后颅窝血管畸形出血的外科治疗

目的：探讨后颅窝血管畸形出血的外科治疗方式及其疗效。方法：收集2008年1月至2013年10月在我科住院手术治疗的后颅窝出血、有明确术前影像学诊断和术后病理学诊断的血管畸形患者共24例（动静脉畸形15例,毛细血管扩张1例,静脉畸形2例,硬脑膜动静脉瘘6例）,7例为蛛网膜下腔出血,17例为后颅窝血肿,结合手术记录、术后随访进行回顾性分析。结果：动静脉畸形11例开颅动静脉畸形切除＋血肿清除,2例行栓塞治疗,2例手术＋立体定向放射治疗;毛细血管扩张和静脉畸形行血肿清除、畸形血管切除;硬脑膜动静脉瘘4例行栓塞治疗,1例行血肿清除＋二期栓塞治疗,1例行硬脑膜瘘切除术。本组1例动静脉畸形破裂出血患者术前深昏迷,术后死亡;1例静脉畸形患者术前脑疝、术后生命体征不稳而自动出院;其余患者术后及随访（3~54个月）示好转或痊愈。结论：个体化的综合治疗是后颅窝血管畸形破裂出血的治疗趋势,可提高疗效,改善预后。

The surgical strategy of vascular malformation hemorrhage of posterior fossa

Objective： To discuss the surgical strategy and curative effect of vascular malformation hem-orrhage of posterior fossa.Methods： The clinical data of 24 patients, from January 2008 to October 2013, with vascular malformation hemorrhage of posterior fossa were analyzed retrospectively. All patients received preop-erative imaging scaning and/or pathologic diagnosis, 15 with arteriovenous malformation, 1 with telangiectasis, 2 with venous malformation, and 6 with dura arteriovenous ifstulas （DAVF）. Seven cases suffered with subarach-noid hemorrhage （SAH） and 17 cases had posterior fossa hematoma.Results： Eleven cases of the arteriovenous malformation got arteriovenous malformation resection and hematoma evacuation, 2 were treated with endovas-cular embolization and another 2 got radiotherapy after part arteriovenous malformation resection. The telangiec-tasis cases and venous malformation patients were performed hematoma evacuation. Four DAVF patients got em-bolization and 1 got two-stage embolization after hematoma evacuation, and 1 got DAVF excision. Patients were followed up for a period from 6 months to 54 months. Of these patients, the curative effect was excellent in 22, bad in 2.Conclusion： Individualized comprehensive treatment of vascular malformation hemorrhage of posterior fossa can improve efifcacy and prognosis.