丘脑底节区动静脉畸形的显微外科手术治疗

目的观察显微外科手术治疗丘脑底节区脑动静脉畸形（AVM）的疗效。方法回顾性分析24例经显微外科手术治疗的丘脑底节区AVM患者的临床资料。其中术前有颅内出血者19例，无出血者5例。按照Spetzler—Martin分级标准，Ⅲ级13例，Ⅳ级8例，Ⅴ级3例。术前全部行脑血管造影检查，其中15例行术前畸形血管团的部分栓塞。结果①24例患者无手术死亡病例，其中23例AVM畸形血管团完全消失。1例有少量残留，进一步行立体定向放射外科治疗。②术前行栓塞的15例患者，术中出血量为（511±108）ml，与未行栓塞患者（9例）的（975±162）ml相比，差异有统计学意义（t=8．94，P〈0．01）。③术前肢体无力或偏瘫的12例患者，术后肌力恢复4例，好转6例，2例无明显变化。有6例患者出现其他新增加的神经功能障碍（其中5例为术前无出血者）。有1例患者因术后术野再出血，行再次手术清除血肿。④20例患者获得6～42个月随访，术前6例癫痫患者，术后仍有3例需要继续服用抗癫痫药物治疗；随访患者中无再出血发生。结论显微外科技术治疗丘脑底节区AVM，临床疗效较好。结合术前血管内栓塞，可以减少术中出血，降低手术难度。

The microsurgical management for arteriovenous malformations in the basal ganglia and thalamus

Objective To analyze the microsurgical experience of arteriovenous malformations （ AVMs）, and discuss the strategy and selection of the surgical approach. Methods The clinical data of 24 patients who underwent microsurgery in our department for AVM in basal ganglia and thalamus were analyzed retrospectively. There were 19 cases presented with intracranial hemorrhage preoperation, and the other 5 cases without hemorrhage. According to the Spetzler-Martin grading system, there were 13 cases with grade Ⅲ, 8 with grade Ⅳ, and 3 with grade Ⅴ. Angiography were performed in all patients to evaluate the feeding arteries and drainage veins, and 15 cases were partially embolized before surgery. Results All the patients were alive after surgery, the AVM were totally removed in 23 cases, and one patient underwent stereotaxic radiosurgery for the nidus residual. The mean volume of blood loss during operation in patients after embolization was 511 -＋ 108 ml, and 975 -＋ 162 ml in patients without embolization, there were significant difference between them（ t = 8.94 ,P 〈 0.01 ）. Of the patients with preoperative motor weakness or hemiparesis, 4 eases were totally recovered, 6 improved and 2 unchanged. 6 patients had newly developed neurological deficits postoperatively, and 1 patient underwent reoperation to evacuate the hemutoma resulted from postopera- tive hemorrhage. During the follow up period of 6 - 24 months, 3 of the 6 patients with preoperative seizure still need antiepileptic medications. No rcblecding was found during the follow-up period. Conclusion Microsurgery is an effect treatment for AVMs in basal ganglia and thalamus. Preoperative endovascualr emolization could effectively reduce the blood loss during operation and reduce the difficulty of operation.