59例儿童脑动静脉畸形诊治体会

Cerebral arteriovenous malformations in children:Report of 59 cases

目的报道59例儿童脑动静脉畸形诊治体会。方法回顾分析长征医院1990～2000年收治59例18岁以下脑AVM患儿诊治结果,其中单纯手术治疗10例;栓塞后再手术7例;栓塞后伽玛刀治疗18例;手术后伽马刀治疗3例;单纯栓塞治疗5例;直接伽玛刀治疗13例;未治3例。结果48例(48/59)患儿临床表现为出血,47例(47/56)治疗后没有产牛任何新的神经功能缺损,6例(6/56)治疗后出现轻度神经功能缺损或神经功能缺损加重,2例(2/56)患儿遗留严重的神经后遗症,死亡1例。未治3例,死亡1例。结论儿童脑AVM具有出血率高及出血凶猛的特点,应争取积极治疗,合理正确使用显微手术、放疗、血管内栓塞等治疗手段,临床效果满意。

Objective To sum up clinical experiences in the treatment of 59 children with arteriovenous malformations （AVM）. Methods The medical records of 59 cases under 18 years of age with AVM that admitted from 1990 to 2000 were reviewed retrospectively. Among them, surgical operation was performed on in 10 cases; operation combined with preoperative endovascular embolization was in 7 cases; Gamma knife after operation was in 3; interventional therapy was in 5; combined endovascular embolization with Gamma knife in 18 cases, simple Gamma knife treatment in 13. No treatment was carried out in three patients because of excessively critical condition on admittion. Results The clinical presentation of 48 cases （81.4%）. was haemorrhage. Of 47 patients （83.9%） resulted in satisfactory outcomes, 6 cases （10. 7 %） had mild neurological deficits; 2 patients （3.57% ） had severe neurological sequelae and 2 died. Conclusions AVM in children have a high risk for haemorrhage as compared with adults and the extension of intracranial haemorrhage is often more massive and violent. The authors consider that a multidisciplinary management is the best treatment for AVM.