脑动静脉畸形破裂出血的急诊手术治疗

目的探讨急诊外科手术治疗脑动静脉畸形（AVM）破裂出血的效果。方法对12例破裂出血并脑内血肿的脑AVM患者实施急诊显微手术治疗,清除血肿,同时切除畸形。结果手术完全切除病灶9例,占75％;次全切除1例,占8％,部分切除2例,占17％。按GOS评分,患者恢复良好10例,轻残1例,重残1例。结论急诊外科手术能够提高脑AVM破裂出血的治愈率,降低死残率,急诊的血管造影可提供一定的信息以降低手术风险,提高治愈率。     

边缘系统脑胶质瘤的临床特点及显微手术方法探讨

目的探讨边缘系统胶质瘤的临床特点和显微外科治疗的手术技巧及术中注意事项。方法回顾性分析我院35例边缘系统脑胶质瘤患者临床资料。所有病例均采用显微手术,在保护重要结构的前提下最大限度地切除肿瘤。结果显微镜下全切除肿瘤26例,次全切除5例,部分切除4例。术后1例死亡。结论熟悉边缘系统的局部解剖和熟练掌握显微神经外科技术是手术成功的关键。术中注意对侧裂区动静脉血管及肿瘤周围重要功能区的保护,能够提高边缘系统胶质瘤的手术治疗效果。     

多层螺旋CT血管造影在急性自发性颅内出血中的应用价值

目的探讨多层螺旋CT血管造影(MSCTA)在急性自发性颅内出血中的应用价值。方法CT诊断急性自发性颅内出血41例,其中蛛网膜下腔出血29例、脑内血肿12例,采用容积重建(VR)和最大密度投影(MIP)方法进行MSCTA检查,并对7例颅内动脉瘤钛夹夹闭术病例和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤手术切除病例进行术后MSCTA评价。结果41例急性自发性颅内出血中,MSCTA检查出颅内动脉瘤11例、脑动静脉畸形4例、脑动静脉畸形伴巢内动脉瘤1例;MSCTA对动脉瘤的瘤体大小、瘤颈、载瘤动脉和脑动静脉畸形的部位、大小、瘤巢的形态、供血动脉和引流静脉的显示均较清楚。7例动脉瘤行钛夹夹闭术和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤行手术切除,手术所见与术前MSCTA表现相符;术后行MSCTA复查,显示夹闭动脉瘤之钛夹位置正常,载瘤动脉、颅内大血管通畅,脑动静脉畸形之瘤巢已切除。结论MSCTA是急性自发性颅内出血病因诊断的一种无创伤、快捷有效的影像学方法,并且在颅内动脉瘤、脑动静脉畸形术后评价方面也具有临床应用价值。     

脑膜脑动静脉畸形的诊断和治疗

目的　分析脑膜脑动静脉畸形血管结构学特征 ,探讨其血管结构与临床诊治之间的联系。方法　对 5 2例脑膜脑动静脉畸形患者的DSA全脑血管造影检查结果及治疗方法进行回顾性分析。结果　 5 2例脑膜脑动静脉畸形病人全部应用微导管插管技术行血管内栓塞治疗。栓塞后行手术切除AVM者 2例 ,行γ 刀治疗 3例 ,均治愈。治疗后临床症状消失 ,完全恢复正常生活工作 17例 ,癫痫或头痛等症状明显好转 16例。结论　血管结构学研究对脑膜脑动静脉畸形的临床诊治有非常重要的指导意义。     

脑动静脉畸形并发破裂出血的显微手术治疗(附32例报告)

脑动静脉畸形(arteriovenous malforrmtions,AVM)破裂出血后死亡率、残疾率较高,目前多考虑在早期行手术清除血肿,出血血管夹闭电凝后,再对血管畸形进行病因学治疗.从2001年6月-2008年1月我们对32例破裂出血的脑AVM患者急诊行显微手术治疗,清除血肿,同时切除畸形,效果满意,现报道如下.     

血管内栓塞治疗脑动静脉畸形（附23例分析）

目的：分析报告23例经血管内栓塞治疗的脑动静脉畸形。材料和方法：23例脑动静脉畸形，11例有癫痫发作史，9例蛛网膜下胜或脑内出血，5例有神经功能障碍、头痛，2例有颅内杂音。畸形团小于3cm2例，3一6cm15例，，大于6cm6例。应用Magic导管系统经股动脉行脑动静脉畸形超选择栓塞，应用NBCA或IBCA16例，线段5例，IBCA和线段2例。结果：畸形血管团栓塞90％以上9例，70—90％10例，小于50％4例，3例栓塞后行手术切除。痊愈10例，改善10例，2例有神经功能障碍，1例死亡。结论：栓塞治疗加手术切除是治疗较大的、高血流量、功能区脑动静脉畸形的较好方法。NBCA或IBCA是安全有效的栓塞材料。     

真丝线段栓塞脑动静脉畸形56例

目的:探讨脑动静脉畸形(AVM)的治疗手段。方法:对56例经真丝线段栓塞的AVM进行分析,按S-M分级Ⅰ级10例,Ⅱ级18例,Ⅲ级19例,Ⅳ级9例。单纯行真丝线段栓塞31例,真丝线段栓塞+γ-刀治疗15例,真丝线段栓塞+手术切除10例。所有患者均经1~6年随访。结果:单纯行真丝线段栓塞病灶消失10例,病灶缩小50%以上14例。真丝线段栓塞+γ-刀治疗病灶消失7例,病灶缩小50%以上3例,5例病灶缩小50%以下。真丝线段栓塞+手术切除病灶消失7例。全组无死亡,1例留有不完全性偏瘫、失语。结论:真丝线段栓塞AVM尤其是位于脑重要功能区的AVM仍然是治疗脑AVM有效的主要手段,真丝线段栓塞结合手术切除或γ-刀治疗脑AVM可提高治疗效果。     

血管内栓塞联合手术切除治疗巨大脑动静脉畸形

为探讨术前血管栓塞在治疗巨大脑动静脉畸形（AVMs）中的作用，对1996年8月至1998年4月27例巨大AVMs患者进行了手术治疗。每个患者手术前均行AVMs血管内栓塞。结果发现，先行血管内栓塞后进行手术切除可明显减少术中出血，大大降低术后致残率和病死率，并可有效防止正常灌注压突破综合征（NPPB）。提示血管内栓塞与手术切除联合治疗巨大脑AVMs是一种行之有效的手段。     

出血性脑动静脉畸形的影像特点与血管内治疗

目的：探讨以出血发病的脑动静脉畸形的影像学特点与血管内治疗的技术操作。方法：经脑CT或MRI确认为脑实质内出血的56例病例，经DSA全脑血管造影证实为脑动静脉畸形(AVM)，根据AVM病灶的特点，行经血管内超选择应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗。结果：56例在1-3次栓塞后，36例病灶完全消除；1例因AVM中有新生的动脉瘤及1例术后1年发生出血而行第2次栓塞治愈，1例在接受X-刀治疗后3个月再次出血，经手术后痊愈。结论：AVM病灶内或病灶旁存在动脉瘤和动脉囊样扩张、引流静脉细小和脑室内生长的AVM是引起脑出血的主要原因，而在栓塞中优先处理动脉瘤样病变对防止脑出血有重要意义。     

Onyx-18栓塞治疗脑动静脉畸形28例临床分析

目的 介绍应用Onyx-18栓塞治疗脑动静脉畸形的体会.方法 采用Onyx-18对28例脑动静脉畸形患者进行栓塞治疗.结果 28例患者中,畸形血管团栓塞80%以上4例,其中2例达到影像学完全栓塞(血管造影动、静脉期均无畸形血管团显影),栓塞范围50% ～ 80% 20例,50%以下4例.28例中5例患者于术中或术后出现...     

Characterization of arteriovenous malformation feeding vessels by carbon dioxide reactivity.

PURPOSETo characterize cerebral hemodynamics in patients immediately before microsurgical resection of moderate to large arteriovenous malformations during isoflurane anesthesia.METHODSIn angiographically defined arteriovenous malformation feeding and nonfeeding arteries, transcranial Doppler studies were performed in 25 surgeries on 22 patients. The mean blood flow velocity and pulsatility index were recorded in the middle, anterior, and posterior cerebral arteries. Transcranial Doppler velocities were measured at end-tidal carbon dioxide tensions (PetCO2) of about 25 and 35 mm Hg. Carbon dioxide reactivity was calculated as percentage mean blood flow velocity change per mm Hg PetCO2 change.RESULTSPatient demographic and clinical data for the arteriovenous malformation group followed the expected strata of a large arteriovenous malformation population. All patients were neurologically stable before surgery. A total of 43 feeding arteries and 55 nonfeeding arteries were studied. Compared with nonfeeders, feeders exhibited higher mean blood flow velocity (68 +/- 5 vs 31 +/- 3 cm/sec, P < 0.0001) and lower pulsatility index (0.64 +/- 0.03 vs 0.88 +/- 0.04, P < 0.001); anterior and middle cerebral artery velocities at normo- and hypocapnia were significantly higher than posterior cerebral arteries for both feeders and nonfeeders (P < 0.001). Carbon dioxide reactivity was 0.2 +/- 0.2%/mm Hg in feeders and 2.1 +/- 0.2%/mm Hg in nonfeeders, with no significant difference between arteries. In four of eight patients with lesions fed by the anterior circulation (middle cerebral artery with or without anterior cerebral artery feeders), posterior cerebral artery nonfeeders exhibited low reactivity. In 2 of 5 patients with ipsilateral posterior cerebral artery feeders, contralateral posterior cerebral artery nonfeeders exhibited impaired reactivity.CONCLUSIONSQuantitative transcranial Doppler studies are technically feasible in the operating room or interventional suite during anesthesia. Hemodynamic assessment using physiologic challenges of arteriovenous malformation feeders as well as angiographically uninvolved vessels may be useful as criteria in the assessment of malformations and arteriovenous malformation patients may exhibit abnormal vasoreactivity in distant uninvolved perfusion territories, suggesting a deranged neural control mechanism.     

Cerebrovascular occlusion by catheterization and embolization: clinical experience

Intravascular occlusion by various catheterization techniques was used to treat 27 cases of carotid-cavernous fistula, giant intracavernous aneurysm, and cerebral or dural arteriovenous malformation. Several case reports are presented. The detachable balloon technique proved valuable in the treatment of traumatic carotid-cavernous fistula and giant aneurysm. Calibrated-leak balloon catheterization with fluid embolization was used to treat cerebral arteriovenous malformation. Selection of embolic material is discussed.     

Embolization of spinal cord vascular malformations via the anterior spinal artery

During a 3 year period, 21 patients with spinal cord vascular malformations involving the anterior spinal artery were treated by embolization through this artery. Of four cases of extramedullary arteriovenous fistula, two patients embolized at an early stage showed excellent results, whereas results were mediocre in two patients who were paraplegic at embolization. Of 17 cases of intramedullary arteriovenous malformation (AVM), nine patients showed clinical improvement either with or without radiologic evidence of residual malformation; three patients had complications that led to clinical worsening; in the other five patients, results were mixed or inconclusive. Angiomyelotomography is recommended to diagnose extramedullary arteriovenous fistulae involving the anterior spinal artery. Pretherapeutic evaluation of intramedullary AVMs must consider the spinal cord level at which the malformation occurs. Angiotomography and temporary occlusion tests permit identification of collateral anastomoses before embolization. Respective criteria for surgery and embolization are defined. In cases where embolization is indicated, short-term results can generally be predicted.     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。     

子宫动静脉畸形介入栓塞治疗19例临床研究

目的探讨子宫动静脉畸形采用子宫动脉介入栓塞治疗的临床效果。 方法选取2014年4月至2019年12月在我院就诊并接受治疗的19例子宫动静脉畸形患者作为研究对象，均给予子宫动脉栓塞术（UAE）治疗，评价治疗效果和患者预后。 结果19例患者中有15例患者均一次性UAE治疗止血成功，术后患者主诉右下腹轻度疼痛不适，术后2～5 d症状消失，剩余4例治疗后阴道仍有出血，其中2例患者转手术治疗，另2例给予保守治疗后好转。19例患者术后均未发生严重并发症。 结论子宫动静脉畸形虽然在临床较为少见，但很容易引起严重后果，UAE治疗子宫动静脉畸形是一种微创、高效且可重复的治疗方式，对无手术禁忌症者可作为首选的治疗方式。     

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

Spontaneous regression of cerebral arteriovenous malformation (AVM) is rare and poorly understood. We reviewed the clinical and angiographic findings in patients who had spontaneous regression of cerebral AVMs to determine whether common features were present. The clinical and angiographic findings of four cases from our series and 29 cases from the literature were retrospectively reviewed. The clinical and angiographic features analyzed were: age at diagnosis, initial presentation, venous drainage pattern, number of draining veins, location of the AVM, number of arterial feeders, clinical events during the interval period to thrombosis, and interval period to spontaneous thrombosis. Common clinical and angiographic features of spontaneous regression of cerebral AVMs are: intracranial hemorrhage as an initial presentation, small AVMs, and a single draining vein. Spontaneous regression of cerebral AVMs can not be predicted by clinical or angiographic features, therefore it should not be considered as an option in cerebral AVM management, despite its proven occurrence.     

妊娠期出血性脑血管病手术治疗后继续妊娠的安全性

 目的 探讨多学科合作手术治疗妊娠期出血性脑血管病后继续妊娠的安全性。方法 2013-01至2016-08医院妇产科收治6例妊娠期出血性脑血管病孕妇,经多学科会诊评估后手术治疗出血性脑血管病,术中选择性应用麻醉药;减少术前应用脑血管造影电离辐射的暴露剂量;手术中维持血流动力和血氧饱和度稳定,全程胎心监护,尽量避免胎盘血流灌注不足。手术方式为动脉瘤切除术1例,动静脉畸形合并动脉瘤切除术1例,动静脉畸形切除术2例,开颅血肿清除术1例,颅内血肿穿刺外引流术1例。结果 继续妊娠至36～37周足月或近足月剖宫产分娩,单活胎5例,双胎1例,新生儿体重2320～3400 g。新生儿预后良好。结论 妊娠期手术治疗出血性脑血管病,多学科协作综合治疗和管理患者,可以期待继续妊娠至近足月分娩。     

显微切除痫灶治疗颞叶顽固性癫痫的疗效分析

目的总结显微切除痫灶治疗颞叶顽固性癫痫的临床疗效。方法颞叶顽固性癫痫24例,手术采用改良翼点入路切口,运用良好的显微外科技术,将癫痫灶切除。结果术后随访半年至3年,16例癫痫发作完全消失,4例术后较术前显著改善,2例术后效果良好,手术总有效率91.7%(22/26)。结论根据脑电监测范围显微切除痫灶治疗颞叶顽固性癫痫是安全、有效的手术方式,辅以综合治疗术后并发症少,疗效满意。     

Occlusion of cerebral arteriovenous malformations with N-butyl cyano-acrylate is permanent.

PURPOSETo verify the permanence of total occlusion of cerebral arteriovenous malformations after embolization with N-butyl cyano-acrylate and to evaluate the occlusion rate.METHODSOne hundred thirty-four patients were treated for cerebral arteriovenous malformations with N-butyl cyano-acrylate embolization after superselective catheterization. Those initially totally occluded have been followed with angiography.RESULTSIn 15 instances (11.2%) the arteriovenous malformations were totally occluded by embolization alone. Follow-up angiograms have been performed in 12 cases (80%) after 4 to 78 (mean, 27) months after embolization. In all instances the arteriovenous malformations have remained occluded, and there have been no clinical signs of activity.CONCLUSIONAfter total occlusion of a cerebral arteriovenous malformation with N-butyl cyano-acrylate, the lesion stays occluded, and the clinical course seems stable.     

Cerebral MR venography

This paper illustrates the technique and clinical use of cerebral MR venography (MRV). Dural sinus thrombosis is detected by both two-dimensional time-of-flight (TOF) and three-dimensional phase-contrast (PC) techniques. Venous angiomas are demonstrated by the three-dimensional PC method. The arterial feeders, nidus and draining veins of cerebral arteriovenous malformation (AVM) can be visualized on contrast-enhanced TOF three-dimensional MR angiogram. The high-flow draining veins of cerebral and dural AVMs, vein of Galen malformation and carotid cavernous fistula are better seen on contrast-enhanced three-dimensional gradient-echo MRV.