动静脉畸形合并颅内动脉瘤的治疗

Arteriovenous malformations associated with intracranial aneurysms

目的分析动静脉畸形合并颅内动脉瘤病人的临床和影像学特点,探讨动静脉畸形合并存在颅内动脉瘤时的临床分型及治疗方案。方法回顾分析天坛医院1995年-2002年之间所收治动静脉畸形合并颅内动脉瘤病人的特点、治疗方案及预后。结果本组20例病人诊断为动静脉畸形合并颅内动脉瘤。其中11例表现为颅内出血7例为动静脉畸形出血,2例为破裂动脉瘤出血,另有2例出血原因不详。临床上分为四型⑴动脉瘤在动静脉畸形主要供血动脉主干的近端;⑵动脉瘤在动静脉畸形供血动脉的远端;⑶动脉瘤在动静脉畸形内部;⑷动脉瘤与动静脉畸形无关。所有的病变均行手术治疗。结论动静脉畸形合并颅内动脉瘤病人发生颅内出血的风险较高,建议对这两种病变行积极的手术治疗。

Objective The objective of the study was to review the clinical and radiographic features of the patients with arteriovenous malformations （AVMs） and associated intracranial aneurysms, to obtain the classification and the management protocol of these lesions. Methods Medical records of all patients admitted to Tiantan Hospital between 1995 and 2002 with a diagnosis of AVMs were reviewed. Aneurysms were identified by angiography and characterized by size, number and location related to the AVMs. Results Twenty patients （ 5. 3% ） were identified as having coexisting aneurysms. Eleven patients （55%） presented with intracranial hemorrhage： bleeding occurred from the AVMs in 7 and from ruptured aneurysms in 2, and the source of the bleeding could not be determined in 2. Classification of the lesions： （1） Aneurysms arising at the proximal end of the major feeding artery that supplying the AVMs. （2） Aneurysms arising at the distal end of the feeding artery that supplying the AVMs. （3） Intranidus aneurysms. （4） Aneurysms arising on vessels that did not supply the AVMs. All the lesions were treated by surgical means successfully. Conclusions Aneurysms associated with AVMs are at risk for rupture. To reduce the complications of intracranial hemorrhage in these patients, we recommend a management protocol to treat these lesions by surgical means.