弥漫性脑动静脉畸形的临床和影像学研究

Clinical and imaging study of diffuse cerebral arteriovenous malformations

目的 :报告和探讨脑动静脉畸形 (AVM)的一种特殊类型———弥漫性AVM的临床特点、影像学特征、病理改变及其治疗方法。方法 :回顾分析 141例经脑血管造影证实为脑AVM患者的有关临床资料。结果 :141例脑AVM患者中有 6例表现为弥漫性AVM。 5例临床上以脑内出血发病 ,脑血管造影上可见多条供血动脉和弥散、松散的异常血管染色 ,染色不均 ,没有明确的畸形血管团边界。手术治疗的 4例中 ,仅有 2例全切。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。结论 :弥漫性脑AVM在脑血管造影和病理上均不同于典型的AVM。该病变在自然病史中易于破裂出血 ,治疗上需积极而谨慎对待。

Objective:To study the clinical features, imaging and pathological characteristics and treatment of a special subtype of cerebral arteriovenous malformations(AVMs) , i e diffuse AVM.Methods:The related clinical information of 141 AVM cases which were diagnosed by cerebral angiogram was reviewed and analyzed.Results:Six examples of diffuse AVMs were found among the 141 cerebral AVMs Five patients experienced intracerebral hemorrhage On angiography, the diffuse AVMs included multiple small arterial feeders, scattered, ill defined and faintly dyed vessels without an identifiable compact nidus Among four cases of surgical excision, total removal was only reached in 2 On histological examination, normal cerebral tissue was found between the abnormal AVM vessels. Conclusion:The diffuse cerebral AVM is different from the typical AVM on angiography and histopathology These lesions are liable to rupture in the nature history and should be treated deliberately It is suggested that surgical excision be taken if only the lesion intersperses among silent areas of the brain.