脑动静脉畸形的微观形态学  

Microstructure of cerebral arteriovenous malformation

作　　者：陈光忠[1] 李铁林[1] 姜晓丹[1] 刘茂才 赵涛[3] 赵庆平[1] 段传志[1] 汪求精[1] 蔡颖谦[1] 杜谋选[1] 全伟[1] 方兵[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282 [2]山东省东平县人民医院急诊科,271500 [3]山东省临沂市人民医院小儿外科,276000

出　　处：《中华神经医学杂志》2005年第8期779-782,共4页Chinese Journal of Neuromedicine

摘　　要：目的通过对脑动静脉畸形(cAVM)微观形态学的系统研究,进一步了解cAVM出血发生机制,探讨其相关临床症状发生的结构学基础。方法应用HE及Masson特殊形态学染色,透射电镜观察及原子力显微镜(AFM)扫描观察15例cAVM的病理组织学及微观形态学改变。结果HE及Masson染色结果显示畸形血管管腔大小不一,管壁厚薄不均,畸形血管壁欠完整,管壁各层排列紊乱,胶原纤维断裂,平滑肌纤维不完整。透射电镜扫描显示栓塞的cAVM血管中,内皮细胞断裂,内膜下层部分缺如;在栓塞与未栓塞的病巢血管壁均显示胶原蛋白束紊乱排列,内皮细胞间紧密连接欠完整,cAVM存在反复出血表现。AFM扫描结果显示畸形血管内皮细胞形态欠完整,内皮细胞之间紧密连接受到一定程度破坏,存在间断的“弹坑样”凹陷和“火山口样”改变。结论外科切除的cAVM微观组织形态学异常,存在反复出血表现,内皮细胞及细胞间的紧密连接破坏与血管壁各层结构排列紊乱可能是cAVM出血的原因,慢性反复出血后局部脑组织中含铁血黄素的沉积可能是导致癫痫发生的主要原因。Objective To explore the pathogenetic mechanism and structural foundation of cerebral arteriovenous malformation （cAVM） by way of the systematic study on the microstructure of cAVM. Methods Using HE staining, Masson staining, transmission electron microscopy and atomic force microscopy （AFM）, we examined the 15 cAVMs pathohistologically and micromorphologically. Results HE staining and Masson staining showed the lumen of blood vessel and vascular walls were uneven in size and thickness respectively in the deformed vessels, and the layers of vascular walls in disorder, collagen fibers broken and smooth muscle fibers incomplete. The results of transmission electron microscopy showed the disruption of vascular endothelia cells and the absence of subendothelial layer after embolization. In spite of the existence or absence of embolization, the collagen proteins of nidus vessel wall were arranged in disorder and the tight junction between endothelial cells were disintegrated. Repeated haemorrhage occurred at cAVMs. Under AFM, the incomplete forms of endothelial cells, the partly destroyed junction between endothelial cells were observed, some like a shell crater and others like volcanic crater. Conclusion Surgically-resected cAVMs demonstrate abnormal ultrastructural features pathologically. Just as cavernous malformation, cAVMs develop repeated haemorrhage, possibly because of the damage of tight junction and the broken layers of vascular walls. The deposited haemosiderin in local cerebral tissues caused by repeated and chronic haemorrhage might be the main cause of epilepcy.

关 键 词：颅内动静脉畸形 显微镜检查 电子 透射 显微镜检查 原子力 MASSON 三色特殊染色 

分 类 号：R743.4[医药卫生—神经病学与精神病学]