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뇌동정맥기형에 대한 임상적 고찰

Other Titles
 Clinical observation and surgical treatment of cerebral arteriovenous malformation 
Issue Date
[한글] 1964년부터 1976년까지 연세의대 신경외과학 교실에 입원하여, 진단을 받은 뇌동정맥기형 37예와 그중 외과적 치료를 받은 28예에 대한 분석고찰을 한 결과 아래와 같다. 1. 총 37예 중 남자가 26예, 여자가 11예 이었다. 30대가 12예 (32.4 %)로 가장 많았으며, 다음이 10대로 29.7%이었고 40대 이전이 31예로 전체의 91.8%로서 대부분을 차지하였다. 2. 내원 당시 주증상은 지주막하출혈 (94.6%) 과 두통 (86.5%) 이었으며 주신경학적 증후는 외식장애와 long tract signs이 각각 60%이었으며, 40%에서 1회이상의 경련 발작을 일으켰다. 3. 과거력에 기형부위에서 출혈한 경험이 있었던 경우는 10예로 29.7%에 달했다. 4. 발생부위는 두정엽 ( 43.2%)이 가장 많았으며, 전두엽, 측두엽, 후두엽, 순이었다. 좌우의 차이는 우측에서 발생빈도가 높았다. 5. 뇌혈관조영상 유입동맥은 중대뇌동맥이 14예 (47.8%)로 가장 많았으며 전대뇌동맥, 후대뇌동맥, 전맥락동맥, 렌즈핵선조체동맥 순으로 호발했으며 다발성 유입동맥인 경우가 24.3%를 차지하였다. 6. 18예에서 완전적출을 시행하였으며 나머지 10예에서 유입동맥 결찰, 또는 응고법 및 경동맥결찰술 등이었으며, 경동맥결착술을 시행한 1예에서는 후에 완전적출을 시행하였다. 7. 완전적출이 가능했던 18예중 최근에 시행된 10예에서는 수술 현미경을 사용하였는데 feederdml 정확한 감별과 적출시 주위 뇌조직 손상을 최소한으로 할 수 있었으며, 특히 심부에 위치한 동정맥기형의 파급정도를 비교적 정확히 파악할 수 있는 잇점이 있었다. 8. 심부에 위치한 뇌동정맥기형에서는 수술중 뇌혈관조영술을 실시하였다. 이상의 경험을 토대로 저자는 뇌동정맥기형 환자에서 병력과 신경학적 증상 및 증후가 진단에 많은 도움을 준다고 생각된다. 여기에 선택적 범뇌혈관조영술을 이용하여 뇌동정맥기형의 정확한 위치와 크기, 유입동맥과 유출정맥 (draining vein)의 수와 분포상태, 그리고 혈종동반유무를 알아내는 것이 가장 중요하다. 수술은 가능한한 완전절제굴을 시행하는 것이 좋은데 이는 수술용 현미경을 이용하므로써 더욱 정확한 수술을 할 수 있었다.
[영문] We have experienced 37 patients of cerebral arteriovenous malformation with subarachnoid hemorrhage, who were admitted to the Department of Neurosurgery of Yonsei Medical College from 1964 to 1976. All of the patients, who have the cerebral arteriovenous malformation, were proved by the cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the results of surgery, various analysis of clinical manifestations and the cerebral angiograpty findings were attempted. Of 37 patients, surgery was performed in 28 patients and its results were analysed correlating to various types of surgical procedures. Following are the results : 1. There were 37 patients of AVM which were proved by cerebral angiography. Among them, there were 26 men and 11 women. Ninety one percent of the group had bleeding from the cerebral arteriovenous malformation before the age of forty. Among them, the highest incidence compromising 12 cases (32.4%) was found in the fourth decade and next, 11 cases (29.7%) in the second decade. 2. On admission, the chief symptoms were SAH(94.6%) and headache (86.5%). Unconsciousness, weakness of extremities and long tract signs were occured in 60% of all at the onset of symptoms. 3. In the past history, convulsive seizure was recorded in 40% of all, but rebleeding episodes were recorded in 29.7%. 4. The parietal lobe (43.2%) was the most Commonly involved by the malformation and next, in orders, frontal lobe, temporal lobe, and occipital lobe. In lesions involving the cerebral hemisphere, there was a predominance of Rt. side. 5. The arteries feeding the malformations were most frequently seen to come from the middle cerebral arteries (47.8%) and next, in order of frequency, anterior cerebral arteries, anfterior choroidal arteries, posterior choroidal arteries and lenticulostriate arteries. 6. Total removal of AVM was carried out in 18 cases and ligation of the internal carotid artery was done in 2 cases. In one of these cases, however, rebleeding developed and so, total removal was performed. Evacuation of the intracraniak hematoma was carried out in 14 cases. There were complications in 8 cases but there was no death following operation. 7. Microsurgical technique was used in 10 cases, of a total of 18 cases, where total removal was carried out. Microsurgery decreased the brain parenchymal injury during operation and allowed exact differentiation between the feeding arteries, drain vein (red vein) and other cortical vessels. 8. Intra-operative selective angiography was performed in one of the deep seated AVM.
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