儿童颅内破裂动静脉畸形的临床特点及手术疗效  

Clinical characteristics and surgical outcomes of intracranial ruptured arteriovenous malformations inchildren

作　　者：邱德智 何俊平[1] 高喆 钱静[1] 祝永杰[1] 郑雷[1] 颜青 张献礼 王刚[1] Qiu Dezhi;He Junping;Gao Zhe;Qian Jing;Zhu Yongjie;Zheng Lei;Yan Qing;Zhang Xianli;Wang Gang(Department of Neurosurgery,Childrens Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院神经外科,南京210000

出　　处：《中华神经外科杂志》2022年第12期1194-1198,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童颅内破裂动静脉畸形(AVM)的临床特点及手术疗效.方法回顾性分析2017年4月至2020年12月南京医科大学附属儿童医院神经外科行显微手术切除的92例儿童颅内破裂AVM患儿的临床资料.根据患儿病情的缓急选择不同的手术时机,其中35例于急性期(AVM破裂时间≤72 h)切除AVM;57例于非急性期(AVM破裂时间≤1个月)切除AVM(包括12例急症治疗后病情稳定的患儿).术后6个月行改良Rankin量表评分(mRS)评估患儿的临床预后.结果92例患儿入院时的格拉斯哥昏迷评分:3~5分10例,6~8分16例,9~12分17例,13~15分49例.其中31例(33.7%)AVM合并动脉瘤;4例(4.3%)AVM短期内(≤14 d)再次出血.术前影像学Spetzler-Martin分级:Ⅰ级42例,Ⅱ级29例,Ⅲ级17例,Ⅳ级4例.AVM首次造影的阳性率为95.7%(88/92).92例AVM切除手术中,共86例AVM一次性手术切除,治愈率为93.5%.急性期手术的治愈率为94.3%(33/35),有2例AVM残留,3例出现并发症,分别为偏瘫、失语及硬膜外血肿;非急性期手术的治愈率为93.0%(53/57),有4例AVM残留,4例出现并发症,分别为失语2例、脑积水和偏瘫各1例.92例患儿的随访时间为6~48个月,至末次随访,患儿均未发现AVM复发,其中89例(96.7%)预后良好(mRS≤2分),3例(3.3%)预后不良(mRS≥3分).结论儿童颅内破裂AVM病情危急,合并动脉瘤的比例较高,短期内容易再出血;显微手术切除是其有效的治疗方式,其治愈率高,手术相关并发症的发生率低.ObjectiveTo investigate the clinical characteristics and surgical outcomes of intracranial ruptured arteriovenous malformations(AVMs)in children.MethodsFrom April 2017 to December 2020,the clinical data of 92 children with intracranial ruptured AVMs who underwent microsurgical resection at the Department of Neurosurgery,Children's Hospital of Nanjing Medical University from April 2017 to December 2020 were retrospectively analyzed.According to the urgency of the patient's conditions,the AVM was resected in 35 patients in acute stage(≤72 h)and in 57 patients(including 12 children with stable condition after emergency treatment)in non-acute phase(≤1 month).Six months after surgery,the modified Rankin Scale(mRS)was used to evaluate the clinical outcomes.ResultsAccording to the Glasgow Coma Scale(GCS)scores at admission,10 cases scored 3-5,16 cases scored 6-8,17 cases scored 9-12 and 49 cases scored 13-15.31 cases(33.7%)were complicated with aneurysms and AVM bled again in 4 cases(4.3%)in a short time(≤14 d).According to the Spetzler-Martin grade,42 cases were grade Ⅰ,29 cases were grade Ⅱ,17 cases were grade Ⅲ and 4 cases were grade Ⅳ.The positive rate of AVM in the first angiography was 95.7%(88/92).In 92 cases of AVM resection,86 cases of AVM were cured by the first resection with the cure rate of 93.5%(86/92).In the acute stage,the cure rate was 94.3%(33/35).There were 2 cases of residual AVM and 3 cases of complications,including hemiplegia,aphasia and epidural hematoma.The cure rate was 93.0%(53/57)in the non-acute stage.There were 4 cases of residual AVM and 4 cases of complications,including 2 cases of aphasia,1 case of hydrocephalus and 1 case of hemiplegia.All 92 patients were followed up for 6-48 months.At the last follow-up,no recurrence of AVM was found in 92 patients.A total of 89 patients(96.7%)had a favorable outcome(mRS≤2 points)and 3(3.3%)had a poor outcome(mRS≥3 points).Conclusions Children with intracranial ruptured AVMs are in critical condition,a high proportion of whom have co

关 键 词：颅内动静脉畸形 脑出血 儿童 疾病特征 显微外科手术 治疗结果 

分 类 号：R726.5[医药卫生—儿科]