摘要
目的探讨儿童脑动静脉畸形(AVM)显微手术的方法、效果与注意事项;以及DSA复合手术室在手术治疗中的应用。方法回顾性分析郑州大学第一附属医院神经外科2010年10月—2018年3月期间,行显微手术治疗的77例儿童(≤18岁)脑AVM患者的临床资料。其中,颅内出血者65例;10例患者为局限性或全面性癫痫发作;20例患者为肢体无力或感觉异常;3例患者为单纯性头痛,无颅内出血;3例患者为偶然发现。按照影像学Spetzler-Martin分级,Ⅰ级者20例,Ⅱ级33例,Ⅲ级18例,Ⅳ级5例,Ⅴ级1例。71例患者行单纯手术治疗,6例患者栓塞后手术。在DSA复合手术室手术的患者46例,在普通手术室手术患者31例。结果本组患者均行显微手术切除AVM,术后65例患者预后良好;12例患者预后不良,其中3例患者为术后新发神经功能障碍,其余患者在术后6个月早期随访时均较术前好转。复合手术室组患者的AVM切除率明显高于普通手术室组,差异有统计学意义(P<0.05)。结论显微手术切除是儿童脑AVM相对安全有效的治疗方法。DSA复合手术室可为脑AVM合并颅内出血患者提供术前、术中血管造影及手术切除的一站式治疗,从而提高畸形血管团的切除率,减少术后复发率。
Objective To investigate the methods,effects and precautions of arteriovenous malformations(AVM)microsurgery in children and the using of the hybrid operation room(OR)during microsurgery.Methods The clinical data of 77 children(≤18 years)with AVM underwent microsurgery from October 2010 to March 2018 in neurosurgery of the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Among them,65 patients had intracranial hemorrhage.10 patients had localized or generalized seizures.20 patients presented with neurological deficit which had paralysis or hemiparesthesia.3 patients presented simple headache without intracranial hemorrhage.3 patients were found by accidence.By Spetzler-Martin grading system,there were 20 patients in grade I,33 patients in gradeⅡ,18 patients in gradeⅢ,5 patients in gradeⅣand 1 patients in grade V.The 71 patients underwent microsurgical only and 6 underwent microsurgery after embolization.The 64 patients underwent microsurgery in the hybrid operation room(OR)and 31 underwent microsurgery in the general operation room.Results Microsurgical treatment was performed in all children with AVM,65 patients recovered well after surgery,12 patients had poor prognosis,3 of them had new neurological deficits after surgery,and the rest of them became better at the early follow-up 6 months after surgery.The AVM resection rate of patients in the hybrid operation room was significantly higher than that in the ordinary operating room,and the difference was statistically significant(P<0.05).Conclusions Microsurgery is the safety and effective treatment for AVM in children.It is better to use the hybrid OR for the hemorrhagic AVM in which angiography can be done before or intraoperation to figure out the cause of the hemorrhage,angio arctecture,and the residue of the AVM during operation.So it can improve the obliteration rate and decrease the recurrence rate.
作者
王正锋
尹梦磊
刘双
翟广
刘献志
WANG Zheng-feng;YIN Meng-lei;LIU Shuang(Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)
出处
《临床神经外科杂志》
CAS
2020年第2期171-175,181,共6页
Journal of Clinical Neurosurgery
基金
河南省科技厅基金资助项目(172102310081)。
关键词
动静脉畸形
儿童
脑
显微手术
arteriovenous malformations
pediatric
brain
microsurgery
