27例儿童脑动静脉畸形的临床症状学特点及显微外科治疗

目的总结分析儿童脑动静脉畸形（AVM）的临床特点及其显微外科治疗效果。方法回顾性分析27例显微手术治疗的儿童脑AVM患者的临床资料。结果本组儿童脑AVM患者平均年龄11．3岁；男女比例为1．5：1；27例中伴脑出血的高达22例（81．5％）；按Spetzler—Martin分级，Ⅰ级10例，Ⅱ级5例，Ⅲ级8例，Ⅳ级4例，术前行脑血管检查阴性2例：显微手术疗效优17例，良6例，差1例，死亡3例。结论儿童脑AVM患者较成人更易出血及复发，显微手术治疗Spetzler—MartinⅠ-Ⅱ级AVM效果显著，Ⅲ-Ⅳ级AVM采取先栓塞再手术的方法也可取得良好的效果。

Clinical Characteristics and Microsurgical Treatment of 27 Cases of Cerebral Arteriovenous Malformations in Children

Objective To summarize and analyze the clinical characteristics of cerebral arteriovenous malformations （AVMs） in 27 children and curative effect of microsurgery on AVMs. Methods The clinical data of 27 children with AVMs who underwent the microsurgery were analyzed retrospectively, including age and sex of patients, location, size, feeding artery, drainage vein and hemorrhage or not of AVMs and the curative effect of the microsurgery on AVMs. Results The patients with AVMs was 11.3 years old averagely. The ratio of male to female was 1.5：1.0. Among the 27 patients, 22 patients （81.5%） suffered simultaneously from cerebral hemorrhage. According to the Spetzler-Martin grading, there were 10 patients with AVMs of grade Ⅰ, 5 with AVMs of grade Ⅱ, 8 with AVMs of grade Ⅲ, and 4 with AVMs of grade Ⅳ. There were negative results on DSA examination in 2 patients. The curative effect was excellent in 17 patients, good in 6 and bad in 1. Three patients died. Conclusions AVMs are proner to hemorrhage and relapse in children than those in adults. The curative effects of microsurgery on grade Ⅰ - Ⅱ AVMs are good. The curative effects of endovascular embolization combined with microsurgery on grade Ⅲ-Ⅳ AVMs are better than that of endovascular embolization or microsurgery.