儿童脑动静脉畸形急性出血40例临床分析

Clinical analysis of 40 cases of cerebral arteriovenous malformation with acute hemorrhage in children

目的探讨儿童脑动静脉畸形急性出血的临床特点、治疗方法及预后。方法对厦门大学附属中山医院神经外科2006年1月—2016年1月收治的40例儿童脑动静脉畸形急性出血患儿的发病特点、临床表现、影像学特点、手术方法及预后进行分析。结果本组患儿中,以9~11岁患儿的比率最高(14例,35.0%);男女比例为1.56∶1。根据患儿脑血管造影的Spetzler-Martin分级采取不同的手术治疗方式,Spetzler-MartinⅠⅡ级者可选择3种手术方式:单纯手术切除、介入栓塞或伽玛刀手术;Spetzler-MartinⅢⅣ级者,脑内畸形血管团直径大于4cm或有多支动脉供血者优先选择介入栓塞,然后二期清除颅内血肿并切除脑动静脉畸形。结论 早期确诊,根据Spetzler-Martin分级采取不同手术治疗方式,预防脑动静脉畸形再出血,防治癫痫及早期恢复神经功能可以有效改善儿童脑动静脉畸形出血的预后。

Objective To explore the clinical features, treatment and prognosis of acute hemorrhage of cerebral arteriovenous malformations(AVM) in children. Methods 40 cases of children with acute hemorrhage of cerebral AVM were included from January 2006 to January 2016 in the department of neurosurgery, Zhongshan Hospital Affiliated to Xiamen University. The characteristics, clinical manifestations, imaging features, surgical treatment and prognosis were analyzed. Results Children aged 9 to 11 had the highest incidence. The incidence rate was 1.56 ∶ 1. Digital subtraction angiography was the diagnostic gold standard for acute hemorrhage in children with cerebral AVM. According to Spetzler-Martin grading, different strategies were performed. Three methods could be chosen. Spetzler-MartinⅠⅡ AVM were treated with surgical resection, interventional embolization or gamma knife radiation. Spetzler-Martin ⅢⅣ larger than 4 cm in diameter or with multiple arterial donors, resection of intracranial hematoma and cerebral AVM were performed. Conclusions Early diagnosis, comprehensive surgical treatment, prevention of rehemorrhage, prevention and treatment of seizure onset and rehabilitation of neurological function can effectively improve the prognosis of patients with acute hemorrhage of cerebral AVM.