CAJ | 학술논문

目的探讨儿童脑动静脉畸形(AVM)破裂出血急性期的诊断方法和显微外科治疗的时机与手术技术.方法对2002年6月至2011年6月间收治的32例儿童AVM出血患者进行回顾性分析.除CTA和MRA检查外,本组行早期全脑DSA检查24例,另外入院时因出血量大发生脑疝者8例,立即行血肿清除术,其中3例病情稳定后再行DSA检查.明确诊断后根据Spetzler-Martin分级选择治疗方案.24例Spetzler-Martin分级Ⅰ～Ⅲ级AVM患者行急性期(3d内)显微外科治疗,其中栓塞后再手术2例.结果 8例急诊行显微手术血肿清除术者,术后死亡2例,镜下AVM完全切除2例,部分切除1例.病情稳定后行DSA检查证实AVM者3例,继而再行显微手术切除.24例急性期显微手术AVM切除者,术中显微镜下AVM血管团和颅内血肿完全清除.术后获DSA或CTA复查18例,均未见病灶残留.随访3-12个月.根据GOS评定:24例Sptetzler-Martin分级Ⅰ～Ⅲ级AVM患者恢复良好者21例,轻残2例,重残1例,无死亡病例.结论 DSA是儿童AVM出血早期诊断主要的检查手段.急性期显微手术可降低出血病死率和改善预后.
목적 탐토인동뇌동정맥기형(AVM)파렬출혈급성기적진단방법화현미외과치료적시궤여수술기술.방법 대2002년6월지2011년6월간수치적32례인동AVM출혈환자진행회고성분석.제CTA화MRA검사외,본조행조기전뇌DSA검사24례,령외입원시인출혈량대발생뇌산자8례,립즉행혈종청제술,기중3례병정은정후재행DSA검사.명학진단후근거Spetzler-Martin분급선택치료방안.24례Spetzler-Martin분급Ⅰ～Ⅲ급AVM환자행급성기(3d내)현미외과치료,기중전새후재수술2례.결과 8례급진행현미수술혈종청제술자,술후사망2례,경하AVM완전절제2례,부분절제1례.병정은정후행DSA검사증실AVM자3례,계이재행현미수술절제.24례급성기현미수술AVM절제자,술중현미경하AVM혈관단화로내혈종완전청제.술후획DSA혹CTA복사18례,균미견병조잔류.수방3-12개월.근거GOS평정:24례Sptetzler-Martin분급Ⅰ～Ⅲ급AVM환자회복량호자21례,경잔2례,중잔1례,무사망병례.결론 DSA시인동AVM출혈조기진단주요적검사수단.급성기현미수술가강저출혈병사솔화개선예후.
Objective To investigate the diagnostic method and microsurgical operation time and the technology of brain arteriovernous malformation in children during acute hemorrhage.Methods A retrospective analysis of 32 cases of children cerebral AVMs,from June 2002 to June 2011,was conducted.Besides CTA and MRA,24 cases received DSA examination at early stages.Since cerebral hernia was caused by huge hematomas,8 cases underwent emergent microsurgical hematoma removal,among which 3 cases received DSA examination after their recovery.Following definite diagnoses,medical treatments were chosen based on the Spetzler-Martin classification:24 cases of Spetzler-Martin classification Ⅰ-Ⅲunderwent emergent microsurgical operations,while 2 of the cases underwent operation following endovascular embolization.Results Among the 8 cases that received emergent microsurgical hematoma removal,there were 2 cases of death after operation,2 cases with the complete resection of AVM under microscope and 1 case of partial resection,and 3 cases underwent microsurgical resection following their definite diagnosis according to the DSA examination.Furthermore,24 cases received emergent microsurgical AVM resection,and all hematomas and AVMs were completely removed under microscope.18 cases were approved after operation,according to DSA and CTA.Classified based on the Glasgow Outcomc Scale,21cases were grade 5,2 cases were grade 4,1 case was grade 3,and no cases of grade 2 or 1.Conclusion During the acute hemorrhage caused by AVM,DSA is the primary examination and the emergent microsurgical operation can reduce mortality and improve prognosis.