小脑血管畸形显微手术治疗的临床分析

Clinical analysis of microsurgical treatment for cerebellar vascular malformation

目的探讨小脑血管畸形的临床特点及手术治疗方法与疗效。方法回顾性分析72例小脑血管畸形病人的临床资料．采用乙状窦后入路或枕下后正中入路进行手术。结果72例病人均手术全切病灶。术后病理结果：动静脉畸形（AVM）67例，海绵状血管瘤（CM）3例，静脉畸形（VM）2例。术后GOS评分：5分64例，4分4例，3分1例，2分1例，1分2例。随访4个月～13年，恢复良好64例，轻残4例，重残1例，植物生存状态1例，死亡2例。无复发病例。术前GCS评分≥8分的AVM病人，其术后GOS评分较GCS评分〈8分者高（P〈0．05）。结论小脑血管畸形应尽早行手术切除治疗，术中采用合适的手术入路、适当的手术技巧，可取得良好的手术效果。AVM病人术前GCS评分≥8分的病人恢复好，〈8分病人恢复较差。

Objective To investigate the clinical characteristics and surgical methods and outcomes of cerebellar vascular malformation. Methods Clinical data of 72 patients with cerebellar vascular malformation were analyzed retrospectively, who underwent surgery via retrosigmoid approach or posterior median suboccipital approach. Results Total resection was achieved in 72 patients. Postoperative pathology results were arteriovenous malformation in 67 patients, cavernous malformation in 3 and venous malformation in 2. Postoperative GOS results were as follows： 5 in 64 patients, 4 in 4, 3 in 1, 2 in 1 and 1 in 2. All the patients were followed up for 4 months to 13 years, 64 patients recovered well, 4 were slight disabled, 1 severely disabled, 1 vegetable and 2 died. No relapse. The postoperative GOS of AVM patients with preoperative GCS ≥ 8 was higher than that of patients with GCS 〈 8 （P 〈 0.05）. Conclusions Cerebellar vascular malformation should be microsurgically resected as early as possible. With proper surgical approach and appropriate surgical technique, the surgery for cerebellar vascular malformation can obtain good outcome. The AVM patients with preoperative GCS ≥8 have better outcome, and the patients with GCS 〈 8 have poorer outcome.