老年人脑动静脉畸形临床特点及治疗分析

Clinical characteristics and therapy of cerebral arteriovenous malformations in elderly patients

目的加深临床医务工作者对老年人脑动静脉畸形临床特点的认识，为进一步指导治疗，改善患者预后提供参考。方法回顾性分析南方医科大学珠江医院神经外科自2000年1月至2011年12月收治的511例脑动静脉畸形患者中28例老年（≥60岁）患者的临床表现、血管构筑特征、病灶部位及治疗方式、结果等临床资料。结果老年人脑动静脉畸形的发病率约占同期脑动静脉畸形发病率的5．4％，其中男性稍多于女性，平均年龄（62．25±3．46）岁，主要表现为出血20例、癫痫4例、头痛2例、面肌痉挛1例、双耳耳鸣1例；病灶位于幕上22例，幕下6例；畸形血管团〈3cm11例、3～6cm16例、〉6cm1例；位于功能区21例、非功能区7例；深静脉引流15例、双向引流1例、浅静脉引流11例；Spetzeler-Martin分级I级1例、Ⅱ级7例、Ⅲ级13例、Ⅳ级6例、V级1例。27例经手术切除、栓塞等治疗后，症状较前明显改善；1例治疗效果欠佳。结论老年人脑动静脉畸形发病率较低，畸形破裂出血仍为其较常见临床表现，病灶多位于幕上，积极治疗（手术切除、栓塞、放射治疗等1有症状患者可明显改善其预后，提高生活质量。

Objective To explore the clinical characteristics and treatment of cerebral arteriovenous malformations （AVMs） in elderly patients to improve their prognoses. Methods Such clinical data as clinical manifestations, angioarchitecture features, location and therapy of 28 elderly patients （≥60 years old） with AVMs, admitted to our hospital from January 2000 to December 2011, were retrospectively analyzed. Results The elderly patients had 5.4% （28/511） morbidity of AVMs, with mean age of （62.25＋3.46） years; the male patients were slightly more than the female patients. The clinical presentations included hemorrhage in 20 patients, seizure in 4, headache in 2, facial tic in 1 and tinnitus in 1. Supratentorial and infratentorial lesions were noted in 22 and 6, respectively. The maximum diameter of AVMs was smaller than 3 centimeters in 11 patients, ranged from 3 to 6 centimeters in 16, and larger than 6 centimeters in 1. Twenty-one AVMs were located in the fimctional areas and 7 in non-functional areas. Deep vein drainage was noted in 15, two-way drainage in 1 and superficial drainage in 11. Spetzeler-Martin grading showed grade I in 1, grade II in 7, grade III in 13, grade IV in 6 and grade V in 1. After operation, endovascular embolization, 27 patients had significantly improved symptoms; one patient had no effect on any treatments. Conclusion The elderly patients with cAVMs have low morbidity with hemorrhage as its most common symptom; and the lesions mostly locate in the supratentorial region; active intervention therapy （resection, endovascular embolization and radiotherapy） can obviously improve the prognosis and quality of lives.