根据LYS分级结果栓基后即刻手术切除颅内动静脉畸形  

Surgical removal of intracranial arteriovenous malformation immediately after embolization according to the results of LYS grading scale

作　　者：王威[1] 盖延廷[1] 李彦江 檀书斌 彭方强 刘旻谛 宋冬雷[1] Wang Wei;Gai Yanting;Li Yanjiang;Tan Shubin;Peng Fangqiang;Liu Mindi;Song Donglei(Department of Neurosurgery,Shanghai Punan Hospital of Pudong New Area,Shanghai 200125,China)

机构地区：[1]上海市浦东新区浦南医院神经外科,冬雷脑科医生集团,200125

出　　处：《中华神经外科杂志》2019年第9期933-937,共5页Chinese Journal of Neurosurgery

基　　金：上海市浦东新区科技发展基金(PKJ2016-Y06)。

摘　　要：目的探讨根据Lawton-Young Supplementary(LYS)分级评估结果行介入栓塞后即刻手术切除颅内动静脉畸形(AVM)的疗效。方法回顾性分析2016年6月至2017年12月上海市浦东新区浦南医院神经外科,冬雷脑科医生集团收治的9例AVM患者(占同期收治的AVM患者的10.6%)的临床资料。9例患者均采用LYS分级评估,并根据评估结果制定手术计划。LYS分级4级2例、5级3例、6级3例、7级1例。所有患者均予血管内栓塞后即刻手术切除AVM。术后行数字减影血管造影(DSA)进行影像学评估,临床疗效以改良Rankin量表评分(mRS)评估。结果9例患者术中的畸形团均顺利切除。行计划内部分栓塞后手术切除7例,栓塞后发现静脉郁滞即刻行开颅手术1例,栓塞后即刻发生出血转开颅手术1例。3例出现并发症,其中1例为栓塞后出血患者发生偏盲,另2例发生颅内感染。9例患者随访6?15个月冲位时间为7个月。行DSA复查显示畸形团均完全消失,治愈率达100%。mRS 0?1分8例、2分1例。结论术前采用LYS分级进行风险评估,选择性采取血管内栓塞后即刻显微手术的方式为AVM患者的治疗提供了一种新的途径,可获得较高的治愈率。Objective To explore the efficacy of surgical removal of intracranial arteriovenous malformation(AVM)immediately after embolization according to the results of Lawton-Young supplementary grading scale(LYS).Methods We retrospectively analyzed the data of 9 patients with intracranial AVM admitted to Department of Neurosurgery,Shanghai Punan Hospital of Pudong New Area from June 2016 to December 2017,accounting for 10.6%of all AVM patients admitted during the same period(85 cases).Nine patients were assessed by LYS grading and a surgical plan was developed based on the results of the assessment.LYS scores were grade 4 in 2 cases,grade 5 in 3 cases,grade 6 in 3 cases and grade 7 in 1 case.All patients underwent surgical resection of AVM immediately after interventional embolization.Digital subtraction angiography(DSA)was performed for imaging evaluation and the clinical efficacy was evaluated based on the modified Rankin Scale(mRS)after operation.Results All malformations of the 9 patients were resected successfully.Seven cases underwent elective microsurgery following partial embolization,1 case underwent immediate surgery after embolization because the drainage vein was clogged,and 1 case underwent immediate surgery due to bleeding after embolization.Tlie postoperative complications occurred in 3 cases,including 1 patient with hemianopia and 2 patients with intracranial infection.All patients were followed up for 6-15 months(median time:7 months),DSA results showed that all the malformations completely disappeared,the cure rate was 100%.The mRS score was 0-1 in 8 cases and 2 in 1 case.Conclusion According to preoperative risk assessment based on LYS grading,selective endovascular embolization combined with sul)sequent microsiugery could provide a new suigical treatment approach for intracranial AVM patients with a relatively liigh cure rate.

关 键 词：颅内动静脉畸形 栓塞 治疗性 治疗结果 LYS分级 开颅手术 

分 类 号：R65[医药卫生—外科学]