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題名 | Surgical Management of Intracranial Arteriovenous Malformation Associated with Aneurysms=顱內動靜脈畸型合併動脈瘤之外科治療 |
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作者 | 沈炯祺; 王有智; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:1 1998.01[民87.01] |
頁次 | 頁8-16 |
分類號 | 416.291 |
關鍵詞 | 動脈瘤; 動靜脈畸型; 腦內出血; 後下小腦動脈; 蜘蛛網膜下腔出血; Aneurysm; Arteriovenous malformation; Intracerebral hemorrhage; Posterior inferior cerebellar artery; Subarachnoid hemorrhage; |
語文 | 英文(English) |
中文摘要 | 背景:顱內動靜脈畸型合併動脈瘤存在的病例危險性很高,臨床上此種病例並不多見。大多數的醫師們都認為治療此類病人必須針對產生症狀的病灶--動脈瘤或動靜脈畸型率先治療。然而手術前要了解何者先行破裂出血卻相當困難。 方法:從1985年至1996年12年期間共有12例顱內動靜脈畸型合併動脈瘤之病例接受手術治療。全部病例都以顱內出血及頭痛為表徵,其中3例合併肢體乏力,1例合併癲癇發作。病兆出血包括蜘蛛網膜下腔出血、腦室內出血或腦內出血。為了避免手術中發生動脈瘤破裂出血,原則上先行夾除動脈瘤然後再切除靜脈畸型。 結果:在12例病例中同時發生蜘蛛網膜下腔出血、腦室內出血或腦內出血者有7例(58.3%),依靠手術發現,動脈瘤破裂出血為10例,動靜脈畸型為2例。8例(67%)動脈瘤位於後循環部位;其中4例為多發受性動脈瘤。此12例病例中共發現21個動脈瘤;其中5例為多發性動脈瘤。10例術後恢復良好,其中8例接受一次手術;兩例接受二次手術(先夾除動脈瘤後再切除動靜脈畸型)。手術死亡病例有兩例:一例為多5發性巨形動脈瘤破裂引起蜘蛛網膜下腔出血、腦室內出血及腦內出血,於施行腦室引流手術後因動脈瘤再度破裂出血而死亡;另一例於切除巨形動靜脈畸型時大量出血導致不幸。 結論:顱內勳靜脈畸型合併動脈瘤存在的病患,術前診斷何者先行破裂出血相當困難。為了避免手術中發生動脈瘤破裂出血,我們認為先夾除動脈瘤然後再切除動靜脈畸型比較安全。大多數病例可以一次手術治療完成,而且預後相當良好。 |
英文摘要 | Background: The association of intracranial arteriovenous malformation (AVM) with aneurysms is hazardous, and various forms of treatment have been suggested. Most authors agree that surgery for these combined lesions should be directed toward the symptomatic lesion first. This may be difficult, however, especially when the source of the hemorrhage is unclear. Methods: Between 1985 and 1996, 12 patients with combined AVM and aneurysms were treated at this institution. Clinical presentations included headache and hemorrhage in all patients, limb weakness in three patients, and seizure in one patient. Hemorrhage types included subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH). To avoid the intraoperative rupture of aneurysms during resection of the AVM, these were routinely clipped first, followed by total extirpation of the AVM. Results: SAH, ICH and/or IVH simultaneously presented in seven patients (58.3%). According to the surgical findings, bleeding resulted from the aneurysm in 10 patients and AVM in two patients. There was a high incidence of combined lesions in the posterior circulation (67%) in our series. Among the patients with combined lesions in the posterior circulation, half had multiple aneurysms. A total of 21 aneurysms were found in the 12 patients, with five patients harboring multiple aneurysms. Among the 12 patients, 10 had good results. Eight patients received one-stage operations and two received two-stage operations. Two patients died, one of massive rebleeding from multiple giant aneurysms with SAH, IVH and ICH after ventricular drainage, and the other died of massive bleeding during resection of a large AVM. Conclusions: It is difficult to predict bleeding sources preoperatively by radiologic images. Our experience has led to the belief that the safest approach is to treat the aneurysm before microsurgical resection of the AVM. Most of our patients were surgically treated in one approach and showed good results. |
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