术中超声辅助下急诊手术切除破裂出血的大型脑动静脉畸形  

Intraoperative ultrasound-assisted emergency microsurgery for large cerebralarteriovenous malformations with hemorrhage

作　　者：张施远[1] 曾春[1] 石海平[1] 龙勇[1] 唐爽[1] ZHANG Shi-yuan;ZENG Chun;SHI hai-ping;LONG Yong;TANG Shuang(Department of Neurosurgery, Suining City Central Hospital, Suining 629000, China)

机构地区：[1]遂宁市中心医院神经外科,四川629000

出　　处：《中国临床神经外科杂志》2017年第12期811-813,818,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨在超声辅助下急诊显微手术治疗破裂出血的大型脑动静脉畸形的方法和效果。方法回顾性分析2008年5月至2016年4月收治的15例急性破裂出血的大型脑动静脉畸形的临床资料,均急诊在显微镜下行血肿清除术并同时在超声辅助下行畸形血管团切除术。结果 13例畸形血管团全切除,2例少量残留;全切率为86.7%。术后3例术区少量积血,2例出现癫痫持续状态,2例出现交通性脑积水,1例偏瘫,2例死亡。出院时GOS评分5分7例,4分4例,3分2例,死亡2例。13例术后随访6~12个月,按照日常生活能力分级分级:Ⅰ级9例;Ⅱ级1例;Ⅲ级1例;Ⅳ级2例。结论在术中超声辅助下急诊显微手术切除脑动静脉畸形能达到较好的效果,是一种安全有效的治疗方式。术前结合3D-CTA以及DSA充分了解畸形血管团的结构以及血流动力学特征能降低手术风险,提高疗效。Objective To explore the key points and outcomes of intraoperative ultrasound-assisted emergent microsurgery on large cerebral ateriovenous malformations(AVMs)with hemorrhage.Methods We analyzed retrospectively a clinical data of15patients with large cerebral AVMs with hemorrhage.Of whom,4had Spetzler-Martin gradeⅢAVMs,8gradeⅣand3gradeⅤ.All the patients underwent emergent microsurgery under the guide of intraoperative ultrasound.Results The large cerebral AVMs were totally removed in13cases(86.7%),and subtotally in2.The postoperative complication included small intracranial hematoma in3,status epilepticus in2,communicating hydrocephalusin2and hemiparalysis in1.Two patients died.The following up of6to12months showed that of13patients,9belonged in activity of daily living grade I,1gradeⅡ,1gradeⅢand2gradeⅣ.Conclusions The intraoperative ultrasound-assisted emergent microsurgery is a safe and effective method to treat large cerebral AVMs.The risk of the operation can be reduced and the curative effect can be improved by good understanding of the the structure of the vascular malformation and hemodynamic characteristics through preoperative3D-CTA and DSA.

关 键 词：颅内动静脉畸形 颅内出血 显微手术 急诊手术 术中超声 疗效 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]