2010年4月 第31卷 第2期 首都医科大学学报Jour na l of Capita lMedical U niversity Apr .2010Vo l .31 No .2[do i :10.3969/j .i ss n.100627795.2010.02.025]临床研究老年患者脑动静脉畸形的临床特点及治疗策略杨力军1 舒 波2 王 硕1 赵继宗1 曹 勇13(1.首都医科大学附属北京天坛医院神经外科;2.贵州省贵阳市第二人民医院神经外科)【摘要】 目的 探讨老年患者脑动静脉畸形的临床特点及治疗策略。
方法 对首都医科大学附属北京天坛医院自1997年3月至2008年9月收治的老年脑动静脉畸形患者25例进行回顾性分析,总结患者的临床症状、治疗策略及其预后。
结果 患者首发症状为颅内出血者17例(68.0%),非出血引发的神经功能缺失者4例(16%),顽固性头痛、头晕者4例(16%)。
25例患者中有4例行多种治疗方案,累计治疗共30次。
选择保守治疗者7例,其中有4例(57.1%)患者在保守治疗期间发生出血或再出血;选择进行放射治疗者共7例,其中3例(42.9%)随访过程中出现出血,2例患者出现神经功能缺失;选择进行介入栓塞治疗者共5例,2例为完全栓塞,1例死于术后脑梗死;另外3例部分栓塞;选择进行手术治疗者共11例,其中急诊手术3例,择期手术8例,11例患者手术患者中死亡2例(18.2%),其余9例患者中,2例急性出血患者术后分别出现不全混合性失语和癫痫发作,7例择期手术患者未出现与手术相关的神经功能缺失,术前症状得到不同程度改善。
结论 老年患者脑动静脉血管畸形多见于男性,有较高出血率。
显微神经外科手术切除是治疗老年脑动静脉畸形安全和有效的方法,高龄不是手术切除脑动脉畸形的禁忌证。
【关键词】 脑动静脉畸形;老年患者;手术治疗【中图分类号】 R 651.1+1C li n i ca l Fea tur es and Tr ea t m en t Stra tegy of Bra i n Ar ter i oven ous M a lform a t i on si n E l der ly Pa ti en tsY ANG L i 2jun 1,S HU Bo 2,WANG Shuo 1,ZHA O Ji 2z ong 1,Cao Y ong 13(1.D epa rt ment of N eurosurgery,Beiji ng T iantan Hospita l ,Capita lM edica l U niv ersity ;2.D epa rt ment of N eurosurgery,Guiyang CityB ra in D i sease Hospita l)【ABSTRAC T 】 O b jec ti ve T o analyze clinica l feature s and treat m ent stra tegy of bra i n a rte ri ovenous m alfor ma tions (AV M s )in elderly pa tients (age ≥60y ).M e thod s A retros pec tive survey of 25case s of brain AV M s in e lderly pa tients diagnosed fro m Ma rch 1997t oSeptember 2008in B eijing Tiantan Hos p ita l wa s unde rtaken .The c linica l feature s,trea t m ent and outcome s were ana lyzed along wit h a systema tic review of litera ture .T he median foll o w 2up per i od was 50months (4～120months ).Re s u lts In this series the median age of pa tients was 65.2years ;the m ale:fema le ratio was 2.6∶1;the most co mmon pri mary sy mpto m s wa s i ntracrani a l hemorrhage (68.0%).Seven case s were trea ted conse rvati ve ly when diagnosed,of who m hemorrhage at AV M s or recurrent he morrhage occurred i n 4pati ents (57.1%)during the f o ll ow 2up;7pa tients selec t ed ste reotactic radi osurge ry,after radi osurgery hemorrhag e at A VM s occurred i n 3(42.9%);5pati entswere trea t ed with endovascular embolization of feeding arte rie s of A VM s,in 2(40%)t he a rte ries were e m bolized comple t e ly,of who m 1died due to cerebral infarction after em b olis m ,the othe r 3we re em b olized pa rtially ;11pa tients took m icroneur o s urgical resec ti on,2died because of post ope rative he morrhage and cerebra l infarcti on re s pectiv e ly ,othe rs achieved sa tisfact ory outco m es .C onc lusi on Elde rly pa tients with bra in a rteri ovenous ma lfor ma ti ons had a high incidence of hemorrhage co mpa red with y oung e r ones .M i c roneurosurge rica l remova l of AV M s can achiev e satisfac t ory post ope rativ e outco m es .Age itse lf is not a li m iting fac t or for the s urgical exc ision of AV M s .【KEY WO RD S 】 brain arteri oven ous ma l for m ati ons ;elderly pa tients;m icroneurosurge ry基金项目北京市科技新星计划(53)资助项目,S yS 2“N 2”f B j (53)3,2y 6@ 脑动静脉畸形(arteri ovenousm alf or m ati ons,AV Ms)多发生于中青年,老年患者(≥60岁)发病少见。
