复合手术在复杂脑动静脉畸形治疗的应用分析

Analysis on application of hybrid operation in the treatment of complex intracranial arteriovenous malformations

目的评估复合手术在治疗脑动静脉畸形(AVM)的应用价值。方法回顾性分析6例采用复合手术治疗的复杂脑AVM病例资料,病例均在DSA辅助下定位畸形血管团,切除畸形血管团病灶后再次行DSA,即刻评估治疗效果。结果术后即刻DSA显示畸形血管团完全不显影5例,畸形血管团较术前明显减小1例(左侧丘脑与基底核区AVM,因畸形供血动脉过多)。术后随访10~14个月,恢复良好4例,改良Rankin量表评分(mRS)0分,轻度神经功能障碍1例(mRS 2分),中度残障1例(mRS 3分)。结论复合手术能够降低AVM病人出血等并发症发生率,提高畸形血管团切除率,为实现脑AVM疗效最优化提供广阔前景。

Objective To evaluate the applied value of hybrid operation in the treatment of complex intracranial arteriovenous malformations（AVM）. Methods The clinical data of 6 patients with complex intracranial AVM undergoing hybrid operation were analyzed retrospectively. The malformed vessels were located by DSA. After resection of the lesion, and the treatment effect was immediately evaluated by DSA. Results Immediate postoperative DSA revealed that the malformed vessels were completely undeveloped in 5 cases and decreased significantly than preoperation in 1 case with left thalamus and basal ganglia AVM caused by excessive blood supply. The follow-up was performed for 10 to 14 months, good recovery was achieved in 4 patients with modified Rankin scale score（mRS was 0）, mild neurological dysfunction in 1（mRS was 2）, and moderate disability in 1（mRS was 3）. Conclusions Hybrid operation can reduce the incidence of complications such as bleeding and increase the excision rate of malformed vessels, and provide a broad prospect for the optimization of the therapeutic effect of intracranial AVM.