复杂脑动静脉畸形的治疗策略及显微手术治疗
Treatment strategy and microsurgical operation of complex cerebral arteriovenous malformations
目的 探讨复杂脑动静脉畸形(CAVM)的治疗策略和手术要点.方法 2004年6月至2011年5月共显微手术切除27例复杂CAVM,占同期病例的67.5%,其中功能区CAVM 25例,非功能区2例.27例中,大型12例,中型8例,小型7例.CAVM Spetzler-Martin分级:Ⅱ级8例,Ⅲ级5例,Ⅳ级9例,V级5例.2例行术前栓塞治疗,均行CAVM切除术.术后定期进行随访.结果 23例患者全切除,全切除率85.2%.4例少量残留,其中3例行放射外科治疗.19例恢复良好,偏盲2例,肌力下降4例,2例术前昏迷者术后昏迷变浅.随访2个月至6年,格拉斯哥预后评分(GOS)5分22例,4分3例,2例术前昏迷患者意识好转.结论 显微外科手术全切除是CAVM最有效的治疗方法,掌握相关的显微外科手术方法,可以使多数复杂CAVM获得良好的效果.术前栓塞和残余畸形血管团放射外科治疗是治疗的良好补充.
更多Objective To study the treatment strategies and operative principles of complex cerebral arteriovenous malformation ( CAVM ).Methods Total 27 cases of complex CAVM were microsurgically resected from June 2004 to May 2011.These account for 67.5% of CAVMs in the same time.Of the CAVM,25 were eloquent CAVMs and 2 were non-eloquent CAVM.Among the 27 cases,the size of CAVM was large in 12 cases,median in 8,and small in 7.According to Spetzler-Martin CAVM grading,8 cases were grade Ⅱ,5 cases were grade Ⅲ,9 cases were grade Ⅳ,and 5 cases were grade Ⅴ.Pre-operative endovascular embolizations were carried out in 2 large CAVMs.All CAVMs were resected by microsurgical techniques.Results There were 23 cases of complex CAVMs totally removed.The total resection rate was 85.2%.The residual CAVMs were found in postoperative digital subtraction angiography(DSA) in 4 cases.Three of these residual cases were treated with gamma knife.Nineteen cases recovered very well after operation.The main complications were hemianopsia in 2 cases,moderate weakness in 4 cases.Two patients in coma before operation were still comatose after operation.The follow-up period were 2 months to 6 years.Twenty-two cases were Glasgow outcome scale (GOS) 5,3 cases were GOS 4,and 2 comatose patients were improved a little during the follow-up.Conclusions The microsurgical total resection of the CAVMs is the most effective method to cure the disease.With the use of microsurgical technique skillfully,mose complex CAVMs can achieve good outcomes.Preoperative embolization and radiosurgery on the residual nidus are good supplementary methods to treat the complex CAVMs.
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