妊娠期脑动静脉畸形破裂出血脑疝的急诊显微手术治疗4例报告并文献复习

目的探讨妊娠期脑动静脉畸形（bAVM）破裂出血脑疝的临床特点、转归和治疗对策，临床疗效。方法回顾性分析2015年3月—2021年2月临沂市人民医院神经外科经显微外科手术治疗的4例妊娠期bAVM破裂出血脑疝患者的临床资料。结果全切除病灶4例，病理检查结果均为bAVM。急诊剖宫产1例，引产1例，2例孕期自然分娩，3例胎儿均存活，随访2年智力和身体发育无异常。孕妇随访1～4 年，中重度残疾1例，偏瘫2例，视野偏盲1例。术后6个月改良Rankin量表评分，1例为1级，2例为2级，1例为4级。无再出血，DSA复查4例未见血管畸形残留或复发。结论妊娠期bAVM破裂出血脑疝的处理治疗原则建议急诊开颅手术，妊娠足月患者全麻剖宫产终止妊娠，同时做好新生儿抢救的准备，多学科合作能够有效地降低风险。

Objective To investigate the clinical characteristics, outcome, treatment strategy and clinical effect of rupture hemorrhage cerebral hernia with brain arteriovenous malformation(bAVM) during pregnancy. Methods The clinical data of 4 patients with rupture and hemorrhage cerebral hernia during pregnancy with bAVM treated by microsurgery in Department of Neurosurgery, Linyi People's Hospital from March 2015 to February 2021 were analyzed retrospectively. Results Four patients underwent total resection of the lesion, and the pathological examination results were all bAVM. There were 1 emergency cesarean section, 1 induced labor, 2 natural delivery during pregnancy, 3 fetuses survived, and no abnormality in mental and physical development was observed during 2-year follow-up. The pregnant women were followed up for 1 to 4 years, including 1 case of moderate to severe disability, 2 cases of hemiplegia and 1 case of hemianopsia. 6 months after surgery, the modified Rankin scale score was 1, 2, and 4 in 1 case. There was no recurrence of bleeding, and no residual or recurrence of vascular malformations was observed in 4 cases during DSA review. Conclusion The treatment principle of rupture hemorrhage of bAVM in pregnancy suggests emergency craniotomy, termination of pregnancy by caesarean section under general anesthesia for full-term pregnant patients, and preparation for rescue of newborn babies, multidisciplinary cooperation can effectively reduce the risk.