颅内动静脉畸形显微外科手术治疗策略

Strategies of microsurgical treatment of intracranial arteriovenous malformation

目的分析86例颅内动静脉畸形（AVM）患者临床特征，探讨显微手术治疗颅内动静脉畸形的策略及方法。方法回顾性分析2010年1月至2013年1月86例行颅内动静脉畸形显微手术治疗患者的临床资料。术前采用3D—CTA、DSA，充分评估动静脉畸形的位置、大小、供血动脉及回流静脉情况，联合Spet—zler．Martin分级、首发症状等制定详细的显微手术方案。术中应用神经电生理监测评价手术前后神经功能保留和损害的程度；通过微血管多普勒超声的定性和定量分析联合术中荧光造影评定血管畸形供血动脉和引流静脉以及周围邻近功能血管的血液流速及位置。手术采用术前巨大AVM栓塞、术中供血动脉控制性夹闭等技术联合显微外科技术治疗。结果显微外科手术切除颅内动静脉畸形86例，其中Spetzler—Martin分级Ⅰ～Ⅲ级37例，Ⅲ级23例，Ⅳ级17例，V级9例，术后恢复良好70例，出现轻残9例，重残5例，死亡2例。DSA复查血管畸形均全部切除。远期随访仍在进行中。结论术前制定详细的方案，显微手术联合应用多种技术方式能有效治疗脑动静脉畸形，减少手术风险。

Objective To analyse clinical features of 86 cases of intracranial arteriovenous malformation （ AVM ） and explore strategies and methods of the microsurgical treatment of intracranial arteriovenous malformations. Methods The clinical data of 86 intracranial arteriovenous malformation from January 2010 to January 2013 were retrospectively reviewed. For diagnosis, computed tomography （ CT ） with angiography （ CTA ）, and DSA were used, which could provide real size, location, feeding arteries and draining veins of AVM, and apply NEPM to evaluate the nerve function, assess the qualitative and quantitative flow rate of AVM and surrounding blood vessels by Doppler uhrasonography and fluorescein angiography, and reveal opography of AVM. Operative techniques were used including embolization, feeding artery control. Results Eighty-six cases of AVM were resected successfully under muti- technology. Following-up demonstrated excellent neurological outcomes in 70 cases, nine case had mild disability, five cases had severe disability, two dead cases. DSA shows resected completely, and long-term follow-up was still in progress, conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intraeranial arteriovenous malformations.