天幕下小脑上部动静脉畸形的临床特点及显微手术治疗

Clinical characteristics and microsurgical treatment for infratentoria-supra-cerebella arteriovenous malformations

目的回顾分析14例天幕下小脑上部动静脉畸形(AVMs)患者的临床特点,分析评估手术入路的选择及显微手术的效果。方法天幕下小脑上部AVMs 14例均分别经影像学．手术及病理证实,其中9例选择枕叶下经天幕入路显微手术切除AVMs。结果本组14例平均年龄32．9岁；头痛伴呕吐为主要表现者10例,有小脑共济失调体征10例；AVMs伴出血者13例。AVMs直径0．5～2．5cm 6例,3-5cm 7例；小脑上动脉为主要动脉供血13例,单纯由小脑上动脉供血者6例；引流静脉向大脑大静脉或横窦引流者7例,向深浅两个方向引流者4例。9例枕叶下经天幕人路显微镜下切除AVMs,8例临床治愈,1例术后死亡,随访半年至1年,生活完全自理7例,基本自理1例。结论本组天幕下小脑上部AVMs以青壮年居多,病人头痛、小脑共济失调症状突出：该部位AVMs中小型多,小脑上动脉为主要供血动脉,引流静脉多向大脑大静脉及横窦引流：枕叶下经天幕入路对该区域病变显露佳,具有病变易切除、创伤小的优点,是切除天幕下小脑上部AVMs的理想入路选择。

Objective To analyze clinical characteristics of 14 cases ofinfratentorial-supra-cercbella arteriovenous malformations （AVMs） retrospectively, and to evaluate the option ofmicrosurgical approach and its outcome. Methods All 14 cases of infratentorial-supra-cerebella AVMs were verified by radiographic, operative and pathologic study. Of all cases, 9 cases of AVMs were completely removed microsurgically via occipital transtentorial approach. Results The patients averaged 32.9 years old. Of all cases, 10 cases presented headache combined with vomiting, and another 10 cases manifested with cerebella ataxia. CT scan confirmed cerebella hemorrhages in 13 cases. Of all cases, size （diameter） of AVMs was from 0.5 to 2.5 cm in 6 cases, and 3 to 5 cm in 7 cases. In 13 cases, superior cerebella artery （SCA） was the main feeding artery, but 6 of them were only fed by SCA. 7 cases with venous drainage drained into transverse sinus and Galen＇ s vein, and 4 cases into deep and superficial draining veins. Of all cases, 9 cases of AVMs were resected microsurgically via occipital transtentorial approach, 7 cases of whom recovered with full self-care by follow-up for half to a year, I case did with partial self-care and I died postoperatively. Conclusion In our retrospective study, most patients were young or in middle age. Headache and ataxia were remarkable in most cases. In this region, most AVMs in small or middle size possess feeders from the SCA and draining veins to the Galen＇s vein and transverse sinus. Occipital transtentorial approach is the optimal option of better exposure, easy handling, and minimal invasion for resection of infratentorial-supra-cerebella AVMs.