手术切除巨大脑动静脉畸形及其正常灌注压突破的防治

手术切除巨大脑动静脉畸形(arteriovenous malformations,AVMs)术中或术后可能发生一种严重的并发症,表现为脑内出血、脑肿胀。1978年Spetzler医师将其命名为正常灌注压突破(normal perfusion pressure breakthrough,NPPB)。文献报道NPPB发生率为1%~10%,手术治疗巨大AVMs的术后并发症令人不满,致残率和病死率高达50%。本研究采用手术中栓塞加切除联合治疗巨大脑AVMs,研究手术前、后局部脑皮质血流的变化,栓塞后逐步阻断动脉与静脉的短路,有助于将AVMs与正常脑组织分离,预防手术中和手术后再出血以及NPPB的发生。因此,手术中栓塞加切除联合治疗巨大脑AVMs是降低手术后并发症的有效措施。

Surgical Resection of Giant Cerebral AVMs and Prevention of NPPB

There are clearly cases of severe complications after giant AVMs resection, such as brain swelling and hemorrhage. In 1978, "normal perfusion pressure breakthrough, NPPB" has been termed by Dr. Spetzler. The incidence of NPPB is 1%~10%. The surgical management of giant AVMs previously has been associated with an unacceptably high incidence of complications. In the literature, the combined mortality and serious morbidity for resection has approached 50% in the literatures. In our study, that the combination of intraoperative embolization with surgical resection for treatment of giant cerebral AVMs. Pre-and postoperative changes of regional cortical cerebral blood flow in patients with cerebral AVMs. The embolization could block the arteniovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain, so as to prevent the incidence of intra-and postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in treatment of giant cerebral AVMs.