术前部分栓塞联合显微手术切除Ⅲ至Ⅴ级脑动静脉畸形的疗效分析

Efficacy of preoperative partial embolization combined microsurgical resection of Ⅲ-Ⅴ grade cerebral arteriovenous malformations

目的回顾总结72例脑动静脉畸形(CAVM)的治疗经验,探讨术前部分栓塞病灶在显微手术切除Ⅲ-Ⅴ级CAVM中的作用,为临床治疗提供参考。方法 72例CAVM分为24例栓塞加手术组(Ⅲ-Ⅴ级17例)和48例单纯手术组(Ⅲ-Ⅴ级6例)。对术前资料包括:性别、年龄、Spetzler-Martin分级(S-M分级),术后资料GOS评分进行相关性分析,比较两组病例的治疗效果。结果 24例行26次栓塞,平均每次栓塞2支,共52支供血动脉被栓塞,无栓塞相关并发症。全切69例,残留3例。恢复良好61例,轻残6例,重残3例,植物状态1例,术后死亡1例。术后无新增神经功能障碍,癫痫7例6例消失,1例改善。两组治疗效果无显著性差异。结论Ⅰ-Ⅱ级CAVM显微手术切除是主要手段,Ⅲ-Ⅴ级者术前栓塞能降低或改善S-M分级,减少手术风险。显微手术切除联合术前栓塞是对Ⅲ-Ⅴ级CAVM最直接,最有效的治疗方法。

Objective To summarize the treatment experience of 72 cases with cerebral arteriovenous malformation （ CAVM ） and explore the role of preoperative embolization parts of the lesion in the microsurgical resection of m-v grade of CAVM. Methods 72 patients with CAVM treated in our department for five years whose preoperative data include sex, age, Spetzler-Martin grade（SM grade） and postoperative data（postoperative GOS score）. Using statistical analysis, we compared the treatment of the embolization-surgery group （ Ⅲ-V ：17/24） with surgery-alone group （ Ⅲ-V ：6/48）. Results 24 cases were embolized preoperativedly in 26 sessions and a total of 52 feeding artery were embolized. No significant embolic complications were shown in all case. 69 total resection and 3 residual. 61 good recovery,6 mild disability,3 severe disability, 1 vegetative state and 1 died. No new neurological dysfunction, of 7 epilepsy cases, 6 disappeared and 1 improved. Conclusions Microsurgical resection is the primary means for grade I-II CAVM patients. Preoperative embolization call reduce SM grade and surgical risk for m-v grade ones. Microsurgical resection combined preoperative embolization is the most direct and effective treatment method for m- V grade CAVM patients.