Spetzler-MartinⅢ级以上脑动静脉畸形综合治疗的临床研究

The clinical study on multimodal treatments of cerebral arteriovenous malformation over Spetzler-Martin grade Ⅲ

目的 探讨 Spetzler-Martin Ⅲ级以上脑动静脉畸形（AVM）综合治疗的疗效。方法 回顾性分析1998年10至1999年4月采用血管内栓塞联合显微手术或立体定向放射治疗的9例Spetzler-Martin Ⅲ级以上脑AVM的临床资料。结果 9例脑AVM经血管内栓塞治疗后完全栓塞2例,大部栓塞2例,不全栓塞5例。其中4例栓塞后行手术切除,无死亡及手术所致并发症。5例栓塞后接受立体定向放射治疗,随访22-28个月,经MRI和MRA检查提示AVM闭塞3例,缩小2例;5例患者中临床症状恢复良好4例,中度致残、生活能自理1例,无再出血和死亡病例。结论 血管内栓塞联合显微手术或立体定向放射外科是治疗Spetzler-Martin Ⅲ级以上脑AVM的最佳手段。

Objective To evaluate the efficacies of multimodal treatments of cerebral AVMs over Spetzler-Martin grade Ⅲ. Methods Nine cases of AVM over Spetzler-Martin grade Ⅲ treated by combination of intravascular embolization with microsurgical resection or stereotactic radiosurgery from 1998 to 1999 were analyzed retrospectively. Results All patients underwent intravascular embolization. Among them, 100% obliteration was achieved in 2 cases, 75%-99% obliteration in 2 cases, 50%-74% obliteration in 5 cases. Four patients underwent complete surgical resection of AVMs following embolization with no postoperative neurological deterioration and death. Five patients underwent follow-up MRI and MRA 22-28 months after stereotactic radiosurgery. Three patients had complete obliteration and two patients had subtotal or partial obliteration. The clinical symptoms of five patients following radiosurgery showed good recovery in 4 cases, moderate disability in 1 case, and no rebleeding and death case. Conclusion Combination of intravascular embolization with microsurgical resection or stereotactic radiosurgery is the most efficacious way in the treatment of AVMs over Spetzler-Martin grade Ⅲ.