显微外科手术联合不同方法治疗高级别颅内动静脉畸形

目的探讨对高级别颅内动静脉畸形（AVM）患者的治疗方法和疗效。方法回顾性分析23例高级别AVM患者开颅手术治疗的临床资料。男15例,女8例;平均（18±6）岁。Spetzler-Martin分级：Ⅳ级13例,Ⅴ级10例。畸形团的长径为3.5～15.0 cm,平均（7.5±2.0）cm。所有病例均接受了显微外科手术治疗。其中2例入院前1年和8年在外院接受栓塞治疗,3例近期接受术前栓塞,对18例直接实施显微外科手术。对切除后部分残留畸形团的5例行伽玛刀治疗。以格拉斯哥预后评分（GOS）评价疗效。结果①术前近期栓塞＋手术切除的3例术后恢复良好,术后GOS4分的1例,5分2例;远期栓塞＋手术2例和直接手术18例,在切除术后,1例昏迷及四肢瘫痪,1例死亡。GOS 5分的12例,4分5例,3分1例,2分1例,1分1例。②对17例患者术后行DSA复查,1例行MRA复查。显示11例获得全切,6例近全切除,1例部分切除。病死率为4%（1/23）,重残率为4.5%（1/22）。③随访1～95个月,GOS 5分14例,4分6例,3分2例。结论对高级别颅内动静脉畸形行手术切除是主要的治疗方法,并且疗效肯定,而适当的术前栓塞是手术成功的重要辅助手段。

Microsurgery in combination with other methods in the treatment of high-grade intracranial arteriovenous malformations

Objective To investigate the efficacy of treatment methods in patients with high-grade intracranial arteriovenous malformations(AVMs).Methods The clinical data of 23 patients with high-grade AVMs treated with microsurgery were analyzed retrospectively.There were 15 males and 8 females in the study.Their mean age was 18±6 years.The Spetzler-Martin grade: 13 patients with grade Ⅳ and 10 with grade Ⅴ.The long diameter of nidi was 3.5 to 15 cm(mean 7.5±2.0 cm).All the patients received microsurgery.Two of them had received embolization therapy in other hospitals before admission,3 received preoperative embolizations recently,and 18 were operated directly.Five patients with partial residual nidus after resection were treated with Gamma knife.Results Three patients with recent embolization + surgical resection before operation had a good recovery after resection,The in postoperative Glasgow Outcome Scale(GOS) scores were 4 in 1 case and 5 in 2 cases.There were 2 patients had embolization + surgery before,and 18 patients underwent direct microsurgery.One patient had coma and quadriplegia and 1 died after AVM resection.The GOS scores were 5 in 12 cases,4 in 5 cases,3 in 1 case,2 in 1 case,and 1 in 1 case.②17 patients received postoperative DSA reexamination,one received MRA reexamination,the AVMs of 11 patients were resected completely,6 were nearly total resected,and 1 was partially resected.The mortality rate was 4%(1/23),and the severe disability rate was 4.5%(1/22).③The patients were followed up for 1 to 95 months.The GOS score was 5 in 14 cases,4 in 6 cases,3 in 2 cases,and 1 in 1 case.Conclusion Microsurgical resection of high-grade AVM is the chief treatment method for high grade arteriovenous malformation,it has definite curative effect.Appropriate preoperative embolization is an important assistant means for the success of the AVM microsurgery.