Хирургическое лечение интрамедуллярных гемангиобластом: современное состояние проблемы (обзор)

Интрамедуллярные гемангиобластомы (ГАБ) относятся к очень редким высоковаскуляризированным сосудистым опухолям спинного мозга, ассоциированным с различными неврологическими нарушениями. Эффективная терапия ГАБ в значительной мере зависит от точности диагностики и отсутствия интра- и послеоперационных осложнений.

Данная работа представляет собой обзор публикаций, посвященных современным диагностическим и терапевтическим методам борьбы с ГАБ спинного мозга. Показано, что ввиду высокой степени васкуляризации ГАБ в ряде случаев для их диагностики и дифференциации целесообразно применять такие методы, как перфузионная компьютерная томография, компьютерная томографическая ангиография и магнитно-резонансная ангиография. Высокой эффективностью обладает метод предоперационной эмболизации, заметно снижающей риски интраоперационных кровотечений. Ряд авторов рекомендуют применение этой процедуры в случае больших размеров опухоли и высоких рисков интраоперационного кровотечения. Рассмотрена также процедура интраоперационной визуализации опухоли и ее питающих сосудов при помощи индоцианина зеленого, обеспечивающая возможность контроля за тотальным удалением опухоли и четкой визуализации ее сосудистой архитектуры. Описаны преимущества и ограничения вышеупомянутых процедур.

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