血管内栓塞联合显微外科手术治疗脑动静脉畸形的临床研究

Microsurgical excision combined with preoperational endovascular embolization in treatment of cerebral arteriovenous malformation

目的评估血管内栓塞联合显微外科手术治疗位于功能区的大型脑动静脉畸形(AVM)的效果和手术风险。方法回顾性分析35例单纯显微外科手术治疗(手术组)和23例栓塞联合显微外科手术治疗(栓塞联合手术组)的Spetzler-Martin分级Ⅲ～Ⅴ级的AVM病例,对比两组的平均术中出血量、畸形血管全切除率和术后神经功能缺失情况。结果栓塞联合手术组的平均术中出血量均明显低于同级别手术组患者(均P<0.01),Ⅲ～Ⅳ级患者的AVM全切除率为88.9%,较同级别手术组患者的62.5%明显为高(P<0.05),而两组Ⅴ级患者全切除率的差别无显著性意义(P>0.05);神经功能缺失率仅8.7%,较手术组的34.3%为低(P<0.05)。结论血管内栓塞联合显微外科手术能够提高Spetzler-Martin高级别AVM的治愈率,降低手术风险;是大型的和位于重要功能区的AVM的有效治疗方式。

Objective To evaluate the therapeutic efficacy and risks of microsurgical excision combined with preoperational endovascular embolization for huge arteriovenous malformation (AVM) and AVM localized in eloquent areas of the brain.Methods Data from 58 patients with cerebral AVM of Spetzler-Martin gradesⅢ～Ⅴ were retrospectively reviewed.The first 35 patients underwent resection without preoperational embolization (group 1), whereas the remaining 23 patients underwent resection with preoperational embolization (group 2).The mean intraoperative blood loss,complete resection of arteriovenous nidus and postoperative neurological deficit of each group were analyzed.Results The estimated mean intraoperative blood loss in group 2 was significantly less than that in group 1 in every Spetzler-Martin grade of Ⅲ～Vcerebral AVM(P<0.01 ).The intact resection rate of arteriovenous nidus for group 2 was 88.9%,compared with 62.5%for group 2 in grades of Ⅲ～Vcerebral AVM (P<0.05), but for the grade Ⅲ AVM there was no significant difference between two groups(P>0.05). Postoperative neurological deficit rate was 34.3% (12/35) in group 1, by contrast, only 8.7%(2/23) patients in group 2 had postoperative neurological deficit(P<0.05).Conclusion Microsurgical resection combined with preoperational endovascular embolization is a effective treatment modality to improve clinical outcomes and to reduce the complication for patients with cerebral AVM of Spetzler-Martin grades Ⅲ～V.