Tumorblutungen bei intrakraniellen Geschwülsten

Zusammenfassung

Es wird über 50 Patienten mit spontanen Hämatomen bei intrakraniellen Tumoren berichtet. Die Blutungsinzidenz aller Geschwülste zusammen betrug 4,1%, in der Hauptsache handelte es sich um Metastasen und Glioblastome. Besonders zu erwähnen sind außerdem 2 hämorrhagische konnatale Tumoren sowie ein Chondrom im Kleinhirnbrückenwinkel. Die Blutung war in 80% Anlaß eines akuten klinischen Verlaufs, welcher bei 10 Patienten einen letalen Ausgang nahm. In etwa der Hälfte der Fälle stellte das Blutungsereignis das Initialsymptom der Tumormanifestation dar, bei einem Drittel der Patienten blieb die Blutung zunächst die einzige klinische Diagnose. In 30% war ein sofortiger operativer Eingriff erforderlich, in 32% erfolgte eine primäre intensiv-medizinische Behandlung, die restlichen 19 Fälle nahmen einen weniger bedrohlichen Verlauf. Von den operierten Patienten verstarb einer an den unmittelbaren Folgen der akuten Blutung, unter den primär intensiv-medizinisch therapierten (n = 16) kamen 10 Patienten ad exitum.

Pathologisch-anatomisch ließen sich mehrere Typen von Tumorblutungen unterscheiden. Eine korrekte Diagnosestellung im CT war in 86% möglich, wobei einige typische CT-Befunde herausgearbeitet werden konnten. Mögliche kausale Faktoren spontaner Tumorblutungen werden ebenso diskutiert wie diagnostische Kriterien zur Abgrenzung gegenüber Spontanblutungen anderer Genese.

Abstract

From 1975 to 1981, 50 patients with spontaneous hematomas due to intracranial tumours were treated in the Neurochirurgische Universitätsklinik Erlangen-Nürnberg. 33 tumours were located within the cerebral hemispheres, 6 within the oral brain stem, 6 tumours had a cerebellar origin, 2 neoplasms were located within the cerebellopontine angle, and 3 tumours grew in the sellar region. In most of the patients we found metastatic neoplasms (26%) and glioblastomas (22%), 6 tumours (12%) could not be identified histologically; 2 of these cases were assumed to be malignant gliomas. Two congenital tumours and a chondroma of the cerebellopontine angle were particularly notable. The incidence of tumour hemorrhage reported here was 4.1%.

In 40 patients (80%) the hemorrhage was the cause of an acute clinical course, leading to death in 10 cases. 30% of the patients had to be operated on immediately, 32% were primarily treated in the intensive-care unit. Ten patients of the latter group died because of the acute hemorrhage. In the remaining 19 patients the course appeared to be less threathening and generally of an apoplectiform type. In about 50% the hemorrhage represented the first reliable sign of the hitherto asymptomatic tumour growth, in 32% it remained the only clinical diagnosis for a certain time. In 3 patients the brain tumours were not definitely diagnosed until some months later. One tumour was identified at autopsy.

In pathological anatomy we could differentiate between several types of tumour bleedings. CT scan enabled the identification of the neoplastic origin in 86%, in 5 cases (10%) CT failed to yield the correct diagnosis. Twice CT scan had not been performed. We were able to demonstrate some typical CT findings of brain tumour hemorrhage.

Possible factors promoting hemorrhagic complications of intracranial neoplasms (e.g. therapeutic measures, trauma, endogenic risk factors) are discussed. Diagnostic criteria for achieving more reliable differentiation against spontaneous hematomas of other origin are also given.

Key-Words

Spontaneous intracranial hemorrhage - Brain neoplasms - Computerized tomography - Spontaneous intracerebral hematoma