出血性高级别脑动静脉畸形血管内治疗的临床疗效分析

Clinical effect of intravascular treatment of hemorrhagic high-grade brain arteriovenous malformation

目的观察出血性高级别脑动静脉畸形(BAVM)血管内治疗的临床疗效。方法回顾性分析2017年1月至2023年1月海南省人民医院采用血管内治疗的37例高级别脑动静脉畸形患者的临床资料。所有患者术前均行CT血管造影(CTA)、数字减影血管造影(DSA)分析脑动静脉畸形血管的构筑。血管内治疗采用动脉入路、静脉入路、分次治疗、高压锅等技术,未完全栓塞患者术后行放射治疗。术后定期随访3个月,行CT、CTA或DSA复查,并进行格拉斯哥预后评分(GOS)以评估神经功能的恢复情况。结果按Spetzler-Martin分级,37例高级别脑动静脉畸形患者中Ⅳ级25例和Ⅴ级12例;单支动脉供血10例,多支动脉供血27例,畸形团单次栓塞6例,分次栓塞31例。治愈性栓塞29.7%(11/37),大部分栓塞54.1%(20/37),部分栓塞16.2%(6/37);术后随访3个月,按GOS评分评价预后,其中恢复良好56.8%(21/37),轻度残疾21.6%(8/37),重度残疾10.8%(4/37),植物生存8.1%(3/37),死亡2.7%(1/37)。结论血管内介入技术治疗出血性高级别脑动静脉畸形临床疗效可靠。

Objective To observe the clinical effect of intravascular treatment of hemorrhagic high-grade brain arteriovenous malformation.Methods The clinical data of 37 patients with high-grade brain arteriovenous malformation who received endovascular therapy in Hainan General Hospital from January 2017 to January 2023 were retrospectively analyzed.All patients underwent CT angiography(CTA)and digital subtraction angiography(DSA)before surgery to analyze the vascular construction of brain arteriovenous malformations(BAVM).Intravascular therapy was performed by arterial approach,venous approach,fractional treatment,pressure cooker,and other techniques,and postoperative radiotherapy was performed for patients with incomplete embolization.CT,CTA or DSA were performed regularly during the follow-up of 3 months,and Glasgow prognostic Score(GOS)was used to evaluate the recovery of neurological function.Results According to Spetzler-Martin classification,there were 25 cases of gradeⅣand 12 cases of gradeⅤin 37 patients with high-grade cerebral arteriovenous malformations.There were 10 cases of single artery blood supply,27 cases of multiple artery blood supply,6 cases of single embolization of malformation,and 31 cases of multiple embolization.Curative embolism accounted for 29.7%(11/37),most embolism 54.1%(20/37),partial embolism 16.2%(6/37).The prognosis was evaluated by GOS score at 3 months after the operation,including good recovery of 56.8%(21/37),mild disability of 21.6%(8/37),severe disability of 10.8%(4/37),plant survival of 8.1%(3/37),death of 2.7%(1/37).Conclusion The clinical efficacy of endovascular interventional technology in the treatment of hemorrhagic high-grade brain arteriovenous malformations is reliable.