血管内栓塞辅助显微手术治疗复杂难治性脑动静脉畸形

Microsurgical treatment of cerebral arteriovenous malformations of Spetzler Martin grade Ⅲ or higher following endovascular treatment

目的 探讨复杂难治性脑动静脉畸形 (AVM)的血管内栓塞辅助显微手术治疗的临床效果。 方法 分析 1999年 11月～ 2 0 0 3年 12月治疗Spetzler分级Ⅲ级以上脑AVM的 3 3例临床资料。Spetzler分级Ⅲ级 2 2例 ,Ⅳ级 9例 ,Ⅴ级 2例。脑AVM体积最大为 7 0cm× 8 6cm× 6 1cm ,最小为 2 5cm× 3 0cm× 2 8cm。所有病例均接受了血管内栓塞辅助显微手术治疗。 结果 3 3例中 3 1例术后恢复良好 ,其余 2例中度致残。术后行MRI、MRA及DSA检查 ,未见血管流空影像及畸形血管影像。术后 6个月内行DSA血管造影检查证实 3 3例脑AVM完全切除 ,未见畸形血管影像。 结论 Spetzler分级Ⅲ级以上脑AVM是难治性疾病。血管内栓塞辅助显微手术切除可以取得良好的临床疗效。

Objective Review the treatment,angiographic results and clinical outcomes in 33 patients with AVM of Spetzler Martin grade Ⅲ or higher who were treated in our hospital between November 1999 to December 2003 Methods Twenty two patients were in Spetzler Martin grade Ⅲ,nine were in Spetzler Martin grade Ⅳ and 2 were in Spetzler Martin grade V The size of the AVMs ranges from 7 0cm×8 6cm×6 1cm to 2 5cm×3 0cm×2 8cm All the patients received multi modality treatment with embolization followed by surgery ( n =33) There were 41 times of embolization totally Results The clinical results after follow up were 31 excellent or good (93 9%) The long term treatment related morbidity rate was 6 1%( n =2) Conclusion AVM of Spetzler Martin grade Ⅲ or higher are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVM Microsurgical treatment following endovascular treatment is usually necessary to achieve AVM obliteration [Key words] Arteriovenous malformation; Embolization; Microsurgical operation