CT血管成像指导下急诊手术治疗脑动静脉畸形并脑内血肿

CT angiography-guided emergency operation in cerebral arteriovenous malformation combined with intracranial hematoma

目的研究CT血管成像(CTA)对脑动静脉畸形(AVM)并脑内血肿在急诊术前诊断和手术评估中的价值,以及急诊手术方法的选择及疗效。方法选择2012年2月至2015年12月解放军第一七一医院收治的经CT和CTA检查确诊为AVM并脑内血肿的患者32例,其中男性22例,女性10例;年龄14~57岁,平均年龄33.1岁。发病至住院时间1~36 h。根据CTA进行术前评估,对其中28例急诊行畸形血管切除术加脑内血肿清除术,4例行血肿清除术。术后行数字减影血管造影(DSA)或磁共振血管造影(MRA)检查。随访3~12个月,对患者神经功能按日常生活能力(ADL)量表进行评价。结果 28例急诊行畸形血管切除术者均存活,术后DSA或MRA检查,脑AVM血管团均消失。4例仅行血肿清除术者,1例术后6 h死亡(畸形血管团位于基底节区,术前双侧脑疝),另外3例后期行介入或放射治疗。31例随访3~12个月,ADLⅠ级13例,Ⅱ级8例,Ⅲ级7例,Ⅳ级3例。结论手术是脑AVM并急性脑内血肿的首选治疗方法 ,CTA检查对脑AVM并急性脑内血肿的诊断及急诊手术评估有重要的价值,能作为判断手术方式的依据,指导手术过程,提高手术的安全性。

Objective To explore the value of CT angiography（CTA） in preoperative diagnosis and surgical evaluation of emergency operation in cerebral arteriovenous malformation（AVM） combined with intracranial hematoma, and study selection and curative effects of emergency operations. Methods From February 2012 to December 2015, a total of 32 patients with AVM combined with intracranial hematoma diagnosed by CT and CTA were enrolled, which included 22 males and 10 females, aged14-57 years old with mean age of 33.1 years old, and the time of onset to hospitalization was 1-36 hours. For preoperative assessment of CTA, 28 cases were performed emergency malformation vascular resection and intracranial hematoma removal,and 4 performed hematoma removal, then digital subtraction angiography（DSA） and magnetic resonance angiography（MRA）were used after operation. All of the patients were followed up 3-12 months, and the neurological functions were assessed by activity of daily living（ADL） scale. Results All of 28 cases with emergency abnormal vascular resection survived, and the postoperative DSA and CTA showed that malformation blood vessels were removed; In 4 cases with hematoma removal, 1case died at 6 hours after operation（malformation blood vessel located in basal ganglia, and bilateral herniation in preopera-tive）, the other 3 cases were performed interventional embolization or radiotherapy after operation. Thirty-one cases were followed up 3-12 months, and the results showed that 13 of them rated ADL grade Ⅰ, 8 of grade Ⅱ, 7 of grade Ⅲ and 3 of grade Ⅳ. Conclusion It is demonstrated that emergency operation is the primary treatment method in cerebral AVM combined with acute intracranial hematoma. CTA showed important value for diagnosis of cerebral AVM combined with acute intracranial hematoma and evaluation of emergency operation, which could be used as the basis for evaluating the operation methods, guiding operation process and improving the operation safety.