小児脳動静脈奇形47例の長期成績の検討 : 初回治療法との関連性について

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We retrospectively analyzed the clinical features, initial managements, and long-term clinical outcomes in 47 young patients with intracranial AVMs. All patients, 24 males and 23 females, were under 15 years of age; their mean age at symptom onset was 9.4 ± 3.8 years. The follow-up period was longer than 2 years; the average was 14.8 years. In 39 (83%) patients, the first symptoms were hemorrhage; 8 (17%) had epileptic seizures.Of the 47 patients, 25 had AVMs with a small nidus, and 15 had deep venous drainage; 23 (92%) of the former and 14 (93%) of the latter manifested hemorrhage. We posit that the small nidal size and deep venous drainage contribute to the bleeding tendency of pediatric AVMs. Of the 47 patients, 15 (32%) patients had an excellent outcome, 20 (43%) a good outcome, 9 (19%) a fair outcome, and 1 (2%) a poor outcome. Two patients (4%) died. Satisfactory outcomes were obtained in 28 of 39 (72%) patients with hemorrhage and in 7 of 8 (88%) patients with seizures. The remaining 12 patients (26%) had poor outcomes, 11 (92%) of them presenting with hemorrhage. In 10 (83%) patients, the AVMs were in an eloquent area of the brain or drained into the deep venous system. In 9 (82%) patients, the outcomes were poor because of initial irreversible brain damage. Total removal of the AVM was performed initially in 29 patients. Of the 39 patients with hemorrhage, 25 (64%) underwent total removal; 19 (76%) had satisfactory outcomes. In the other 6 patients, the outcomes were poor because initial bleeding was massive or occurred in an eloquent area. Of the 18 patients managed by other methods, 14 had hemorrhagic AVMs, and the outcome was poor in 5 (36%) of them. Furthermore, 6 of the 14 (43%) suffered recurrent bleeding and deterioration of clinical outcome scale for the follow-up period, the average of which was 5.3 years; 3 (50%) of 6 patients had a poor outcome. In the 8 patients with seizure as the initial symptom, the outcomes of both surgical and conservative management were equally satisfactory. However, 2 (50%) of the conservatively treated patients later developed incurable convulsions. Our data suggest that the initial treatment significantly affects the outcome in young patients, although hemorrhagic onset and severity of the patients' neurological conditions correlate strongly with clinical outcome. Initial curative surgery should be considered-especially in patients with hemorrhagic AVMs-because rebleeding often leads to poor outcomes.
日本脳卒中の外科学会の論文
2003-07-31

小児脳動静脈奇形47例の長期成績の検討 : 初回治療法との関連性について

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