幕上大中型脑动静脉畸形的显微外科治疗  

Microsurgical treatment of medium and large supratentorial arteriovenous malformations

作　　者：王汉东[1] 史继新[1] 谢伟[1] 潘云曦[1] 孙康健[1] 杭春华[1] 成惠林[1] 樊友武[1] 李杰[1] 李劲松[1] 乔梁[1] 印红霞[1] 

机构地区：[1]南京军区南京总医院暨南京大学医学院临床学院神经外科,210002

出　　处：《中华神经外科杂志》2007年第1期28-30,共3页Chinese Journal of Neurosurgery

摘　　要：目的总结幕上大中型脑动静脉畸形（AVM）的手术治疗经验，探讨其处理策略和手术治疗要点。方法对我科收治的72例幕上大中型脑AVM进行回顾性总结。按照Spetzler-Martin分级系统，Ⅱ级30例，Ⅲ级24例，Ⅳ级16例，Ⅴ级2例。均经脑血管造影证实和显微手术切除，其中8例行术前栓塞。结果本组72例的畸形血管团均被全切除，无手术死亡。3例因术后术野出血再次手术，共12例出现新增神经功能障碍。51例获得随访，术前癫痫者18例中11例消失；术前无癫痫史者，33例中7例出现癫痫。结论在作出AVM的治疗决定时，既要考虑患者方面的因素也要考虑医生方面的因素，包括患者年龄、临床状况和Spetzler-Martin分级以及治疗小组的技术能力。我们认为，显微手术切除是大中型AVM的最主要和最有效的治疗手段；对有些大型AVM患者来说，术前栓塞是有帮助的。Objective The present article aims at summarizing our operative experiences and exploring the management strategies and some key operative techniques of the medium and large supratentorial arteriovenous malformations （AVM）. Methods 72 patients with medium and large supratentorial AVM which were operated on were retrospectively analyzed. The size, location and pattern of venous drainage of the AVM were determined by angiography. According to the Spetzler-Martin grading system, there were 30 cases with grade Ⅱ,24 cases with grade Ⅲ, 16 cases with grade Ⅳ and 2 cases with grade V among them. Operation was performed in all the patients. Preoperative embolization prior to microsurgical resection was used in 8 cases. Results AVM was completely resected in all cases and there was no surgical mortality. Reoperation to evacuate hematoma was made because of postoperative hemorrhage. Twelve had additional neurological deficits postoperatively. In 51 cases who were followed up, preoperative seizures disappeared in 11/18 cases. Postoperative seizures occurred in 7/33 cases without preoperative seizures. Conclusion The decision to treat an AVM revolves around many considerations and factors that are both patient and surgeon. Consideration must be given to the age and clinical condition of the patient; the Spetzler-Martin grading score; and the technical ability of the treatment team. We consider that microsurgical resection in the treatment of cerebral AVM remains the leading and most effective treatment modality. Preoperative embolization prior to microsurgical resection is useful for some large AVM.

关 键 词：脑动静脉畸形 显微手术 栓塞 

分 类 号：R686[医药卫生—骨科学]