大型或巨大型脑动静脉畸形的显微外科治疗25例

Microsurgical treatment of 25 cases of large and giant cerebral arteriovenous malformation.

目的 总结25例大型或巨大型脑动静脉畸形(AVM)患者的显微外科治疗经验,探讨降低手术死亡率和致残率的有效方法。 方法 25例AVM患者,男17例,女8例,平均年龄26.8岁,均经数字减影全脑血管造影确诊。病变大小为5-6 cm者12例,>6 cm者13例;按照国内史玉泉分级法:3级15例,3-4级10例;位于幕下2例。全部患者行显微外科手术治疗,病灶完全摘除,其中8例行病灶血管内栓塞加手术切除。 结果 完全切除畸形血管团,24例痊愈,1例重残(1年后恢复),无手术死亡,1例术中出现正常脑灌注压突破;17例术后复查DSA,均未见残留畸形血管团。结论 显微外科手术切除畸形血管团,仍然是治疗脑AVM的有效手段,血管内栓塞加手术切除是治疗巨大型AVM的理想方法。

Objective To review the mierosurgical experience of large and giant cerebral AVMs, and to discuss the ways to reduce mortality and morbidity. Methods 25 patients of large or giant cerebral AVMs were diagnosed by digital subtraction angiography (DSA). 17 cases were male and 8 cases were female. The mean age was 26. 8 years old. 24 cases presented with intracranial hematoma or subarachnoid hemorrhage. 12 of them were 5 to 6 cm in diameter, and 13 were larger than 6 cm. According to the Shi's grading scale, 15 patients were grade 3 and 10 were grade 3 to 4. Only 2 cases were located infratentorially. All patients were treated with micro surgical removal, with all AVMs were completely excised. Preoperative endovascular embolization were performed in 6 patients. Results All 25 patients survived after operation, one of them had severe neurological deficit and recovered after 1 year. 1 case has normal perfusion pressure breakthrough (NPPB) during the operation. 17 cases had postoperative DSA examination, all of them showed no residual AVM. Conclusion Mierosurgical resection of AVMs is effective. Combination of endovascular embolization with surgical resection is an effective way in the treatment of giant AVMs.