显微外科手术结合术前栓塞治疗颅内高级别动静脉畸形

Combination therapy with preoeprative embolization and microsurgery for high-grade cerebral arteriovenous malformations

目的：探讨显微外科手术结合术前栓塞在治疗颅内高级别动静脉畸形中的临床价值。方法：回顾分析使用显微外科手术结合术前栓塞治疗的11例高级别动静脉畸形患者的临床资料。结果：（1）10例患者均在术前栓塞完成后立即行显微外科切除,1例患者因知情同意取得的原因在栓塞完成后10 d行外科切除,全部病例均成功切除血管畸形。（2）术后出现相关并发症2例（占18.1%）,即偏瘫及癫痫各1例;其余9例术后未出现明显的神经功能障碍,恢复良好。（3）出院时患者GOS评分5分9例（81.8%）,4分1例（9.1%）,3分1例（9.1%）。（4）随访6个月,1例偏瘫患者肌力由出院时Ⅲ级恢复至Ⅳ~Ⅴ级,1例癫痫发作患者由丙戊酸纳口服控制未再发作。结论：结合术前栓塞的显微外科手术切除高级别脑动静脉畸形可结合2种治疗方法的优点,抵消单一治疗方案的缺陷,从而获得更为理想的治疗效果。

Objective： To investigate the clinical efficacy of combined therapy of preoperative embolization and microsurgery for high-grade（ Spetezler-Matrtin grades Ⅳ and Ⅴ） cerebral arterio-venous malformations（ AVM）.Methods： Medical records of 11 patients（ 6 male and 5 female） with high- grade cerebral arterio- venous malformations who had underwent combination therapy with preoperative embolization and microsurgery were analyzed. Results： Resection of AVMs were performed immediately after the embolization in 10 patients,with 1patient had surgery 10 days later because of delayed consent. All AVMs were completely resected successfully. 9patients（ 81. 9%） had fully recovery without any functional disturbance of nerves. Complications were observed in2 patients,1 had hemiplegic paralysis and the other had seizure. GOS score was 5 in 9 patients（ 81. 8%）,4 in 1patient（ 9. 1%）,3 in 1 patient（ 9. 1%） when discharged from hospital. After a follow up of 6 months,muscle strength of the patient with hemiplegic paralysis had recovered from grade Ⅲ to grade Ⅳ-Ⅴ,and the seizure was controlled by orally taken sodium valproate in the other patient. Conclusion： Combination of preoperative embolization and microsurgery can increase benefit from both therapies and decrease their disadvantages to achieve better outcomes.