157例脑动静脉畸形的治疗体会

Experience in Treating 157 Cases Cerebral Arteriovenous Malformation

目的探讨脑动静脉畸形(AVM)治疗方法的选择。方法对1996年1月￣2003年1月间我科收治的157例脑AVM按S-M分级进行分析,Ⅰ级22例,Ⅱ级53例,Ⅲ级59例,Ⅳ级23例。显微手术72例,镜下AVM全切除61例,供血动脉切断术11例;X刀治疗39例,其中8例由于再次出血手术治疗;血管内栓塞治疗46例,其中9例残余畸形血管团另行X刀治疗,13例栓塞治疗后行手术治疗。所有患者均经随访2￣9年。结果手术治疗的72例,术后因并发症死亡2例,59例AVM消失,余11例再行X刀治疗。X刀治疗的39例,8例再次行手术治疗;余31例半年后复查,畸形血管团缩小,2年后复查,13例完全消失,18例缩小50%以上。血管内治疗的46例,11例AVM完全消失,13例缩小50%以上;血管内治疗后再行手术治疗或X刀者22例,2年后畸形血管团均消失。恢复原工作或轻体力劳动者126例,生活自理29例。结论显微外科手术仍是治疗脑AVM的主要方法,放射外科治疗和血管内治疗对于不适合或不能接受手术者也是行之有效的方法,与手术结合的方法可取得更好的疗效。

Objective To explore the methods to treat cerebral arteriovenous malformation （AVM）. Methods According to Spetzler-Martin （S-M） grading, of 157 patients with AVM, who were treated in our hospital from January, 1996 to January, 2003, 22 belonged in grade Ⅰ , 53 in grade Ⅱ, 59 in grade Ⅲ and 23 in gradeⅣ . Of 157 patients, 72 underwent surgery, 39 X-knife and 46 endovascular embolization. All the patients were followed up for 2 to 9 years. Results Of 72 patients undergoing the surgery, 2 died from postoperative complications, 59 received total resection of AVM and 11 were treated with X-knife after the surgery. Of 39 patients treated with X-knife, 8 were retreated by microsurgery and 2 years after the X-knife treatment, 31 received angiography, which showed that the AVM disappeared in 13 patients and the AVM shrank by more than 50% in 18. Of 46 patients treated by endovascular embolization, 11 had disappearance of AVM, 13 a shrinkage of more than 50% in the size, and 22 were cured with microsurgery or X- knife after intravescular embolization. There was good recovery in 126 cases and moderate disability in 29 cases. Conclusions Microsurgery is the main method to treat cerebral AVM, and the X-knife and endovescular embolization are also effective methods to treat patients with AVM who are not unfit for the operation. The operation combined with radiosurgery and endovascular embolization is a more effective method to treat AVM.