脑血管畸形急性出血并脑内血肿的手术治疗

目的 探讨脑动静脉畸形(AVM) 出血并颅内血肿形成的急诊手术问题.方法 37例CT示颅内血肿,怀疑AVM 出血,32例急诊手术前经MRA检查提示脑AVM21例,其中29例行血肿清除加AVM显微切除术,8例行单纯血肿清除术,10例行去骨瓣减压术.结果 死亡4例,存活33例中恢复优良21例,良7例,差5例. 29例术后复查DSA或MRA,20例AVM消失.结论 急诊显微外科手术治疗是AVM破裂出血首选治疗方法,能够提高脑AVM破裂出血的治愈率,降低致残率.MRA适合急诊术前检查,可快捷、安全显示AVM及主要供血动脉,指导制定手术方案.

Experience of surgical treatment of acute hemorrhagic intracranial arteriovenous malformation with intracerebral hematoma

Objective To study the emergent operative treatment of cerebral arteriovenous malformations(AVMs) with intracerebral hematoma. Methods 37 cases of cerebral AVMs underwent surgical treatment were retrospectively reviewed.21 cases were confirmed by preoperative magnetic resonance angiography(MRA),including hematoma debridement plus AVM excision in 29 cases,hematoma debridement in 8 cases,skull windowing decompression in 10 cases.Results 4 patients died after operation.The AVMs were totally removed in 20 patients and subtotally in 9 patients confirmed by postoperative MRA or digital subtraction angiography(DSA).The therapeutic effect of 33 cases categorized as excellent in 21 cases,fair in 7 cases and poor in 5 cases. ConclusionThe emergent hematoma debridement and AVMs excision by microneurosurgery is the optimal effective method to treat AVMs with intracerebral hematoma because it can heighten cured rate and decrease disability rate.Preoperative MRA is valuable for emergent operation to guide operative project by advantages of safety and speediness to show AVMs and primary artery.