老年人脑动静脉畸形的治疗

The Treatment of Brain Arteriovenous Malformations in Elderly People

目的：总结老年人脑动静脉畸形的治疗经验。方法：对2002年12月至2005年8月收治的17例老年脑动静脉畸形病例进行叫顾性研究。结果：17例患者年龄55～74岁，平均年龄63．4岁，其中男性12例，女性5例。17例患者中11例出现脑出血而急诊入院，4例因突发癫痫急诊入院，仅2例因头痛平诊入院。入院后有10例病患通过急诊显微神经外科手术清除脑内血肿同时切除畸形血管团，除1例放弃治疗，1例行介入栓塞＋γ刀治疗外，其他病例于入院后1周内择期显微神经外科手术清除病灶及畸形血管团。术后死亡2例，1例因大面积脑梗塞而死亡，另1例因就诊时脑出血已继发脑疝，于术后死亡。术后发生偏瘫1例。其他病患无严重神经功能废损而顺利康复出院。结论：老龄不一定是手术的绝对禁忌症，通过显微神经外科手术治疗老年人脑血管畸形，可以达到切除病灶，预防出皿，从而改善患者生活质量的目的。

Objective： To summarize the experience of treatment of brain arteriovenous malformation in the elderly patients. Method： Retrospectively analyzed 17 cases of elderly Hrteriovenous malformation diagnosed between 2002 December and 2005 Augest in the department of neurosurgery of West China hospital of Sichuan University. Results： Seventeen patients ages rangl from 55 to 74 with an average of 63.4, including 12 men and 5 women. Eleven cases were transferred urgently to our hospital because of intracranial hemorrhage, and 4 cases of seizures, and 2 cases of headache. Ten of these patients were given emergency operation by microneurosurgery to evacuate intracranial hematoma and excise the lesion of arteriovenous malfonnation, except in 1 patient the treatment was gwoup and discharged, 1 patient was given partial embolisation and radiosurgery treatment, others of these patients received operations in the first week ofter have admitted. Two patients died, one was due to extensive brain infarction after operation, and the other had tonsillar hernia from huge intracerebral hematoma when admitted, however died after operation. Only 1 ease had hemiparalysis after operation. Others patients had no severe neurological deficits and discharged uneventfully. Conclusion： Age ＇alone should no longer be considered as a contraindicatian to surgerey, the arteriovennus malformation in the elderly patients could be well treated by microneurosurgery, complete resection gave the chance to lead an active life.