儿童颅内动静脉畸形的显微外科治疗

目的 总结显微手术治疗31例儿童颅内动静脉畸形的经验体会,探讨其治疗方案和手术注意事项.方法 我院自2003年6月～2007年6月对31例儿童颅内动静脉畸形的临床资料、治疗过程以及诊治结果进行回顾性分析.31例中有25例以脑内出血起病,5例以癫痫为主要表现,1例表现为轻度头痛.按照Spetzler-Martin分级,Ⅰ级2例,Ⅱ级12例,Ⅲ级10例,Ⅳ级5例,Ⅴ级2例.单纯手术治疗24例,栓塞后手术7例.结果 31例动静脉畸形团均全切除.6例治疗后出现一过性神经功能缺损或轻度新增神经功能缺损,1例患儿遗留偏瘫.无死亡病例.结论 显微手术切除术可以相对安全有效地治疗儿童颅内动静脉畸形,对于大型或位于功能区的颅内动静脉畸形(AVM),术前栓塞有助于提高疗效.

Microsurgical treatment of pediatric intracranial arteriovenous malformations

Objective To summarize the experience of micmsurgical treatment of intracranial arterio-venous malformation(AVM)in children.Methods Between June 2003 and June 2007,31 Dediatric patients with intracranial AVMs were surgically treated in this institute.The clinical data and surgical results of those patients were retrospectively reviewed.The symptom of onset included:intracranial hemorrhage'in 25 cases,seizure in 5 cases,and mild headache in 1 case. According to the Spetzler-Martin(S-M)Grading Scale,The AVMs were graded Ⅰ in 2,Ⅱ in 12,Ⅲ in 10,Ⅳin 5 and Ⅴ in 2.Surgical resection was performed in a11 thesecases.Preoperative embolization was used in 7 cases.Results The total obliteration rate was 100%.Transient postoperative complications or minor new neurological signs Occurred in 6 patients.Good recovery was aehieved in 30 out of 31 patients except 1 patient was moderately disabled.There was no mortality.Conclusions The goal of cerebral arteriovenous malformation therapy in pediatric patients should be complete resection of the AVM to eliminate subsequent hemorrhage.Microsurgical treatment is a safe and effeclive method for pediatric intracrnial AVMs.