介入栓塞联合显微手术一站式切除高级别脑动静脉畸形疗效分析  

Interventional embolization combined with microsurgery for one-stop resection of high-grade brain arteriovenous malformations

作　　者：吕忠中 邱志超 潘俊辰[1] 薛奥诺 骆慧[2] 王协锋[2] 颜伟[2] 朱乾渺 吴伟 LYU Zhong-zhong;QIU Zhi-chao;PAN Jun-chen;XUE Ao-nuo;LUO Hui;WANG Xie-feng;YAN Wei;ZHU Qian-miao;WU Wei(Department of Neurosurgery,Nanjing BenQ Hospital Affiliated to Nanjing Medical University,Nanjing Jiangsu 210029,China;Department of Neurosurgery,First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]南京医科大学附属明基医院神经外科,江苏南京210029 [2]南京医科大学第一附属医院神经外科,江苏南京210029

出　　处：《局解手术学杂志》2019年第11期896-900,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：江苏省高等学校自然科学研究面上项目(17KJB320002)

摘　　要：目的探讨介入栓塞联合显微手术一站式切除高级别脑动静脉畸形的手术要点和临床价值。方法回顾性分析使用介入栓塞联合显微手术一站式切除的33例高级别脑动静脉畸形患者的临床资料,包括临床表现、影像学特征、治疗指征和结果,并用改良的Rankin量表(mRS)评估结果。结果19例(57.6%)患者存在出血,7例(21.2%)存在癫痫发作,6例(18.2%)存在头痛,1例(3.0%)出现进行性神经功能缺损。根据Spetzler-Martin分级(SMG):Ⅲ级7例(21.2%)、Ⅳ级22例(66.7%)、Ⅴ级4例(12.1%)。切除术后共7例(21.2%)患者出现治疗相关并发症。32例(97.0%)患者术后造影显示畸形团完全闭塞。无死亡患者。随访3~36个月,平均9.6个月,31例(93.9%)患者mRS为0分,1例(3.05%)患者mRS为1分,1例(3.05%)患者mRS为4分。结论介入栓塞联合显微手术一站式切除高级别脑动静脉畸形弥补单了一治疗方案的缺陷,获得了较高的即时闭塞率和相对较低的致残率和病死率。Objective To explore the clinical value and main points of interventional embolization combined with microsurgery for one-stop resection of high-grade cerebral arteriovenous malformations.Methods The clinical data of 33 patients with high-grade brain arteriovenous malformations treated with interventional embolization combined with microsurgery were retrospectively analyzed.The clinical manifestations,imaging features,therapeutic indications and results were analyzed.The results were assessed by using the modified Rankin scale(mRS).Results The results showed that 19 patients(57.6%)had cerebral hemorrhage,7 cases(21.2%)had seizures,6 cases(18.2%)had headache,and 1 case(3.0%)had progressive neurological impairment.According to Spetzler-Martin classification(SMG),7 cases(21.2%)were levelⅢ,22 cases(66.7%)was levelⅣ,4 cases(12.1%)was levelⅤ.After treatment,7 patients(21.2%)had developed treatment-related complications.Postoperative angiography showed complete occlusion of the malformation in 32 cases(97.0%).No patients died.The follow-up period was 3 to 36 months,with an average of 9.6 months.Among the 33 patients,the mRS score was 0 in 31 cases(93.9%),the mRS score was 1 in 1 case(3.05%)and the mRS score was 4 in 1 case(3.05%).Conclusion Interventional embolization combined with microsurgery for one-stop resection of high-grade cerebral arteriovenous malformations can combine the advantages of two treatment methods to make up for the shortcomings of single treatment,and achieve a higher immediate occlusion rate and a relatively lower disability and mortality rate.

关 键 词：介入栓塞 显微手术 一站式切除 高级别脑动静脉畸形 

分 类 号：R651.1[医药卫生—外科学]