脑动静脉畸形伴发动脉瘤的出血风险因素分析及介入治疗  

Risk factors and interventional therapy of hemorrhage in brain arteriovenous malformation associated with aneurysm

作　　者：李星海 赵卫[1] 杨净松 陈超[1] 范宏杰[1] 李爱华 LI Xinghai, ZHAO Wei, YANG Jingsong, CHEN Chao, FAN Hongjie, LI Aihua(Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Chin)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032

出　　处：《中国介入影像与治疗学》2018年第4期204-208,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：云南省卫生内设研究机构项目(2017NS037)

摘　　要：目的探讨脑动静脉畸形伴发动脉瘤出血风险因素及介入治疗策略。方法收集并整理42例脑动静脉畸形伴发动脉瘤患者的临床和影像学资料。根据患者术中造影结果,分析脑动静脉畸形血管特点,制定相应介入栓塞治疗方案。术后3个月、6个月及1年分别复查DSA,明确病灶有无复发。结果病灶位于幕下、由深静脉引流或混合静脉引流、Spetzler-Martin分级Ⅲ~Ⅳ以及Redekop分型Ⅰ型和Ⅱa型动脉瘤患者易出血。38例介入治疗后经康复治疗后格拉斯哥结果评分>4分,1例视力受损,2例有不同程度肢体功能障碍,1例死亡。随访复查37例,均无动静脉畸形复发,且动脉瘤栓塞良好。结论术前明确血管构筑特点及潜在出血风险因素并制定个体化治疗方案,有助于提高介入栓塞治疗脑动静脉畸形伴发动脉瘤的安全性和有效性。Objective To explore the risk factors and interventional strategies of bleeding caused by brain arteriovenous malformations associated with aneurysms. Methods Clinical and imaging data of 42 cases of brain arteriovenous malformations associated with aneurysms were collected and analyzed. According to the results of intraoperative angiography and the architectural characteristics of vessels, the therapeutic schedule was formulated. Three months, 6 months and 1 year after interventional management, all patients were followed with DSA to observe whether arteriovenous malformations recurred or not. Results The risk factors of hemorrhage caused by brain arteriovenous malformations associated with aneurysms included lesions located in subtentorium, deep vein or mixed venous drainage, Spetzler-Martin grade Ⅲ-Ⅳ, as well as type Ⅰ and type Ⅱa aneurysms of Redekop classification. Glasgow outcome score of 38 postoperative patients were more than 4 points, visual impaired happened in 1 patient, whereas 2 patients had different degree of limb dysfunction and 1 patient died. DSA follow-up found no recurrence of arteriovenous malformation in 37 patients. Conclusion Understanding the vessel architectural characteristics and substantial hemorrhage risk factors before intervention, therefore formulating individualized therapeutic schedules are benefit to improving safety and efficacy for the treatment of brain arteriovenous malformations associated with aneurysms.

关 键 词：脑 动静脉畸形 动脉瘤 介入治疗 出血 

分 类 号：R743[医药卫生—神经病学与精神病学] R817.4[医药卫生—临床医学]