Takeuchi Satoru, Takasato Yoshio, Masaoka Hiroyuki, Nagatani Kimihiro, Otani Naoki, Wada Kojiro, Mori Kentaro
Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
J Clin Neurosci. 2015 Mar;22(3):483-7. doi: 10.1016/j.jocn.2014.08.033. Epub 2015 Jan 3.
Arteriovenous malformation (AVM)-related intracerebral hemorrhage (ICH) is the cause of approximately 2-3% of ICH and is an important factor in the significant morbidity and mortality in patients with AVM. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure. The use of DC to treat patients with AVM-ICH has been much less common. The present study describes our experience with DC for AVM-ICH and discusses the safety of this procedure. The present retrospective analysis compared 12 consecutive patients treated with DC for AVM-ICH with 23 patients treated with DC for hypertensive ICH. Nine patients were male and three were female, aged from 11 to 53 years (mean, 31.7 years). Hematoma volumes ranged from 50 to 106 ml (mean, 75.8 ml). The outcomes were good recovery in one patient, moderate disability in three, severe disability in seven, and vegetative state in one. Complications after DC included subdural hygroma in four patients, hydrocephalus in one, intracranial infection in two, and intracranial hemorrhage in one. No significant difference was found in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. In conclusion, the present study found no significant difference in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. Further investigations including a prospective randomized trial are needed to confirm the safety and efficacy of DC for the treatment of large AVM-ICH.
动静脉畸形（AVM）相关的脑出血（ICH）约占脑出血病例的2%-3%，是导致AVM患者出现严重病残率和死亡率的重要因素。去骨瓣减压术（DC）是一种用于缓解颅内压恶性升高的外科手术。使用DC治疗AVM-ICH患者的情况则要少见得多。本研究描述了我们使用DC治疗AVM-ICH的经验，并讨论了该手术的安全性。本回顾性分析将12例接受DC治疗的AVM-ICH患者与23例接受DC治疗的高血压性ICH患者进行了比较。9例为男性，3例为女性，年龄在11至53岁之间（平均31.7岁）。血肿体积在50至106毫升之间（平均75.8毫升）。结果为1例患者恢复良好，3例中度残疾，7例重度残疾，1例呈植物状态。DC术后的并发症包括4例患者出现硬膜下积液，1例出现脑积水，2例出现颅内感染，1例出现颅内出血。大型AVM-ICH患者接受DC治疗与高血压性ICH患者接受DC治疗的并发症发生率未见显著差异。总之，本研究发现大型AVM-ICH患者接受DC治疗与高血压性ICH患者接受DC治疗的并发症发生率无显著差异。需要进一步开展包括前瞻性随机试验在内的研究，以证实DC治疗大型AVM-ICH的安全性和有效性。
