深部脑动静脉畸形的显微手术治疗  

Microsurgery on deep-seated brain arteriovenous malformation

作　　者：刘德华[1] 李朝晖[1] 苗壮[1] 杜超[1] 韩亮[1] 房向阳[1] 

机构地区：[1]吉林大学中日联谊医院神经外二科,长春130031

出　　处：《中华神经医学杂志》2010年第10期1053-1056,共4页Chinese Journal of Neuromedicine

摘　　要：目的 探讨深部脑动静脉畸形（BAVM）的显微手术技巧及效果。方法吉林大学中日联谊医院自2001年1月至2008年6月对收治入院的70例深部BAVM患者采用显微手术治疗，其中70例患者脑部畸形血管团属小型（直径〈3cm）31例，中型（直径3-6cm）36例，巨大型（直径〉6cm）3例；按Spetzler—Martin分级：Ⅰ级11例，Ⅱ级12例，Ⅲ级23例，Ⅳ级16例，V级8例，对术中的显微手术技巧及术后疗效进行总结分析。结果70例患者深部畸形血管团术中均完整切除，27例复查MRI、8例复查DSA证实。1例Spetzler—MartinV级患者术后发生正常灌注压突破。所有患者随访6个月-3年，均无复发及再次出血。8例术前脑疝患者术后3例重残，2例中残，3例生活能自理。10例癫痫患者术后服用抗癫痫药物症状得到控制。余患者术后未遗留明显神经功能障碍。结论深部BAVM血管构筑复杂，手术全切除最为彻底。高流量BAVM行术前栓塞及口服B受体阻滞剂，术中降低动脉压、延长麻醉苏醒时间，术后减少液体摄入及应用脱水疗法，可降低正常灌注压突破的发生率。Objective To explore the skills and efficacy ofmicrosurgery on deep-seated brain arteriovenous malformation （BAVM）. Methods Seventy consecutive patients with deep-seated BAVM were treated by microsurgical resection in our hospital between January 2001 and June 2008. Thirty-one patients had the malformation with diameter of the malformed vessels less than 3 cm, 36 with that between 3 to 6 cm and 3 with that larger than 6 cm. The Spetzler-Martin grading scale was performed, showing 11 with grade Ⅰ, 12 with grade Ⅱ, 23 with grade Ⅲ, 16 with grade Ⅳ, and 8 with grade Ⅴ. Intraoperative microsurgical technique and postoperative effects were analyzed. Results All the malformations in patients with deep-seated BAVM were completely removed during the operation, which was proved by postoperative MRI in 27 patients and postoperative DSA in 8 patients. One patient with grade V in the Spetzler-Martin scale suffered from normal perfusion pressure breakthrough （NPPB）. No recurrence and re-bleeding were noted by follow-up from 6 months to 3 y. Of the 8 patients experienced preoperative hemiation, severe disability was noted in 3, moderate disability in 2, and the other 3 could take care of themselves. The symptoms were controlled by taking anti-epileptic drugs in all the 10 patients with preoperative epilepsy. No neurological deficit was found in the other patients. Conclusions The angioarchitecture of deep-seated BAVM is complex and microsurgical resection is the most radical therapy. Preoperative embolization, and many other methods such as oral β-blocker, reducing the intraoperative blood pressure, prolonging the anesthesia time, reducing the fluid intake and dehydration therapy after operation can prevent the happening of NPPB.

关 键 词：动静脉畸形 显微外科手术 正常灌注压突破 

分 类 号：R686[医药卫生—骨科学]