复合手术治疗脑动静脉畸形的效果及症状进展分析:一项单中心回顾性队列研究  

Analysis of the effect and symptom progression of hybird surgery for cerebral arteriovenous malformation:a single-center retrospective cohort study

作　　者：丁前进 宋子豪 马永杰[1] 于嘉兴 胡鹏[1] 张鸿祺[1] Ding Qianjin;Song Zihao;Ma Yongjie;Yu Jiaxing;Hu Peng;Zhang Hongqi(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2024年第10期664-670,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市首批医师科学家培训项目(BJPSTP-2024-26)。

摘　　要：目的探讨复合手术治疗脑动静脉畸形(CAVM)的安全性与有效性以及术后症状进展的可能因素。方法回顾性连续纳入2016年1月1日至2021年12月31日入住首都医科大学宣武医院神经外科并接受复合手术治疗的61例CAVM患者,记录其人口学信息(性别、年龄)、发病情况[首次通过影像学检查诊断CAVM和(或)首次出现出血、癫痫等CAVM相关症状]、起病至复合手术时间、入院时改良Rankin量表(mRS)评分、既往CAVM治疗史(既往CAVM外科手术切除以及血管内栓塞治疗情况)、CAVM影像学资料(病变大小、位置、引流情况)、Spetzler-Martin分级、病变致密程度(疏松、致密)、CAVM合并动脉瘤或动脉瘤样结构、手术方式(显微外科手术+术中DSA、显微外科手术+术中DSA+术中血管内栓塞)、治疗相关并发症[手术相关区域的颅内出血和(或)缺血事件和(或)水肿、穿刺点血肿和(或)瘘和(或)假性动脉瘤、治疗相关感染、消化道出血和(或)牙龈出血和(或)鼻衄、对比剂过敏、全因死亡]、临床及影像学随访资料。评估复合手术治疗的安全性[治疗相关并发症、症状进展(术后6个月的mRS评分减去治疗前mRS评分的差值为正值)]与有效性[闭塞(术后6个月DSA显示原畸形团部位完全不显影为闭塞)、预后良好(术后6个月mRS评分≤2分)]。依据术后6个月临床随访结果显示症状是否进展,将接受复合手术治疗的CAVM患者分为进展组和无进展组,并比较两组患者的基线及临床特征。结果(1)61例接受复合手术治疗的CAVM患者中,男性37例(60.7%),中位年龄25(13,42)岁;无症状患者11例(18.0%),以出血为首发症状的患者39例(63.9%),以癫痫为首发症状的患者11例(18.0%);入院时mRS评分≤2分者54例(88.5%),既往接受血管内栓塞治疗后残余或复发的CAVM患者38例(62.3%);CAVM病变Spetzler-Martin分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为13例(21.3%)、22例(36.1%)、21例(34.4%)、5例(8.2%);2Objective To investigate the safety and efficacy of bybrid surgery in the treatment of cerebral arteriovenous malformation(CAVM)and possible factors for postoperative symptom progression.Methods A total of 61 patients with CAVM admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from January 1,2016 to December 31,2021 who underwent bybrid surgery were retrospectively included.Demographic information(sex,age),incidence(first diagnosis of CAVM by imaging and/or first appearance of CAVM-related symptoms such as hemorrhage and epilepsy),time from onset to hybrid surgery,modified Rankin scale(mRS)score at admission,history of previous CAVM treatment(surgical removal of previous CAVM and intravascular treatment),CAVM imaging data(lesion location,size,drainage),Spetzler-Martin grade,lesion density(loose,dense),CAVM combined with aneurysm or aneurysmal structure,surgical method(microsurgery+intraoperative DSA,microsurgery+intraoperative DSA+endovascular embolism),treatment-related complications(intracranial hemorrhage and/or ischemic events and/or edema in surgery-related areas,puncture site hematoma and/or fistula and/or pseudoaneurysm,gastrointestinal and/or gingival bleeding and/or epistaxis,contrast hypersensitivity,all-cause death),clinical and radiological follow-up data were recorded.The safety(treatment-related complications,symptom progression[positive difference between the mRS score at 6 months postoperatively and the baseline mRS score])and effectiveness(occlusion,complete absence of the malformation on DSA at 6 months postoperatively;good prognosis,mRS score≤2 at 6 months postoperatively)of hybrid surgery treatment were evaluated.Based on the clinical follow-up results at 6 months after surgery,patients who underwent hybrid surgery for CAVM were divided into the progressive group and the non-progressive group,and their baseline and clinical characteristics were compared.Results(1)Among the 61 patients who underwent hybrid surgery for CAVM,37(60.7%)were male,with a median a

关 键 词：中枢神经系统血管畸形 显微外科手术 血管内操作 复合手术 

分 类 号：R651.12[医药卫生—外科学]