儿童脑动静脉畸形破裂出血致脑疝的急诊手术治疗效果分析  

Effect analysis of emergency surgical treatment of cerebral hernia caused by cerebral arteriovenous malformation rupture and hemorrhage in children

作　　者：钟波 邹国荣 张冬根 胡友珠 罗庆勇 樊琼 Zhong Bo;Zou Guorong;Zhang Donggen;Hu Youzhu;Luo Qingyong;Fan Qiong(Department of Neurosurgery,Xinyu Hospital Affiliated to Nanchang University,Xinyu,Jiangxi 338000,China)

机构地区：[1]南昌大学附属新余医院神经外科,338000 [2]南昌大学附属新余医院康复科,338000

出　　处：《中国脑血管病杂志》2022年第6期412-416,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：江西省卫生健康委科技计划项目(SKJP420202225)。

摘　　要：目的 探讨儿童脑动静脉畸形(AVM)破裂出血急性期致脑疝形成的临床特点、治疗方法和效果。方法 回顾性分析南昌大学附属新余医院神经外科于2017年1月至2021年8月连续收治的8例因脑AVM破裂出血导致急性期脑疝形成患儿的临床资料,所有患儿术前行头部CT血管成像(CTA)检查证实脑AVM,因病情急骤行CTA后直接急诊接受开颅血肿清除+畸形血管团切除术,术后根据患儿意识的好转、瞳孔回缩情况评估术后即刻效果,术日当天或者术后第2天复查头部CT评估血肿清除情况,出院前行CTA或DSA评估畸形血管团切除情况(全切除和部分切除)。出院后1个月、3个月、半年和1年对患儿进行临床随访,根据格拉斯哥预后量表(GOS)评分评估患儿恢复效果(包括恢复良好、轻度残疾、重度残疾和死亡)。结果 8例患儿均因自发性脑出血入院,出血量均>30 ml并发生脑疝,其中额叶3例,颞叶2例,顶叶1例,枕叶1例,小脑1例;5例还纳骨瓣,3例去骨瓣减压。出院前复查CTA(2例DSA检查)结果示7例畸形血管全切除,1例部分切除。出院随访1年,根据GOS评分,恢复良好6例,轻度残疾1例,重度残疾1例,无植物人状态和死亡病例。结论 脑AVM是儿童患者自发性脑出血的主要原因,破裂出血致脑疝的患者急诊行血肿清除+一期畸形血管切除术可降低死亡风险和改善患者预后。Objective To explore the clinical features,treatment and effect of cerebral hernia caused by acute cerebral arteriovenous malformation(AVM) rupture and hemorrhage in children.Methods The clinical data of 8 children with acute cerebral hernia due to cerebral AVM rupture and hemorrhage and admitted Neurosurgery Department,Xinyu Hospital Affiliated to Nanchang University from January 2017 to August 2021 were retrospectively analyzed.Cerebral AVM was confirmed by head CT angiography(CTA) before operation.All patients were treated with craniotomy hematoma removal and vascular malformation resection after CTA because of their emergent condition.The immediate postoperative effect was evaluated according to the improvement of consciousness and the retraction of pupil.On the day or the second day after operation,CT examination of the head was rechecked to evaluate the clearance of hematoma,and CTA or DSA examination before discharge to evaluate the resection of malformed vascular mass(total resection and partial resection).Follow-up visits were conducted 1 month,3 months,half a year and 1 year after discharge,and the recovery effect was evaluated according to Glasgow coma scale(GOS) score(including good recovery,mild disability,severe disability,vegetative state and death).Results There were 8 cases admitted to hospital due to spontaneous intracerebral hemorrhage.Patients had hematoma volume>30 ml and brain hernia,including frontal lobe in 3 cases,temporal lobe in 2 cases,parietal occipital lobe in 2 cases,and cerebellum in 1 case.Five patients underwent bone flap reduction and 3 patients underwent bone flap decompression.All patients were reexamined by CTA(DSA in 2 cases) before discharge.Seven cases were totally resected and 1 case was partially resected.The patients were followed up for 12 months.According to GOS score,6 cases recovered well,1 case was mild disability,1 case was severe disability,and no vegetative state and death occurred.Conclusions Cerebral AVM is the main cause of spontaneous cerebral hemorrhage in

关 键 词：脑动静脉畸形 儿童 脑疝 显微手术 

分 类 号：R726.5[医药卫生—儿科]