Diagnosis and treatment of diffuse cerebral arteriovenous malformations

目的 探讨弥漫型颅内动静脉畸形(AVM)的临床特点、影像学特征、病理改变及 治疗方法。 方法 回顾分析8例经脑血管造影证实为弥漫型颅内动静脉畸形患者的临床及影像 资料。 结果 8例弥漫型脑AVM的脑血管造影影像不同于典型的脑AVM,可见多条供血动脉和 弥漫的异常血管染色,边界不清,染色不匀,没有明显的畸形血管团边界,有数条引流静脉。手 术治疗的4例中,2例畸形团全部切除,1例先栓塞后切除畸形团,术后复查仍有残留,1例因位 于重要功能区未能全部切除。术中及组织病理学检查发现,在异常的动静脉血管间有正常脑组织 存在。另4例中,2例再出血死亡,2例未做治疗。 结论 弥漫型脑AVM在脑血管造影和组织 病理学上不同于典型的AVM,其病变范围可能存在一个局限病灶到弥漫性损害的发展变化过程。 对于非重要功能区的患者可以考虑手术切除,但是全部切除比较困难。

Objective To describe the clinical features, radiological and pathological characteristic and the treatment of the cerebral arteriovenous malformations (AVM) which were appeared diffuse on angiography. Methods The related clinical information of 8 cases with AVM which were diagnosed by cerebral angiogram were reviewed and analyzed. Results 8 cases were found to be diffuse AVM. They were mostly presented with intracerebral hemorrhage. On angiography, the AVM included multiple small arterial feeders, a diffuse, wedge-shaped and puddling appearance of the contrast dye, without an identifiable compact nidus. Multiple draining veins were noted. 4 cases were underwent craniotomy, the AVM were completely removed in 2 cases, 1 case who was pretreated with embolization had residual nidus after operation, and the nidus of the other one case was not removed completely because the nidus located in the eloquent area of the brain. On histological examination, normal brain tissue were found in the abnormal AVM vessels. In the rest 4 cases, 2 patients died of repeated intracerebral hemorrhage, and the other 2 cases received no special treatment. Conclusion The diffuse cerebral AVM is different from the typical AVM on angiography and histopathology. Because of its’ diffuse character, it should be treated individually. If the lesion locates in the silent areas of the brain, craniotomy should be taken, but it is difficult to remove the nidus completely.