侧脑室动静脉畸形伴脑室出血临床特点和外科治疗分析  

Clinical Features of Arteriovenous Malformation Accompanied by Cerebroventricular Hemorrhage and Surgical Effect

作　　者：李宗平[1] 唐志[2] 杨旭[1] 钟琪[1] 王晓毅[1] 吴健[1] 刘泓渊 LI Zong-ping;TANG Zhi;YANG Xu;ZHONG Qi;WANG Xiao-yi;WU Jian;LIU Hong-yuan(Department of Neurosurgery,Mianyang Central Hospital,Mianyang,Sichuan 621000,China;Department of Neurosurgery,the People's Hospital of Yanting,Yanting,Sichuan 621600,China)

机构地区：[1]绵阳市中心医院神经外科,四川绵阳621000 [2]盐亭县人民医院神经外科,四川盐亭621600

出　　处：《临床误诊误治》2020年第11期96-99,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家十二五科技支撑计划课题(2011BA108B05);四川医学科研课题(S16042)。

摘　　要：目的探讨侧脑室动静脉畸形(arteriovenous malformation,AVM)伴脑室出血的临床特点和外科治疗效果。方法回顾性分析9例侧脑室AVM伴脑室出血的临床资料。结果9例侧脑室AVM中脑室前角及体部AVM各1例,三角区AVM 3例,下角区AVM 4例,均合并脑室出血。2例为中型AVM,7例为小型AVM。9例中1例仅行脑室外引流术,余8例均行侧脑室AVM切除加脑室外引流术。9例术中深部操作均使用显微镜,除1例仅行脑室外引流术无法获得病灶组织外,余8例术后均行病理检查明确诊断为AVM。术后癫痫4例,对侧肢体活动障碍2例,迟发性脑积水1例。术后3个月,9例根据Spetzler-Martin分级,Ⅲ级2例,改良Rankin量表(mRS)评分0~1分和2分各1例;Ⅳ级6例,mRS评分0~1分1例,2分4例,3分1例;Ⅴ级1例,mRS评分4分。9例均术后定期门诊或电话随访,随访时间5~36个月。术后癫痫4例,给予苯巴比妥钠等对症治疗1年后病情控制;对侧肢体活动障碍2例,给予定期康复训练,6个月后对侧下肢肌力恢复正常,上肢肌力恢复至3~4级;迟发性脑积水1例再次行脑室-腹腔分流手术,术后1年得到控制;2例恢复良好。结论侧脑室AVM伴脑室出血患者行外科手术治疗不仅可以完整切除畸形血管团,且可同时清除脑室内血肿,还可引流血性脑脊液,减少脑积水发生。Objective To explore the clinical features and surgical treatment effect of arteriovenous malformation(AVM)accompanied by cerebroventricular hemorrhage.Methods The clinical data of 9 patients with AVM accompanied by cerebroventricular hemorrhage were analyzed retrospectively.Results There were 9 cases with lateral ventricle AVM,including 1 case with AVM in the anterior ventricle,1 case with AVM in the body,3 cases with AVM in the triangle area,and 4 cases with AVM in the lower angle area,and all of them were accompanied by with ventricular hemorrhage.Two patients had medium-sized AVM,and 7 patients had small-sized AVM.One of the 9 cases underwent ventricular drainage,and the remaining 8 cases underwent lateral ventricle AVM resection and ventricular drainage.In 9 cases,the intraoperative deep operation was performed under a microscope.Except 1 patient with ventricular drainage whose the lesion tissue could not be obtained,the remaining 8 cases were diagnosed as AVM by pathological examination after operation.There were 4 cases with postoperative epilepsy,2 cases with contralateral limb dysfunction,and 1 case with delayed hydrocephalus.At three months after the operation,9 cases were classified according to Spetzler and Martin grades,including 2 cases in gradeⅢ.In addition,1 case had 0-1 Modified Rankin Scale(mRS)score and 1 case had 2 mRS scores.There were 6 cases in gradeⅣ,1 case with 0 to 1 score of mRS,4 cases with 2 scores,and 1 case with 3 scores.There was 1 case in gradeⅤ,and the mRS score was 4.Nine cases were followed up by outpatient service or telephone,and the duration of follow-up was 5 to 36 months.Four cases of postoperative epilepsy were given symptomatic treatment such as phenobarbital sodium,and they were all effectively controlled at 1 year after surgery.Two cases of contralateral limb dysactivity were given regular rehabilitation training.After 6 months,the muscle strength of the contralateral lower limb returned to the normal and the muscle strength of the upper limb returned to the grad

关 键 词：颅内动静脉畸形 脑出血 临床特征 外科手术 

分 类 号：R743.4[医药卫生—神经病学与精神病学]