儿童出血型颅内动静脉畸形显微外科手术的疗效分析  

Clinical experience in the microsurgery for the treatment of hemorrhagic arteriovenous malformation of children

作　　者：甄英伟 张永良 占益平 郭社卫 汪刚[1] 周国胜[1] Zhen Yingwei;Zhang Yongliang;Zhan Yiping;Guo Shewei;Wang Gang;Zhou Guosheng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurosurgery,Ruzhou First People's Hospital,Ruzhou 467599,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052 [2]汝州市第一人民医院神经外科,汝州467599

出　　处：《中华神经外科杂志》2024年第4期391-396,共6页Chinese Journal of Neurosurgery

基　　金：河南省重点研发与推广专项(232102311121)。

摘　　要：目的探讨显微外科手术治疗儿童出血型颅内动静脉畸形(AVM)的临床效果。方法回顾性分析2017年6月至2022年6月郑州大学第一附属医院神经外科行显微外科手术治疗的34例出血型颅内AVM患儿的临床资料。术前Spetzler-Martin评分(SMG)1分4例,2分11例,3分13例,4分6例。所有患儿均开颅行AVM切除术及血肿清除术,根据适应证选择合适的手术方案。术后第1天行头颅CT检查评估有无颅内出血及脑组织肿胀情况,术后1周行头MRI检查评估有无血管畸形团残留;采用格拉斯哥昏迷评分(GCS)评估患儿术后意识障碍的改善情况。采用门诊或电话方式对患儿进行随访,术后3、6个月行头颅MRI或者全脑数字减影血管造影(DSA)检查评估有无血管畸形残留或复发;采用改良Rankin量表评分(mRS)评估患儿神经系统功能恢复情况,mRS0~1分为预后良好;并根据术前SMG分级情况分为SMG≤3分组和SMG>3分组,比较两组存活患儿的预后差异。结果34例患儿的手术均顺利完成,其中25例患儿直接行开颅手术切除AVM及血肿;6例行复合手术;3例先行AVM部分栓塞,再行手术切除。31例(91.2%)患儿初次手术行AVM全切除;3例(8.8%)行近全或大部分切除,其中1例二次手术行AVM全切除。术后2例(术前SMG均为3分)患儿死亡;3例(术前SMG3分1例,4分2例)出现重度残疾。出院时GCS3~8分2例,9~12分2例,13~15分28例。32例存活的患儿均获得临床随访,随访时间为(35.2±10.1)个月;至末次随访,均无AVM残留或复发,预后良好26例,预后不良6例。与术前SMG>3分组相比,术前SMG≤3分组患儿的预后明显较好(预后良好比例分别为2/6、23/26,P=0.012)。结论显微外科手术是儿童出血型AVM首选的治疗措施,尤其对于SMG≤3分的患儿。根据患儿适应证采取合理的手术方案,术前血管栓塞、复合手术治疗均有助于实现AVM全切除。Objective To explore the clinical effect of microsurgery in the treatment of hemorrhagic intracranial arteriovenous malformation(AVM)in children.Methods The clinical data of 34 children with hemorrhagic intracranial AVM who underwent microsurgery at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2022 were retrospectively analyzed.The preoperative Spetzler-Martin score(SMG)was 1 in 4 cases,2 in 11 cases,3 in 13 cases,and 4 in 6 cases.All children underwent craniotomy for resection of cerebral vascular malformations and hematoma evacuation,and the appropriate surgical plan was selected according to the indications.A head CT examination was performed on the first day after the operation to evaluate whether there was intracranial hemorrhage and brain tissue swelling.A head MR examination was performed one week after the operation to evaluate whether there was any residual vascular malformation.The Glasgow coma scale(CCS)was used to evaluate the postoperative improvement of consciousness disorder of the children.Children were followed up in outpatient clinics or by telephone,and cranial MRI or whole-brain DSA was performed 3 and 6 months after surgery to evaluate whether there was residual or recurrence of vascular malformations.The modified Rankin scale score(mRS)was used to evaluate the recovery of neurological function in children and the mRS of O-1 was considered as good outcome.According to the preoperative SMG grading,the patients were divided into SMG≤3 group and SMG>3 group,and the outcome difference between the two groups of surviving children was analyzed.Results The operations of 34 children were successfully completed.Among them,25 children underwent direct craniotomy to remove vascular malformations and hematomas;6 children underwent hybrid surgeries;3 children underwent partial embolization of cerebral vascular malformations and then surgical resection.Thirty-one cases(91.2%)of the children underwent total resection of intracranial AVM during

关 键 词：颅内动静脉畸形 脑出血 显微外科手术 血管内操作 儿童 治疗结果 

分 类 号：R651.1[医药卫生—外科学]