急诊手术治疗脑动静脉畸形出血26例分析

目的探讨脑动静畸形破裂出血的急诊术前检查、手术方法和治疗效果。方法回顾性分析26例经CT、CT血管造影(CTA)、磁共振血管造影(MRA)、数字减影血管造影(DSA)及手术病理确诊的脑动静畸形破裂出血的手术效果及临床特征。并随访6个月的GOS评分。结果 26例均急诊行开颅血肿清除加畸形血管切除。动静脉畸形全部切除14例,部分动静脉畸形切除并供血动脉夹闭12例;恢复良好12例(46.15%),轻残7例(26.92%),重残4例(15.38%),植物生存状态1例(3.85%),死亡2例(7.69%)。结论脑动静脉畸形并出血病人,合理选择术前血管造影检查(CTA,MRA及DSA),急诊手术方法的正确选择和恰当处理是关键。

Analysis of the effect of emergent operation 26 cases of intracranial arteriovenous malformation and intracerebral hemorrhage

Objective To study the emergent operation treatment and clinical characteristics of cerebral arteriovenous malformations(CAVM) and intracerebral hemorrhage.Methods The operative treatment and its efficacy of 26 patients with AVM and intracerebral hemorrhage confirmed by CT,CTA,MRA,DSA,operation and pathological examination were analyzed retrospectively.Results Some 14 patients were treated by removing hematoma and complete resection of AVM,12 patients were treated by removing hematoma,partial resection of AVM and occlusion of feeding arteries.According to Glasgow outcome score(GOS) on follow-up of 6 months,12 patients(46.15%) recovered well,7(26.92%) moderately disabled,4(15.38%) severely disabled,1(3.85%) vegetatively survived and 2(7.69%) died.Conclusion It is very important to select a reasonable angiography(CTA,MRA and DSA) before operation.It is critical to select correct emergency surgical methods and appropriate treatment.