儿童脑动静脉畸形出血早期诊断和显微外科治疗  

Diagnostic and the microsurgical operation of brain arteriovernous malformation in children during acute hemorrhage

作　　者：田进军[1] 张晋宁[1] 张含[1] 林志忠[1] 蔡永辉[1] 江志贤[1] 

机构地区：[1]福建医科大学附属泉州第一医院神经外科,362000

出　　处：《中华神经外科杂志》2013年第2期182-185,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童脑动静脉畸形（AVM）破裂出血急性期的诊断方法和显微外科治疗的时机与手术技术。方法对2002年6月至2011年6月问收治的32例儿童AVM出血患者进行回顾性分析。除CTA和MRA检查外，本组行早期全脑DSA检查24例，另外入院时因出血量大发生脑疝者8例，立即行血肿清除术，其中3例病情稳定后再行DSA检查。明确诊断后根据Spetzler—Martin分级选择治疗方案。24例Spetzler—Martin分级I～Ⅲ级AVM患者行急性期（3d内）显微外科治疗，其中栓塞后再手术2例。结果8例急诊行显微手术血肿清除术者，术后死亡2例，镜下AVM完全切除2例，部分切除1例。病情稳定后行DSA检查证实AVM者3例，继而再行显微手术切除。24例急性期显微手术AVM切除者，术中显微镜下AVM血管团和颅内血肿完全清除。术后获DSA或CTA复查18例，均未见病灶残留。随访3—12个月。根据GOS评定：24例Sptetzler—Martin分级I-Ⅲ级AVM患者恢复良好者21例，轻残2例，重残1例，无死亡病例。结论DSA是儿童AVM出血早期诊断主要的检查手段。急性期显微手术可降低出血病死率和改善预后。Objective To investigate the diagnostic method and microsurgical operation time and the technology of brain arteriovernous malformation in children during acute hemorrhage. Methods A retrospective analysis of 32 cases of children cerebral AVMs,from June 2002 to June 2011, was conducted. Besides CTA and MRA, 24 cases received DSA examination at early stages. Since cerebral hernia was caused by huge hematomas, 8 cases underwent emergent microsurgical hematoma removal, among which 3 cases received DSA examination after their recovery. Following definite diagnoses, medical treatments were chosen based on the Spetzler - Martin classification： 24 cases of Spetzler - Martin classification I - III underwent emergent microsurgical operations, while 2 of the cases underwent operation following endovascular embolization. Results Among the 8 cases that received emergent microsurgical hematoma removal, there were 2 cases of death after operation, 2 cases with the complete resection of AVM under microscope and 1 case of partial resection, and 3 cases underwent microsurgical resection following their definite diagnosis according to the DSA examination. Furthermore, 24 cases received emergent microsurgical AVM resection, and all hematomas and AVMs were completely removed under microscope. 18 cases were approved after operation, according to DSA and CTA. Classified based on the Glasgow Outcome Scale, 21 cases were grade 5, 2 cases were grade 4, 1 case was grade 3, and no cases of grade 2 or 1. Conclusion During the acute hemorrhage caused by AVM, DSA is the primary examination and the emerzent microsurgical operation can reduce mortality and improve r）rognosis.

关 键 词：儿童 颅内动静脉畸形 出血 显微外科手术 

分 类 号：R726.5[医药卫生—儿科]