CAJ | 학술논문

目的探讨破裂小脑动静脉畸形出血的临床特点及外科手术治疗的效果.方法对象为北京天坛医院2003年1月至2009年12月收治的616例颅内动静脉畸形(AVM)患者(其中小脑AVM 32例)以及北京朝阳医院2003年1月至2011年12月收治的60例脑AVM患者(其中破裂出血的小脑AVM 8例).手术均采用显微外科手术清除血肿,并切除AVM.结果 636例大脑AVM患者和40例小脑AVM患者的术后日常生活活动能力分级(ADL)差异无统计学意义.40例小脑AVM中35例以小脑出血为首发症状.术后复查头颅CT,血肿均清除,无再出血发生.术后39例小脑AVM患者复查血管造影未见畸形残留,1例因术前发生枕骨大孔疝,未复查血管造影.术后3例出现平衡障碍；2例出现爆破性语言；1例术前发生枕大孔疝患者,术后出现平衡及语言障碍.术后(ADL)分级:Ⅰ级26例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例.随访半年,患者无再出血及神经功能障碍加重.结论急性期显微手术是治疗破裂小脑动静脉畸形的有效方法.
목적 탐토파렬소뇌동정맥기형출혈적림상특점급외과수술치료적효과.방법 대상위북경천단의원2003년1월지2009년12월수치적616례로내동정맥기형(AVM)환자(기중소뇌AVM 32례)이급북경조양의원2003년1월지2011년12월수치적60례뇌AVM환자(기중파렬출혈적소뇌AVM 8례).수술균채용현미외과수술청제혈종,병절제AVM.결과 636례대뇌AVM환자화40례소뇌AVM환자적술후일상생활활동능력분급(ADL)차이무통계학의의.40례소뇌AVM중35례이소뇌출혈위수발증상.술후복사두로CT,혈종균청제,무재출혈발생.술후39례소뇌AVM환자복사혈관조영미견기형잔류,1례인술전발생침골대공산,미복사혈관조영.술후3례출현평형장애；2례출현폭파성어언；1례술전발생침대공산환자,술후출현평형급어언장애.술후(ADL)분급:Ⅰ급26례,Ⅱ급10례,Ⅲ급3례,Ⅳ급1례.수방반년,환자무재출혈급신경공능장애가중.결론 급성기현미수술시치료파렬소뇌동정맥기형적유효방법.
Objective To analyze the clinical characteristics and surgical outcomes of ruptured cerebellar arteriovenous malformations (AVM).Methods The clinical data were retrospectively analyzed for 676 brain AVM patients.Among them,616 cases were treated at Beijing Tiantan Hospital from January 2003 to December 2009 and 32 cases of them were of cerebellar AVM.Another 60 cases of intracranial AVM were managed at Beijing Chaoyang Hospital from January 2003 to December 2011 and there were 8 cases of cerebellar AVM.Microsurgery was performed to remove hematoma and excise AVM.And the postoperative outcomes were evaluated.Results Statistics analysis of activities of daily living (ADL) scores for 636 cases of cerebral AVM and 40 cases of cerebellar AVM showed no significant difference.Among 40 cases of cerebellar AVM,hemorrhage occurred first in 35 (87.5％) patients.Postoperative re-examinations of computed tomography revealed the resolution of hematoma and the absence of re-hemorrhage.Digital subtraction angiography (DSA) examinations were performed in 39 cases and no residual nidus was observed.Tonsillar herniation occurred preoperatively in 1 case and DSA was not re-examined.There were balance dysfunction (n =3),dysarthria (n =2) and dystaxia and dysphasia (n =1).The postoperative ADL degrees were Ⅰ (n =26),Ⅱ (n =10),Ⅲ(n =3) and Ⅳ (In =1).During a follow-up period of 6 months,no re-hemorrhage occurred and there was no worsening function of central nerve system.Conclusion Emergency microsurgery is effective in the treatment of ruptured cerebellar AVM.