Early microsurgical removal of 31 patients with bleeding arteriovenous malformations
-
摘要:
目的探讨早期显微手术切除出血性脑动静脉畸形的安全性和有效性。 方法对2015年1月~2019年4月收治的46例经CTA和（或）DSA证实为脑动静脉畸形的患者资料进行回顾性分析。 结果46例脑脑动静脉畸形（AVM）患者中，86.9%（40/46）的患者获得全部切除，26例出院时恢复良好，轻残13例，重残5例，死亡2例。高级别脑动静脉畸形（AVM）、血肿量>50 mL、幕下动静脉畸形患者预后较差。 结论 早期显微手术治疗出血性AVM，特别是低、中级别脑AVM是安全有效的，其能够快速降低颅内压，全切畸形团，预防再出血，同时保留神经功能，促进患者更加快速及时的康复。 -
关键词:
- 脑动静脉畸形 /
- 早期显微外科技术 /
- Spetzler—Martin分级
Abstract:Objective To explore the safety and effectiveness of early microsurgical removal of bleeding arteriovenous malformations. Methods The clinical data of 46 patients with AVM by early microsurgical treatment in our hospital from January 2015 to April 2019 were retrospectively reviewed in the acute stage of bleeding（within the first week after bleed）. All patients showed a cerebral AVM on DSA or CTA at admission. Results In the 46 patients, total resection was achieved in 40 cases（86.9%, 40/46）. A favorable functional outcome was observed in 26 patients, 13 cases were mild disability, 5 cases were severe disability, and 2 patients died. The patients with high Spetzler-Martin（SM）grade, volume hematoma larger than 50 ml, AVM located in cerebellar resulted in poor outcomes. Conclusion Early microsurgery for bleeding AVMs is a safe and definitive treatment. It achieves both immediate cerebral decompression and protection against rebreeding, resects cerebral AVMs totally, avoids neurologic comprimise and allows a more rapid rehabilitative course whenever necessary. -
Key words:
- cerebral arteriovenous malformation /
- microsurgery /
- Spetzler-Martin grade
-
图 1 左侧枕叶动静脉畸形术前、术后影像学检查
A~F: 术前CT、CTA、DSA结果; A: 术前头颅CT平扫提示左侧枕叶少量出血; B、C: 术前头颅CTA检查可见左侧枕叶动静脉畸形, 两支引流静脉分别引流入上矢状窦与乙状窦; D~F: 术前DSA检查提示左侧枕叶动静脉畸形, 供血动脉分别为大脑后动脉与脑膜后动脉, 两支引流静脉分别引流入上矢状窦与乙状窦; G~I：术后头颅CT、CTA检查未见病灶残留.
表 1 Spetzler—Martin分级与预后关系[n(%)]
Spetzler分级（例数） 恢复良好 轻残 重残 死亡 I级（4） 4（100.0） − − − II级（10） 9（90.0） 1（10.0） − − Ⅲ级（22） 12（54.5） 10（45.5） − − Ⅳ级（8） 1（12.5） 2（25.0） 4（50.0） 1（12.5） Ⅴ级（2） − − 1（50.0） 11（50.0） 
下载: 导出CSV
表 2 血肿量、AVM部位与预后关系[n(%)]
部位 血肿量 例数 恢复良好 轻残 重残 死亡 幕上 30 mL 7 6（85.7） 1（14.3） − − 30~50 mL 14 10（71.4） 3（21.4） 1（7.2） − 50 mL以上 22 10（45.5） 8（36.4） 3（13.6） 1（4.5） 幕下 10 mL以上 3 − 1（33.3） 1（33.3） 1（33.3）
下载: 导出CSV
-
[1] 张永力, 石祥恩, 孙玉明, 等. 复杂脑动静脉畸形的治疗策略及显微手术治疗[J]. 中华外科杂志, 2011, 49(11): 1017-21. doi: 10.3760/cma.j.issn.0529-5815.2011.11.016 [2] Spetzler RF, Ponce FA. A 3-tier classification of cerebral arteriovenous malformations clinical article[J]. J Neurosurg, 2011, 114(3): 842-9. doi: 10.3171/2010.8.JNS10663 [3] Beecher JS, Vance A, Lyon KA, et al. Delayed treatment of ruptured arteriovenous malformations: is it ok to wait[J]. Neurosurgery, 2016, 63(Suppl 1): 206-19. [4] Gross BA, Lai PM, Du R. Hydrocephalus after arteriovenous malformation rupture[J]. Neurosurg Focus, 2013, 34(5): E11-23. doi: 10.3171/2013.2.FOCUS12368 [5] Lawton MT, Du R, Tran MN, et al. Effect of presenting hemorrhage on outcome after microsurgical resection of brain arteriovenous malformations[J]. Neurosurgery, 2005, 56(3): 485-93. doi: 10.1227/01.NEU.0000153924.67360.EA [6] van Beijnum J, van der Worp HB, Buis DR, et al. Treatment of brain arteriovenous malformations a systematic review and meta-analysis[J]. J Am Med Assoc, 2011, 306(18): 2011-9. doi: 10.1001/jama.2011.1632 [7] Abecassis IJ, Xu DS, Batjer HH, et al. Natural history of brain arteriovenous malformations: a systematic review[J]. Neurosurg Focus, 2014, 37(3): 6-18. doi: 10.3171/2014.7.FOCUS14211 [8] Yamada S, Takagi Y, Nozaki K, et al. Risk factors for subsequent hemorrhage in patients with cerebral arteriovenous malformations[J]. J Neurosurg, 2007, 107(5): 965-72. doi: 10.3171/JNS-07/11/0965 [9] Bradac O, Charvat F, Benes V. Treatment for brain arteriovenous malformation in the 1998-2011 period and review of the literature[J]. Acta Neurochir(Wien), 2013, 155(2): 199-209. doi: 10.1007/s00701-012-1572-1 [10] Ding D, Xu Z, Yen CP, et al. Radiosurgery for unrupturedcerebral arteriovenous malformations in pediatric patients[J]. Acta Neurochir(Wien), 2015, 157(2): 281-91. doi: 10.1007/s00701-014-2305-4 [11] Ding D, Yen CP, Starke RM, et al. Radiosurgery for rapturedintracranial arteriovenous malformations[J]. J Neurosurg, 2014, 12l(2): 470-81. [12] Stapleton CJ, Waleott BP, Fusco MR, et al. Brain mapping for safe microsurgical resection of aaefiovenous malformations inEloquent codex[J]. World Neurosurg, 2015, 28(1): 40-53. [13] Korja M, Bervini D, Assaad N, et al. Role of surgery in the management of brain arteriovenous malformations prospective cohort study[J]. Stroke, 2014, 45(12): 3549-55. doi: 10.1161/STROKEAHA.114.007206 [14] Teo MK, Young AM, St George EJ. Comparative surgical outcome associated with the management of brain arteriovenous malformation in a regional neurosurgical centre[J]. Br J Neurosurg, 2016, 30(6): 623-30. doi: 10.1080/02688697.2016.1199776 [15] Pavesi G, Rustemi O, Berlucchi S, et al. Acute surgical removal of low-grade(Spetzler-Martin I-II)bleeding arteriovenous malformations[J]. Surg Neurol, 2009, 72(6): 662-7. doi: 10.1016/j.surneu.2009.03.035 [16] 郭 鹏, 赵继宗. 脑动静脉畸形3094例的临床特征及外科治疗效果分析[J]. 中华医学杂志, 2011, 91(39): 2740-3. doi: 10.3760/cma.j.issn.0376-2491.2011.39.002 [17] Hafez A, Oulasvirta E, Koroknay-Pal P, et al. Timing of surgery for ruptured supratentorial arteriovenous malformations[J]. Acta Neurochir(Wien), 2017, 159(11): 2103-12. doi: 10.1007/s00701-017-3315-9 [18] 张艳阳, 姜金利, 孙正辉, 等. 多模态技术在脑动静脉畸形显微外科手术中的应用[J]. 中华外科杂志, 2017, 55(5): 389-93. doi: 10.3760/cma.j.issn.0529-5815.2017.05.016 [19] 宫崧峰, 蒋太鹏, 何嘉滨, 等. 小脑血管畸形显微手术治疗的临床分析[J]. 中国微侵袭神经外科杂志, 2014, 19(6): 252-4. doi: 10.11850/j.issn.1009-122X.2014.06.004 [20] Potts MB, Lau D, Abla AA, et al. Current surgical resultswith low-grade brain arteriovenous malformations[J]. J Neurosurg, 2015, 122(4): 912-20. doi: 10.3171/2014.12.JNS14938 [21] Bir SC, Maiti TK, Konar S, et al. Overall outcomes following early interventions for intracranial arteriovenous malformations with hematomas[J]. J Clin Neurosc, 2016, 23(1): 95-100. -
点击查看大图
图(1) / 表(2)
计量
- 文章访问数: 1931
- HTML全文浏览量: 649
- PDF下载量: 11
- 被引次数: 0
