脑动静脉畸形的显微外科治疗

Mcrosurgical Treatment of Intracranial Arteriovenous Malformations

目的 回顾性分析笔者二十年间手术治疗脑动静脉畸形病例,探讨治疗经验。方法 1979年至1999年10月间,采用显微外科技术治疗脑动静脉畸形(AVM)379例,AVM病灶386个。按史氏分级标准,Ⅰ级者15例,Ⅰ～Ⅱ级者36例,Ⅱ级者76例,Ⅱ～Ⅲ级者82例,Ⅲ级者129例,Ⅲ～Ⅳ级者33例及Ⅳ级者8例。结果 367例(374个病灶)手术全切除,全切除率99.2％。死亡率0.26％。术后疗效属优良占88.7％,轻残占8.7％,重残占2.4％。结论 显微技术切除脑AVM是杜绝再次脑出血的首选的治疗方法,详尽的影像放射学资料是术前设计手术方案所必备的,熟练的显微手术操作技巧是手术成功的关键。显微手术、血管内介入栓塞和放射外科的联合治疗有待深入研究。

Objective To introduce our experiences and operative skills in the management of patients with intracranial ar-teriovenous malformations. Methods Data from 379 cases with AVM treated by microsurgery were analyzed retrospectively. Among these, there were 386 AVM lesions. There were 15 cases in grade I, 36 cases in I - H , 76 cases in gradeⅡ , 82 cases in Ⅱ-Ⅲ , 129 cases in grade Ⅲ, 33 cases in grade Ⅲ - Ⅳ and 8 cases in grade Ⅳ(according to shi' s grading scheme) . Results The 374 lesions of the 367 cases were excised. The total removal ratio was 99.2% and mortality was 0.26% . The 88.7% patients had excellent outcome postoperatively, 8.7% mild neurological deficits and 2.4% severe disabilities. Conclusions Microsurgical resection should be the first choice in the treatment of AVMs to prevent the high risk of intracranial hemorrhage. The detailed preoper-ative neuroradiological imfonnations is necessary and skilled microsurgical techniques were the key to successful treatment.