摘要
目的探讨脑血管畸形患儿的诊治特点。方法回顾性连续纳入2007年9月至2016年12月海南省第三人民医院神经外科收治的脑血管畸形患儿25例,经过CT血管成像(CTA)或DSA确诊,其中男10例,女15例;年龄3～15岁,中位年龄8(5,10)岁;未出血者2例,脑出血23例,出血部位包括额叶8例、颞叶5例、枕叶4例、额颞顶叶3例、基底节区丘脑2例、脑室内1例。采用血肿清除并血管畸形切除、血管内栓塞、立体定向放射治疗等方法治疗,急性期因颅内高压行急诊血肿清除术并血管畸形切除术15例,栓塞治疗1例,包括开颅手术、栓塞治疗后脑室外引流各1例;亚急性期或病情平稳后,手术切除血管畸形并清除血肿3例,栓塞治疗3例,单纯血肿清除术1例(脑静脉畸形)),立体定向放射治疗2例。术后6个月、1年后进行随访。采用格拉斯哥预后量表(GOS)评分进行临床疗效评价,采用CTA、DSA进行影像学评价。结果 (1)影像学诊断颅内动静脉畸形24例,包括Sperzler-Martin分级Ⅰ级9例、Ⅱ级11例、Ⅲ级4例,以前循环供血为主18例,后循环供血为主6例;静脉畸形1例。(2)所有患儿随访期间未发生再出血,8例患儿有癫痫发作,1例于术后8个月死亡。25例患儿治疗后6个月首次临床随访,其中GOS评分5分5例,4分12例,3分4例,2分3例,1分1例; 24例患儿随访1年以上,GOS评分5分16例,4分4例,3分2例,2分2例。术后6个月复查CTA或DSA,示脑血管畸形残留3例,其余22例未见颅内畸形血管;存活患儿随访时间均>1年,在治疗后12～38个月完成DSA复查。术后6个月首次复查有血管畸形残留的3例患儿未进展,未发生脑出血,21例DSA阴性患儿未见复发。结论少年儿童脑血管畸形以动静脉畸形为主,多数患儿在发生自发性出血后就诊。及早诊断、合理治疗可尽可能少地遗留神经功能障碍。
Objective To investigate the diagnosis and treatment characteristics in children with cerebral vascular malformation. Methods From September 2007 to December 2016,25 consecutive children with cerebral vascular malformation admitted to the Department of Neurosurgery,the third people＇s Hospital of Hainan Province were enrolled retrospectively. The diagnosis was confirmed by CT angiography（ CTA） or DSA,including 10 males and 15 females,aged 3-15 years,with a median age of 8（ 5,10） years.There were 2 children without hemorrhage and 23 had cerebral hemorrhage. The sites of hemorrhage included frontal lobe in 8 cases,temporal lobe in 5 cases,occipital lobe in 4 cases,and frontal,parietal and temporal lobes in 3 cases,thalamus in basal ganglia in 2 cases,and ventricle in 1 case. The patients were treated with hematoma removal and vascular malformation resection,endovascular embolization,and stereotactic radiotherapy. In the acute phase,15 patients were treated with emergency hematoma evacuation and vascular malformation resection due to intracranial hypertension,and 1 patient was treated with embolization,including 1 craniotomy and 1 external ventricular drainage after embolization. After the subacute phase or when the condition was stable,3 patients underwent surgical resection of vascular malformations and clearance of hematoma,3 received embolization,1 underwent simple hematoma clearance（ cerebral venous malformations）,and 2 underwent stereotactic radiotherapy. They were followed up at 6 months and 1 year after surgery. The clinical efficacy was evaluated by Glasgow outcome scale（ GOS） score,and CTA and DSA were used to conduct imaging evaluation. Results（ 1） Twenty-four patients were diagnosed as intracranial arteriovenous malformation,including 9 patients with Sperzler-Martin gradeⅠ,11 with gradeⅡ,and 4 with grade Ⅲ. There were18 patients mainly with anterior circulation blood supply and 6 mainly with posterior circulation blood supply; 1 with venous malformation.（ 2） No rebleeding o
作者
周奋
何安邦
刘珍
刘成业
李钢
Zhou Fen, He Anbang,Liu Zhen,Liu Chengye ,Li Gang.(Department of Neurosurgery,the Third People＇s Hospital of Hainan Province, Sanya 572000, China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2018年第11期572-577,共6页
Chinese Journal of Cerebrovascular Diseases
关键词
颅内动静脉畸形
颅内静脉畸形
少儿
随访
Intraeranial arteriovenous malformations
Intraeranial venous malformation
Children
Follow up
