侧脑室动静脉畸形伴脑室出血临床特点和外科治疗分析

Clinical Features of Arteriovenous Malformation Accompanied by Cerebroventricular Hemorrhage and Surgical Effect

目的探讨侧脑室动静脉畸形(arteriovenous malformation,AVM)伴脑室出血的临床特点和外科治疗效果。方法回顾性分析9例侧脑室AVM伴脑室出血的临床资料。结果9例侧脑室AVM中脑室前角及体部AVM各1例,三角区AVM 3例,下角区AVM 4例,均合并脑室出血。2例为中型AVM,7例为小型AVM。9例中1例仅行脑室外引流术,余8例均行侧脑室AVM切除加脑室外引流术。9例术中深部操作均使用显微镜,除1例仅行脑室外引流术无法获得病灶组织外,余8例术后均行病理检查明确诊断为AVM。术后癫痫4例,对侧肢体活动障碍2例,迟发性脑积水1例。术后3个月,9例根据Spetzler-Martin分级,Ⅲ级2例,改良Rankin量表(mRS)评分0~1分和2分各1例;Ⅳ级6例,mRS评分0~1分1例,2分4例,3分1例;Ⅴ级1例,mRS评分4分。9例均术后定期门诊或电话随访,随访时间5~36个月。术后癫痫4例,给予苯巴比妥钠等对症治疗1年后病情控制;对侧肢体活动障碍2例,给予定期康复训练,6个月后对侧下肢肌力恢复正常,上肢肌力恢复至3~4级;迟发性脑积水1例再次行脑室-腹腔分流手术,术后1年得到控制;2例恢复良好。结论侧脑室AVM伴脑室出血患者行外科手术治疗不仅可以完整切除畸形血管团,且可同时清除脑室内血肿,还可引流血性脑脊液,减少脑积水发生。

Objective To explore the clinical features and surgical treatment effect of arteriovenous malformation(AVM)accompanied by cerebroventricular hemorrhage.Methods The clinical data of 9 patients with AVM accompanied by cerebroventricular hemorrhage were analyzed retrospectively.Results There were 9 cases with lateral ventricle AVM,including 1 case with AVM in the anterior ventricle,1 case with AVM in the body,3 cases with AVM in the triangle area,and 4 cases with AVM in the lower angle area,and all of them were accompanied by with ventricular hemorrhage.Two patients had medium-sized AVM,and 7 patients had small-sized AVM.One of the 9 cases underwent ventricular drainage,and the remaining 8 cases underwent lateral ventricle AVM resection and ventricular drainage.In 9 cases,the intraoperative deep operation was performed under a microscope.Except 1 patient with ventricular drainage whose the lesion tissue could not be obtained,the remaining 8 cases were diagnosed as AVM by pathological examination after operation.There were 4 cases with postoperative epilepsy,2 cases with contralateral limb dysfunction,and 1 case with delayed hydrocephalus.At three months after the operation,9 cases were classified according to Spetzler and Martin grades,including 2 cases in gradeⅢ.In addition,1 case had 0-1 Modified Rankin Scale(mRS)score and 1 case had 2 mRS scores.There were 6 cases in gradeⅣ,1 case with 0 to 1 score of mRS,4 cases with 2 scores,and 1 case with 3 scores.There was 1 case in gradeⅤ,and the mRS score was 4.Nine cases were followed up by outpatient service or telephone,and the duration of follow-up was 5 to 36 months.Four cases of postoperative epilepsy were given symptomatic treatment such as phenobarbital sodium,and they were all effectively controlled at 1 year after surgery.Two cases of contralateral limb dysactivity were given regular rehabilitation training.After 6 months,the muscle strength of the contralateral lower limb returned to the normal and the muscle strength of the upper limb returned to the grade 3-4.One case of delayed hydrocephalus underwent ventricular-abdominal shunt again,which was controlled 1 year after surgery and 2 cases recovered well.Conclusion Surgical treatment for patients with lateral ventricle AVM and intraventricular hemorrhage can not only completely remove the malformed blood vessel group,but also remove the intraventricular hematoma,drain bloody cerebrospinal fluid and reduce the occurrence of hydrocephalus.