儿童脑动静脉畸形复合手术应用探讨

doi:10.3969/j.issn.1672-6731.2020.04.009

摘要/Abstract

摘要：

目的探讨复合手术在儿童脑动静脉畸形治疗中的临床应用价值。方法 2015年12月至2019年12月经影像学（增强MRI、CTA、MRA或DSA）确诊的19例脑动静脉畸形患儿接受开颅手术联合血管内介入栓塞（复合手术）治疗，并于术中实时DSA确认畸形团切除范围，记录手术时间、术中出血量、住院时间和围手术期相关并发症；术后6个月采用改良Rankin量表（mRS）评价预后。结果 19例患儿Spetzler-Martin分级Ⅰ级2例、Ⅱ级5例、Ⅲ级7例、Ⅳ级5例；致密度分型为致密型4例、中间型4例、弥散型11例。平均手术时间（307.21±115.64）min，术中出血量150（100，260）ml。术中实时DSA显示3例畸形团残留，继续手术切除，影像学治愈率达100%（19/19）。术后并发症包括命名性失语（1例）、肢体偏瘫（1例）、肺部感染（1例）和癫发作（1例）。平均住院时间（15.74±5.04）d，随访时间32（20，40）个月。预后良好率为84.21%（16/19），无再出血或复发病例。结论与单一手术治疗相比，复合手术治疗儿童脑动静脉畸形具有安全、有效且治愈率高等优点，尤其适用于Spetzler-Martin分级较高、位于功能区、结构复杂或弥散型脑动静脉畸形，既往接受过外科治疗的患儿亦为适应证范围。

关键词: 颅内动静脉畸形, 儿童, 外科手术, 血管造影术, 数字减影

Abstract:

Objective To explore the value of hybrid surgery in children with cerebral arteriovenous malformation (CAVM). Methods Nineteen cases of pediatric CAVM from December 2015 to December 2019 were included. After the preoperative enhanced MRI and CTA, MRA or DSA examination confirmed the diagnosis, the hybrid surgery (craniotomy combined with endovascular embolization and intraoperative real-time DSA) were performed. Operative time, intraoperative blood loss, hospital stays and perioperative complications were recorded. The modified Rankin Scale (mRS) was used to evaluate prognosis 6 months later after surgery. Results In 19 CAVM cases, 2 cases were Spetzler-Martin grade Ⅰ, 5 cases were grade Ⅱ, 7 cases were grade Ⅲ and 5 cases were grade Ⅳ, and 4 cases dense type, 4 cases intermediate type and 11 cases diffuse type. The average operative time was (307.21±115.64) min and intraoperative blood loss was 150 (100, 260) ml. Intraoperative endovascular embolization was performed in one case, the DSA after CAVM resection revealed 3 cases with residual malformations, and the final DSA cure rate was 100% (19/19). One patient presented with transient nominal aphasia, one with left limb hemiplegia, one with pulmonary infection, and one with epileptic seizure. Average hospital stays was (15.74±5.04) d, followed-up time was 32 (20, 40) months. Sixteen patients had good prognosis (mRS score <2), and 3 patients had poor prognosis (mRS score ≥ 2). There were no cases of rebleeding or recurrence. Conclusions Hybrid surgery can safely and effectively improve the cure rate of CAVM in children, especially for children with complex structure and diffuse type or with previous treatment.

Key words: Intracranial arteriovenous malformations, Child, Surgical procedures, operative, Angiography, digital subtraction

曾高, 崔德秋, 李静伟, 支兴龙, 杜建新. 儿童脑动静脉畸形复合手术应用探讨[J]. 中国现代神经疾病杂志, 2020, 20(4): 301-309.

ZENG Gao, CUI De-qiu, LI Jing-wei, ZHI Xing-long, DU Jian-xin. Application of hybrid operation in children with cerebral arteriovenous malformation[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(4): 301-309.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I4/301

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