脑动静脉畸形治疗策略(附136例报告并文献复习)  

Strategy for the treatment of arteriovenous malformations-a report of 136 cases and literature review

作　　者：李敬文[1] 刘相轸[1] 梁元[1] 邵斌[1] 耿全海[1] 胡恩喜[1] 

机构地区：[1]哈尔滨医科大学第一附属医院神经外科,黑龙江哈尔滨150001

出　　处：《中风与神经疾病杂志》2003年第5期425-427,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的　通过对 136例脑动静脉畸形 (AVM)治疗分析 ,探讨脑 AVM显微手术、血管内栓塞、放射外科及联合治疗的选择。方法　以 Spetzler- Martin分级系统对脑 AVM分级。显微手术切除 78例 ;单纯栓塞 17例 ;栓塞加手术 6例 ;X-刀放射治疗 33例 ;栓塞加 X-刀治疗 2例 ,均位于基底节区。结果　脑 AVM直接手术组复查AVM76例全部消失 ;单纯栓塞组完全栓塞 4例 ,大部分栓塞 (栓塞范围 >80 % ) 4例 ,部分栓塞 (栓塞范围 >30 %～5 0 % ) 9例 ;栓塞加手术组 1例 IV级 AVM有残余 ;X-刀治疗组及栓塞加 X-刀治疗组 35例中 3年随访间见 2 7例血管团消失 ,8例血管染色变淡 ,2例有新的神经功能缺失 ,3例癫痫发作。全组病例随访 6～ 36个月 ,GOS预后评分良好率 81.2 % ,2例单纯栓塞患者因再出血死亡。结论　脑 AVM的显微外科切除是治疗其主要方法 ,对于 IV级、V级 AVM,栓塞与手术结合是最佳方案 ,放射治疗适于小型和功能区难以切除的病例。综合利弊合理地运用手术、栓塞、放射治疗及联合治疗是提高脑 AVM预后的关键。Objective To discuss the choice of treatment for cerebral arteriovenous malformation(AVM) including microsurgery,endovascular embolization,radiosurgery and combined therapy,we analyzed treatment for cerebral AVM in 136 patients. Methods AVM was classified on Spetzler-Martin grading system. There were 78 cases operated microsurgically,17 cases treated by embolization alone,6 cases by microsurgery followed by embolization,33 cases X-knife radiosurgery,2 cases X-knife plus pre-embolization at the region of basal ganglia . Results Angiography showed disappearance of AVM nidus in 76 cases of microsurgery;Complete embolization was done in 4 cases in the group of embolization alone;One showed residual nidus of AVM in the group of embolization plus microsurgery;Reexamination of 35 cases treated by X-knife or X-knife plus pre-embolization showed the AVM nidus disappearance in 21 cases and reduced in 8 cases in 3 year follow-up,2 cases developed new focal deficits and 3 experienced a seizure. The duration of follow-up for all cases ranged from 6 months to 36 months. The rates of GOS were 81.2%. There were 2 deaths in the group of embolization alone. Conclusion Microsurgery is a major treatment for cerebral AVM. Combination of microsurgery with pre-embolization is a best choice for the patients of Grade Ⅳ or Grade Ⅴ. The patients with small and in functioning areas AVM are suitable for X-knife therapy. Weighing the advantage and disadvantage,it is critical for improving prognosis of cerebral AVM to reasonably use these techniques.

关 键 词：脑动静脉畸形 显微手术治疗 血管内栓塞 放射治疗 X-刀 

分 类 号：R743.4[医药卫生—神经病学与精神病学]