脑血管畸形的诊断与治疗

Diagnosis and Treatment of Cerebrovascular Anomalies

本文报告我科1970年7月～1983年1月收治的脑血管畸形77例。临床资料一、性别及年龄:男46例,女31例。

77 cases were ccrebrovascular malformations (CVM)which were analyzed and reported. Of these 77 case there were 46 male and 31 female, with a mean age of 27.4 years (range 7-58 years). The main manifestations were spontaneous subarachnoid hemorrhage falloewed by paralysis of extremitas,disturbance of consciousness, papilloedma, herniation of the brain and epilepsy etc.In 71 cases the lesion were located above the tentorium, and the other 6 cases were below.The diameter of CVM less than 2 cm were seen in 28 cases. Among them, hemorrhage and hematoma were found in 25 cases. The diameter of CVM between 2-5 cm were seen in 32 cases. Among the 32 cases, 26 cases had hemorrhage and 18 cases had formation hematoma. In 17 cases of CVM, the diameter was more than 5 cm, in 17 cases, 6 cases of them had hemorrhage and 2 cases had hematoma. Thus, it can be seen that the smaller the size of the CVM, the more incidence of hemorrhage and hematoma. Other findings were: the width of the vasogrooves seen on the film of craniam, CSF pressure increased, bloody CSF (more than 2 times for 18 cases), ventricules enlarged and ventricular system deformed. CT has diagnostic value for large CVM and secondary hemorrhage and vascular calcification of CVM. Cerebral angiograph was very significant in diagnosis, treatment and estimation of the prognosis of CVM. There were 5 types of CVM in cerebral angiography: Multiple connecting type, single connecting type, straight (or branch) type, venous type and mixed type.In this series, 67 cases were treated by operation (2 cases were operated twice and 1 case by 3 times), 14 cases treated by conservative methods. Operations include: excision of CVM, removal of the hematoma, partial excision of CVM, ligation of carotid artery and shunt of lateral ventricular-cistern of posterior, etc. of the 67 cases cperated there were 6 cases died, the mortality rate was 7.8％.In the auther′s opinions, it would be better that CVM was removed thoroughly, if the patient′s condition could allow.