儿童颅内动静脉畸形出血的临床特点及治疗分析

Clinical characteristics and treatment of intracranial arteriovenous malformation in children with acute hemorrhage

目的：探讨儿童颅内动静脉畸形（AVM）破裂出血的临床特点及治疗方式。方法对2010～2013年收治的28例儿童 AVM 出血患者（＜18岁）的临床资料进行回顾性分析。结果22例行显微手术、血管栓塞或综合治疗的病例根据 Glasgow outcome scale（GOS）预后评分预后良好20例，中度残疾2例，无死亡。其中8例出血合并脑疝行急诊手术，6例预后良好，2例中度残疾。10例急性期行血管内栓塞、显微手术切除或综合治疗者复查 DSA示畸形团不再显影，预后良好。2例单纯血管内栓塞治疗者及2例血管内栓塞结合伽马刀放射治疗者动静脉畸形复发，行再次栓塞治疗。6例因治疗困难，出血急性期行保守治疗后进一步行伽马刀放射治疗，随访至今未再出血。结论AVM 是儿童自发性颅内出血的主要原因，尽可能早期行 DSA 明确 AVM 情况，积极行介入栓塞、显微手术等是治疗儿童 AVM 的有效方法。

Objective To investigate the clinical characteristics and treatment of rupture and hemorrhage of brain arteriovernous malformation （AVM）in children.Methods Clinical data of 28 children with cerebral AVM treated in our hospital during 2010 to 2013 were retrospectively reviewed.Results Of 22 patients who underwent interventional embolization or microsurgery or both,20 were cured,and 2 were moderately disabled.Of the 8 cases receiving emergency operation due to hemorrhage complicated with cerebral hernia,6 had fine prognosis and 2 were moderately disabled.Of the 10 cases treated with interventional embolization,microsurgery or both,DSA check-ups indicated the malformation was no longer developing.Two cases treated only with intravascular embolization and two cases treated with intravascular embolization combined with gamma knife had recurrence and underwent embolization treatment a second time.Of the 6 cases treated with conservative approach,no recurrent hemorrhage occurred.Conclusion Cere-bral AVM is the primary cause of intracerebral spontaneous hemorrhage in children.DSA check-ups should be performed as early as possible to clarify the condition.Interventional embolization and microsurgery are effective treat-ments for pediatric AVM.