小脑血管畸形手术治疗单中心经验并文献复习

【摘要】目的探讨显微手术治疗小脑血管畸形的效果。方法回顾性分析98例行显微手术治疗的小脑血管畸形患者的临床资料，其中61例动静脉畸形，36例海绵状血管瘤，1例静脉畸形。采用卡氏评分（KPS）评估患者入院及出院时的健康状况和生活质量。术后定期进行临床及影像学随访。结果病灶位于左侧小脑半球32例，右侧小脑半球43例，小脑蚓部23例。98例患者中3例病灶部分切除，95例全切；术后2例出现手术区域出血，6例出现梗阻性脑积水，5例出现颅内感染，4例出现后枕部皮下积液，1例出现脑干受损，1例出现小脑恶性肿胀，1例出现延髓球麻痹；98例患者完成随访64例，2例动静脉畸形患者复发并再次行手术治疗，病灶全切，术后无明显并发症。98例患者术前KPS为（61±13）分，术后KPS为（75±14）分，术前术后相比有统计学差异(t=10.595, P＜0.01)。结论小脑血管畸形的显微手术治疗可以改善患者的健康状况和生活质量，但需大样本、多中心、长期随访等研究结果进一步证实。

Abstract: Objective To analyze the clinical characteristics and microsurgical treatment of cerebellar vascular malformations. Methods The clinical data of 98 patients with cerebellar vascular malformations treated by microsurgery were analyzed retrospectively, including 61 of arteriovenous malformations, 36 of cavernous hemangioma and 1 of venous malformation. Karnofsky performance scale(KPS) was used to evaluate the health status and quality of life of patients at admission and discharge. Clinical and imaging follow-up was conducted regularly after operation. Results The lesions were located in the left cerebellar hemisphere in 32, right cerebellar hemisphere in 43 and cerebellar vermis in 23. Among the 98 patients, 3 underwent partial resection and 95 underwent total resection. Postoperative hemorrhage occurred in 2, obstructive hydrocephalus in 6 cases, intracranial infection in 5, posterior occipital subcutaneous effusion in 4, brain stem damage in 1, malignant swelling of cerebellum in 1 and bulbar palsy in 1. Of 98 patients, 64 were followed up, 2 with arteriovenous malformations recurred and underwent surgery again, the lesions were completely removed without obvious complications. The preoperative and postoperative KPS of 98 patients was(61±13) points and(75±14) points, respectively. There was significant difference before and after treatment(t=10.595,P＜0.01). Conclusion Microsurgical treatment of cerebellar vascular malformation can improve the health status and quality of life, but it needs to be further confirmed by the research results of large sample, multi center and long-term follow-up.