胼胝体动静脉畸形的临床特点和手术疗效

目的探讨胼胝体动静脉畸形（AVM）的临床特点和手术疗效。方法对2005年9月—2011年8月收治的7例胼胝体AVM患者进行手术治疗。AVM分别位于胼胝体膝部1例,体部额段3例,体部顶段1例,压部2例。5例有脑室出血,对其中1例发生脑疝的患者行急诊手术。对膝部AVM经冠状切口单额开颅,行血肿清除及AVM切除术;对体部额段AVM患者,经前纵裂及额叶皮质造瘘后,经侧脑室切除AVM及清除血肿;对体部顶段AVM及压部AVM患者,经纵裂及顶叶切除AVM。结果①6例患者为中型AVM,最大直径为3～4.5 cm,1例为小型AVM,最大直径为2.5 cm。AVM由胼周动脉、胼缘动脉、后胼周动脉及脉络膜后内侧动脉供血。3例单纯浅静脉引流,2例深静脉引流,2例深、浅静脉同时引流。②7例患者的畸形血管团均获得全切。5例恢复良好,其中2例术后一过性肌力下降,1例出现偏瘫,4～14 d后恢复正常。1例术前脑疝患者术后6个月意识逐渐恢复。1例术中大出血病例术后发生脑积水,行脑室-腹腔分流术,术后意识清楚,遗留四肢痉挛性瘫痪、肌张力增高。③术后对6例行DSA或CTA复查,AVM消失,1例未复查。④临床随访3个月至6年,末次随访时,GOS评分为5分的5例,3分的2例。结论胼胝体AVM位置深在,供血动脉、引流静脉复杂,合理手术入路有助于完全切除AVM,术后疗效较好。

Clinical features and surgical outcomes of corpus callosum arteriovenous malformation

Objective To investigate the clinical features and surgical methods of corpus callosum arteriovenous malformation(AVM).Methods Seven patients with corpus callosum AVM admitted from September 2005 to August 2011 were operated on.AVMs were located in the genu(n=1),frontal segment(n=3),parietal segment(n=1) and splenium(n=2) of corpus callosum.Five patients had intraventricular hemorrhage,one of them developed brain herniation and was operated urgently.The AVMs of the genu of corpus callosum were treated via coronary incision,unilateral frontal craniotomy,hematoma evacuation,and AVM resection.Resection of AVM and hematoma evacuation were performed for patients with parietal segment AVM of corpus callosum via anterior interhemispheric approach.The AVMs were resected via interhemispheric and parietal approaches for patients with AVM at parietal segment and splenium of corpus callosum.Results ① 6 patients had medium-sized AVM,the maximum diameter was 3 to 4.5 cm.One had small sized AVM with maximum diameter 2.5 cm.All the patient′s AVM had blood supply of AVMs from the pericallosal artery and callosomarginal artery.Five patients had blood supply from the posterior pericallosal artery and the medial posterior choroidal artery at the same time.One patient had the blood supply from the anterior choroidal artery.Three patients had purely superficial venous drainage,2 had deep venous drainage,and 2 had both deep and superficial venous drainage.②The malformation nidi of 7 patients were resected completely.Five patients had good recovery,3 of them had decreased muscle strength transiently after operation,and they were recovered to normal after 4 to 14 days.The consciousness of 1 patient with preoperative cerebral hernia recovered gradually at 6 months after operation.One patient with intraoperative massive hemorrhage had hydrocephalus after operation and a ventriculoperitoneal shunt was performed.He was conscious,leaving spastic paralysis of extremities and increased muscle tone.③DSA or CTA re-examination revealed that the AVMs in 6 patients were disappeared after operation and 1 did not perform re-examination.④The patients were followed up for 3 months to 6 years.The GOS score 5 were in 5 cases and 3 in 2 cases during the last follow-up.Conclusion The location of the corpus callosum AVM is deep,the feeding arteries and drainage veins are complex,and proper operative approaches contribute to complete resection of the AVMs.The efficacy is better after operation.