颅内动静脉畸形出血的急诊治疗

Surgical treatment on intracranial bleeding caused by arteriovenous malformation

目的探讨颅内动静脉畸形(AVM)出血原因及急诊处理的临床意义。方法回顾分析35例AVM破裂出血患者的临床特点、影像学特征及治疗效果。其中昏迷21例(60.0%);伴脑疝19例(54.3%);嗜睡、朦胧11例(31.4%)。术中清除血肿且全切动静脉畸形19例(54.3%);清除血肿且动静脉畸形部分切除5例(14.3%);清除血肿且夹闭畸形血管1例;单纯清除脑内血肿10例(28.6%)。结果术后死亡5例,手术死亡率14.3%。术后1年随访28例,正常工作17例,生活自理7例,需人照顾4例,致残率为31.4%。结论对动静脉畸形破裂出血,伴有颅内血肿的患者,行血肿清除的同时切除动静脉畸形,有良好的临床效果。

Objective To discuss the significance of emergent surgical treatment on intracranial bleeding and intracranial hematoma caused by arteriovenous malformation. Methods 35 cases were retrospectively analysed for clinical features, radiographic finding and the effectiveness of treatment. 21 cases presented with coma and 19 cases had tentorial herniation before operation, hematoma and malformation were totally removed in 19 cases, on 10 cases only had the hematoma evacuated. Results 5 patients died after operation, the mortality rate was 14.3%. 17 patients returned back to work,7 patients could take care of themselves and 4 patients needed help in daily life. Conclusions Good clinical results can be achieved by acute operation on intracranial arteriovenous malformation with hematoma even in comatose patients with tentorial herniation.