特大型颅内动静脉畸形显微外科手术治疗的临床分析  

Clinical analysis of microsurgical treatment of giant intracranial arteriovenous malformations

作　　者：张绪新[1] 孙丕通[1] 邓东风[1] 高宝山[1] 李彦钊[1] 

机构地区：[1]大连大学附属中山医院神经外科,116001

出　　处：《中华医学杂志》2016年第5期361-363,共3页National Medical Journal of China

摘　　要：目的探讨特大型颅内动静脉畸形（AVM）的临床特点和显微手术治疗的策略及效果。方法回顾分析2001年6月至2015年1月在大连大学附属中山医院显微手术治疗的15例特大型AVM患者，15例患者术前均经3D—CTA、MRA、DSA明确诊断，全部经显微外科手术切除，3例行术前部分栓塞治疗。15例的Spetz｜er—Martin分级：Ⅳ级4例，V级11例。结果术后切除组织病理学检查结果均证实为AVM。15例患者平均手术时间（10±7）h。所有患者术后1—3个月全部予以DSA复查，其中12例特大畸形血管团完全切除，3例手术后有少量残留进一步行伽马刀治疗。术后12个月经MRI和MRA检查提示残留AVM闭塞。术后6、12及24个月进行1次门诊随访，GOS评分：13例良好，1例轻残，1例重残，良好率86．6％，本组无死亡病例。结论对于特大型颅内动静脉畸形术前充分准备，采取正确的手术方法和技巧，可以获得良好的手术效果。Objective To explore the clinical features and microsurgical treatment strategies of giant intracranial arteriovenous malformations （AVM）. Methods A total of 15 cases of giant intracranial AVM treated with microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, there were 4 cases of grade Ⅳ, 11 cases of grade V. Pre-operative endovascular embolizations were carried out in 3 AVMs. Results All the included patients were confirmed as giant intracranial AVM by magnetic resonance angiography （MRA）, digital subtraction angiography （DSA）, 3-dimensional CT angiography （3D-CTA） before surgery. All the resected tissues were sent for pathological examination, and the diagnoses were confirmed as AVM. The average operation time of the 15 patients was 10. 3 ± 6. 9 hours. After 1 - 3 months, all the patients were rechecked by DSA, the large vascular malformations in 12 cases were completely resected, 3 cases had a small amount of residual further treated with gamma knife treatment. Magnetic resonance imaging （MRI） and MRA examination indicated that the residual AVM was occluded after 12 months. Patients were followed up at 6, 12 and 24 months after operation, and assessed by Glasgow outcome scale （GOS） score： 13 cases good, 1 cases mild disability, 1 cases severe disability; the good rate was 86. 6%, with no dead case. Conclusion Sufficiently preoperative preparation, appropriate operative methods and skills are necessary to treat giant intracranial arteriovenous malformation.

关 键 词：颅内动静脉畸形 显微手术 

分 类 号：R651.12[医药卫生—外科学]