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目的探讨儿童颅内动静脉畸形(AVM)破裂出血的临床特点及治疗方式。方法对2010~2013年收治的28例儿童AVM出血患者(<18岁)的临床资料进行回顾性分析。结果 22例行显微手术、血管栓塞或综合治疗的病例根据Glasgow outcome scale(GOS)预后评分预后良好20例,中度残疾2例,无死亡。其中8例出血合并脑疝行急诊手术,6例预后良好,2例中度残疾。10例急性期行血管内栓塞、显微手术切除或综合治疗者复查DSA示畸形团不再显影,预后良好。2例单纯血管内栓塞治疗者及2例血管内栓塞结合伽马刀放射治疗者动静脉畸形复发,行再次栓塞治疗。6例因治疗困难,出血急性期行保守治疗后进一步行伽马刀放射治疗,随访至今未再出血。结论 AVM是儿童自发性颅内出血的主要原因,尽可能早期行DSA明确AVM情况,积极行介入栓塞、显微手术等是治疗儿童AVM的有效方法。
Objective To investigate the clinical features and treatment of intracranial arteriovenous malformation (AVM) rupture and hemorrhage in children. Methods The clinical data of 28 children with AVM hemorrhage (<18 years) admitted from 2010 to 2013 were analyzed retrospectively. Results Twenty patients underwent microsurgical or vascular embolization or combined therapy had a good prognosis of 20 according to the Glasgow outcome scale (GOS) prognosis score. Two patients had moderate disability without death. Among them, 8 had hemorrhage complicated with hernia for emergency surgery, 6 had a good prognosis and 2 had moderate disability. 10 cases of acute endovascular embolization, microsurgical resection or comprehensive treatment of DSA showed no abnormalities were re-imaging group, the prognosis was good. 2 cases of simple endovascular embolization and 2 cases of endovascular embolization combined with gamma knife radiosurgery recurrence of arteriovenous malformations, re-embolization. 6 cases due to treatment difficulties, acute bleeding after conservative treatment line further gamma knife radiation therapy, follow-up no further bleeding. Conclusions AVM is the main reason of spontaneous intracranial hemorrhage in children. DSA should be used as early as possible to confirm the AVM. Active embolization and microsurgery are effective methods to treat AVM in children.