不用釘頭架, 且定位更準, 也因此可以多次治療, 對於脊椎的腫瘤也能治療, 這些都是 GammaKnife 無法做到的.

不過, 如果病人已經因為出血 造成昏迷指數很差及全身癱瘓 必須插管住 加護病房的話, 那麼的確只有開刀可以挽救生命. 但是 開刀大部分都是 damage control. 能夠維持開刀前的症狀就很不容易了, 畢竟神經的復原再生能力相當有限.

aneurysm 與 Cavernoma 在分類上 隔比較遠. 大部分的書是把 cavernoma 與 AVM 放在一起.
Aneurysm 可以用手術將 aneurysm neck 給夾住 預防再出血. Cavernoma 則沒有 neck可以夾
Aneurysm 也有人在血管攝影下 去將 aneurysm 給塞住, 用的可能是金屬 coil 或是其他物質
AVM 也有人在嘗試介入性的血管治療, 在血管攝影下去把 feeding artery 給塞住
至於 Cavernoma 有沒有這樣的治療選擇, 在下就不清楚了.

冷凍切片等結果怎麼會拖上一個星期 ? incubation overnight 的時候都必須擔心長菌吃掉細胞/ 組織溶解的問題 , 測 MDR (或是類似的抗原) + ELISA ABC stain 不過就是十二個小時內要跑出結果 . 如果是緊急狀況 , 通常先做一份 H/E 染色做大致的判讀 . 以前趕 case 都是實習的學長姐立刻從開刀房送樣 (組織還是溫熱的) , 取樣上 OTA (冷凍切片用的介質) , 下 LN2 冷卻 , 拿到切片台回溫 . 上 slide , 略為吹乾固定 , 上 H/E 染色 , EtOH 脫色 , Xylene 去水上封膠 . 由進到出不能超過 20 ~ 30 分鐘否則會被開刀房主刀的砲轟 .

by the way , 冷凍切片的組織沒有固定 , 必須保存在攝氏 -70 或是更低溫度 . 只有在切片前五分鐘才回溫到攝氏 -20 .