【作者】 杨华； 刘健； 陈益民； 宋世宾； 出良钊； 高方友； 赵兵； 隋健美； 李玉明； 董明昊； 刘沣；

【机构】 贵阳医学院附属医院神经外科；

【摘要】 目的:评价脑动静畸形的一期栓塞治疗效果。方法回顾性分析我院收治的 59例患者进行血管内栓治疗的资料,男33例,女26例,年龄9-67岁,平均年龄为37．6岁。结果:(1)影像结果:59例脑动静脉畸形病例,32例行一期血管内栓塞治疗畸形血管团完全消失(占54．2％), 5例(8．5％)行二期栓塞治疗有3例畸形血管团完全消失,3例(5．1％)行三期栓塞治疗有2例畸形血管团完全消失。以最后一期栓塞后的DSA资料统计栓塞程度,畸形血管团完全消失(100％栓塞)37例 (62．7％);70-99％的栓塞13例(22.0％);30-69％的栓塞8例(13．6％);0-29％的栓塞1例(1．4％)。(2)并发症:2例术中出现血管痉挛。1例术后出现偏瘫等神经功能损害。1例术后出现正常灌注压突破(NBPP)并死亡。(3)随访结果:良好54例 (占91．5％);中残2例(占3．4％);重残2例(占3．4％);植物生存(0例);死亡 1例(占1．7％)。其中20例合并有癫痫者15例发作停止、5例偶有发作。结论: 小型AVM、单支供血AVM或Spetzler-Martin分级Ⅲ级以下的病例,追求一期完全栓塞是有可能的;大型AVM(直径大于6cm)或Spetzler-Martin分级Ⅳ、Ⅴ级病例辅以显微外科、立体定向放射治疗是很有必要的。更多还原

【Abstract】 Objective To evaluate the significance of embolism of cerebral arteriovenous malformation(AVM) at the first stage.Materials and methods 59 patients with AVM, male 33, femail 26, age ranging 9 to 67,mean age 37.6, were operated in our hospital through endovascular treatment (EVT) .A retrospective analysis was perfomed. Results (1)Treatment. 32/59(54.2% )were treat at the early stage of disease. Malformation of vessels of all patients disappeared completely. 5/59 (8. 5%) were operated at the second stage,but malformation of vessels of 2 patients disappeared totally . 3/59 ( 5. 1% ) were treated at the third stage, but malformation of vessels of 2 patients disappeared completely. Degrees of embolism were analyzed,depending on materials which were acquired at the latest stage by DSA. Malformation of vessels of 37/59 (62.7%) disappeared with the degree of 100%. 13/59 (22.0%) were occluded with the degree of 70-99%. 8/59 (13.6%) with the degree of 30-69%. 1/59 (1.4%) with the degree of 0-29%. (2)Complication. 2 patients with vasospasm were observed in the midst of operation. One patient with paralysis and other deficit of neurofuncation during the operation.One patient was dead because of normal perfusion pressure breakthrough ( NBPP ) after operation. (3) follow-up. 54/59 (91. 5%) had a good recovery, but 2 ( 3. 4%) with moderate disability, 2 ( 3. 4%) with severe disability. One patient was dead. Vegetative survival condition was never observed. Among 20 patients who had seizured,15 patients had never reoccurred , 5 seizured occasionally. Conclusions The total embolism at the first stage seems to be possible as for patients with small AVM, AVM single blood-supplied,and grading Ⅲ or less than Spetzler-Martin grading Ⅲ and.It is vital for patients with large AVM(D>6cm),larger than Spetzler-Martin grading Ⅲ to be operated with the help EVT in the aid of microneruosurgery or stereotatic radiotherapy.更多还原