脑动静脉畸形综合治疗的疗效分析

Comprehensive treatment of arteriovenous malformation of brain

目的 探讨脑动静脉畸形的治疗方法选择及综合治疗的疗效。方法 根据病灶的部位、大小及供血动脉的情况选择治疗方法。 89例中血管内栓塞治疗 72例 ;单纯手术病灶切除 5例 ;单纯立体定向放射治疗 12例 ;其中血管内栓塞治疗后手术切除 8例 ,血管内栓塞治疗后行立体定向放射治疗 2 2例。结果 血管内栓塞治疗的 72例病例中 (Ⅰ～Ⅴ级 ) 10 0 %闭塞 2 0例 ,70 %～ 90 %闭塞 3 4例 ,5 0 %～ 60 %闭塞 11例 ,3 0 %～ 40 %闭塞的 7例。手术切除全部病灶的 13例 (Ⅰ～Ⅱ级 )。结论 血管内栓塞、显微手术和立体定向放射治疗都是脑动静脉畸形治疗的有效手段。血管内栓塞治疗能减少畸形血管团 ,降低血流量 。

Objective To investigate the selection of therapeutic methods and the therapeutic efficacy of comprehensive treatment for patients with brain arteriovenous malformation. Methods The therapeutic approaches were selected according to the location, size and the arterial supply of the arteriovenous malformation of brain. Of the 89 cases, 72 cases underwent endovascular treatment, 5 operation and 12 stereotactic radiation treatment. After endovascular treatment, 8 cases and 22 cases underwent operation and stereotactic radiation treatment, respectively. Results Of the 72 cases (grades Ⅰ～Ⅴ) treated by endovascular embolization, 100%, 70%～90%, 50%～60% and 30%～40% occlusions were found in 20, 34, 11 and 7 cases, respectively. Surgical removal of the brain arteriovenous malformation was performed in 13 cases (grades Ⅰ～Ⅱ). Conclusion Endovascular embolization, microsurgery and stereotactic radiation treatment are the effective methods for the treatment of brain arteriovenous malformation. Endovascular embolization can decrease malformed blood vessels and reduce blood flow, which can ensure the safety of operation and the therapeutic efficacy of radiation treatment.