ONYX栓塞脑动静脉畸形八例临床分析

目的 介绍应用新型液态栓塞剂ONYX栓塞脑动静脉畸形的临床经验和疗效.方法 8例脑动静脉畸形患者均采用Seldinger技术在股动脉内置入6F鞘,6F导引导管进入颈内动脉或椎动脉,Ultraflow微导管超选择进入畸形团内,采用"阻断和前推技术"长时间缓慢注射ONYX栓塞脑动静脉畸形.结果 治疗后脑动静脉畸形的体积缩小为40%～100%,其中1例患者达到影像学完全栓塞,1例患者出现偏瘫,其余无严重并发症.结论 ONYX可提高脑动静脉畸形的栓塞效果,但单纯栓塞的长期疗效有待随访.     

脑动静脉畸形显微手术治疗及血管内介入治疗分析

目的 通过对169例脑动静脉畸形的显微手术切除治疗及血管内介入治疗进行分析,评估两种治疗方式的疗效.方法 回顾性分析1999年1月至2007年12月脑动静脉畸形治疗的临床资料,其中显微手术治疗95例,血管内介入治疗74例.结果 术后随访时间6～24个月,根据GOS预后评定:结果恢复良好106例,占62.7%;轻残47例,占27.8%,重残16例,占9.5%,无死亡病例.结论 显微外科手术切除是治疗脑动静脉畸形安全有效的治疗方法.     

大型脑动静脉畸形的显微外科手术治疗

目的：探讨并总结大型脑动静脉畸形（AVM）的显微外科手术治疗策略及手术要点。方法回顾性分析71例大型 AVM病例,按照 Spetzler-Martin 分级,3级者31例,4级者25例,5级者15例,均采用显微手术治疗,其中30例有高出血风险者行术前血管内栓塞。65例全切,6例少量残留,2例残余动静脉畸形外院行伽玛刀治疗。出院行格拉斯哥预后评分（GOS）评价预后。结果1例术前持续昏迷术后轻度改善,余病例主要并发症有偏盲、轻度失语、肌力下降及癫痫等,术后均得到较好恢复。无长期昏迷及死亡病例。术后随访 GOS,恢复良好61例（85．9％）,中残8例（11．2％）,重残2例（2．8％）。结论大型 AVM治疗风险较高,显微外科手术是治疗 AVM的有效手段,术前精确的判断及术中精细的操作是手术成功的关键,术前血管内栓塞为 AVM的治疗提供了新思路。     

脑膜脑动静脉畸形

作者单位在近六年间共收治脑膜脑动静脉畸形２２例，主要临床症状表现为头痛、头昏、眩晕、恶心、癫痫发作、颅内出血和神经缺失症状等。病变广泛且多位于顶枕部。颈内、颈外动脉同时参与供血。所有病例均行血管内治疗，４例行手术治疗，效果满意。作者认为，对于本病的治疗，较为常用的是血管内栓塞治疗。颈外动脉供血支的栓塞效果较好。     

血管内栓塞辅助显微手术治疗复杂难治性脑动静脉畸形

目的　探讨复杂难治性脑动静脉畸形 (AVM)的血管内栓塞辅助显微手术治疗的临床效果。　方法　分析 1999年 11月～ 2 0 0 3年 12月治疗Spetzler分级Ⅲ级以上脑AVM的 3 3例临床资料。Spetzler分级Ⅲ级 2 2例 ,Ⅳ级 9例 ,Ⅴ级 2例。脑AVM体积最大为 7 0cm× 8 6cm× 6 1cm ,最小为 2 5cm× 3 0cm× 2 8cm。所有病例均接受了血管内栓塞辅助显微手术治疗。　结果　 3 3例中 3 1例术后恢复良好 ,其余 2例中度致残。术后行MRI、MRA及DSA检查 ,未见血管流空影像及畸形血管影像。术后 6个月内行DSA血管造影检查证实 3 3例脑AVM完全切除 ,未见畸形血管影像。　结论　Spetzler分级Ⅲ级以上脑AVM是难治性疾病。血管内栓塞辅助显微手术切除可以取得良好的临床疗效。     

显微外科手术治疗脑动静脉畸形27例

【摘要】〓目的〓探讨显微外科手术治疗脑动静脉畸形的临床效果。方法〓回顾性分析自2006年至2012年间在本院住院手术治疗的27例脑动静脉畸形患者,所有患者均行显微外科手术治疗,观察治疗效果。结果〓27例患者中有13例治愈,12例好转,2例重残,总体有效率为92.60%。结论〓对于脑动静脉畸形患者,术前应充分评价病变区域的血管形态、位置和血流动力学,制定优化外科手术治疗方案,以取得满意的疗效。     

X-刀治疗脑动静脉畸形

目的总结Ｘ－刀治疗脑动静脉畸形的效果。方法作者应用Ｘ－刀技术治疗脑动静脉畸形（ＡＶＭ）１７例。其中,位于幕上者１５例,幕下者２例。１７例患者均为单次照射,边缘剂量１５～３０Ｇｙ。结果２年内ＡＶＭ完全消失者１３例,部分消失者３例,无变化者１例。治疗后出现放射性脑水肿２例。经保守治疗患者症状改善。结论Ｘ－刀治疗脑血管畸形有其独特的作用,它为手术和栓塞不能治疗的ＡＶＭ提供了一种新的方法     

脑动静脉畸形并出血的显微手术治疗

目的 回顾性分析78例脑动静脉畸形（AVM）并出血的显微外科手术治疗结果，探讨AVM并出血的显微手术技巧及适应证。方法 所有病例术前均接受CT检查，术后均接受CT及MRI检查，其中25例接受了DSA检查。所有病例均在全麻状态下进行显微外科手术治疗，少部分AVM未能全切的病例，术后用γ-刀或血管内介入治疗。结果 血肿全清除69例，大部分清除9例；AVM全切除70例，8例部分切除或未能切除，加用γ-刀或血管内介入治疗。手术后死亡6例（8．0％），偏瘫4例（5．1％），失语2例（2．6％），偏盲1例（1．3％），脑神经功能障碍4例（5．1％），无颅内感染。结论 应用显微外科手术治疗脑AVM并出血安全有效，而且并发症、后遗症较少，应成为脑AVM并出血患者治疗的最佳选择，对特殊位置的AVM，不宜强行切除，手术时只作血肿清除，术后加用γ-刀或血管内介入治疗。     

脑动静脉畸形合并畸形团外囊性动脉瘤六例

我科自2001年1月～2002年12月共收治脑动静脉畸形(arteriovenous malformation，AVM)合并畸形团外囊性动脉瘤6例，占同期69例脑AVM的8．7％，同期103例脑动脉瘤的5．8％，现报告如下。     

脑动静脉畸形的血管内治疗

１９９３年６月至１９９６年３月，作者应用血管内技术治疗脑动静脉畸形（ＡＶＭｓ）１８例。其中２例完全闭塞，８例闭塞７０％～９０％，５例闭塞５０％～７０％，３例闭塞少于５０％。２例栓塞后出现轻度神经功能缺失。栓塞后１周，４例位置表浅的ＡＶＭ进行了手术治疗。２例位于深部的ＡＶＭ栓塞后１个月进行了γ－刀治疗。１８例患者中，１４例得到随访，１２例临床症状减轻或缓解，１例癫痫发作较栓塞前频繁，１例栓塞后６个月发生颅内再出血。脑ＡＶＭ经血管内栓塞治疗，可使部分患者治愈，对于大型及重要功能区的ＡＶＭ，血管内栓塞治疗可为手术及放疗提供条件。     

Surgical treatment of cerebral arteriovenous malformations. Follow-up study of 43 cases

Summary In 43 patients with arterio-venous malformations and one patient with a cavernous haemangioma, whose angiomas were completely removed by the same Surgeon, pre- and postoperative angiograms were reviewed and the clinical results documented in a follow-up study. Mortality rate (7%) and severe disability (7%) are significantly lower than in untreated patients.A poor outcome strongly depends on the number of feeding arteries, on localization (midline) and size.Dedicated to Prof. Dr. W. Krenkel on his sixtieth birthday.     

Shear stress in cerebral arteries supplying arteriovenous malformations

Summary Arteries supplying cerebral arteriovenous malformations (AVMs) are known to dilate with time. These changes are reversible, and the feeders have been shown to slowly decrease in calibre after removal of the AMV. There is evidence that arteries alter their internal diameters in response to sustained changes of blood flow so that shear stress is kept constant. This implies that blood flow-induced shear stress might be the driving force for remodelling of the cerebral vascular network in the presence of an AVM, and for reversion of these changes after radical operation. The objective of this study is to examine the hypothesis that the shear stress in cerebral arteries supplying AMVs is of the same magnitude as in arteries supplying normal brain tissue in spite of larger blood flow rate. Fifteen patients with supratentorial cerebral AVMs admitted for endovascular treatment were examined with transcranial Doppler ultrasound in the distal Willisian vessels. Vessel calibres were measured in angiograms with magnification correction. Shear stress was estimated assuming a constant value for blood viscosity. Corresponding arteries in the cerebral hemisphere with AVM and in the contralateral one were compared in pairs. Thirty-four pairs of homonymous arteries were studied. The arteries on the AVM side presented larger calibres, higher axial blood flow velocities, lower pulsatility index and larger blood flow rates than the contralateral side. There was a clear positive correlation between blood flow velocities and vessel calibres. The estimates of shear stress did not differ significantly in corresponding arteries of both hemispheres (p = 0.18).The results indicate a precise adjustment of cerebral arterial calibre and blood flow-induced shear stress that presumably induces the progressive dilation of AVM feeders, and the slow regression of the vessel calibres to average dimensions after removal of the lesion. Each vessel seems to remodel itself in response to long-term changes in blood flow rate so that the vessel calibre is reshaped to maintain a constant level of wall shear stress.     

复杂脑动静脉畸形的治疗策略及显微手术治疗

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.     

Intraoperative angiography in the surgical treatment of cerebral arteriovenous malformations and fistulas

Summary ?Background. The role of intraoperative angiography in the surgical treatment of cerebrovascular malformations remains controversial. The authors report on their experiences with intraoperative angiography in a series of 20 cases with cerebrovascular malformation to determine whether the use of intraoperative angiography has a favorable impact on the surgical treatment of cerebrovascular malformations. Methods. Intraoperative angiography was performed in the surgical resection of arteriovenous malformation in 18 patients and in the surgical obliteration of arteriovenous fistula in 2 patients. The incidence of unexpected findings, such as residual nidus, demonstrated by intraoperative angiography was determined. Findings. High-quality subtraction images were obtained by intraoperative angiography in every case and the findings prompted an additional procedure in 1 case that displayed an unexpected residual nidus (5.6%). There were no complications from the intraoperative angiography procedure. Interpretation. Intraoperative assessment of technical results prior to wound closure offers the neurosurgeon the opportunity to resect or obliterate a vascular malformation completely, obviating a second operation. Published online May 19, 2003     

脑动静脉畸形栓塞术后颅内出血影响因素的多元回归分析

目的分析脑动静脉畸形栓塞术后颅内出血的相关影响因素。方法选取315例脑动静脉畸形患者(c AVM)作为研究对象,运用多元回归分析对患者的性别、年龄、出血史、栓塞体积、高血压病史等脑动静脉畸形出血的多种影响因素进行分析。结果单次栓塞体积≥36.5%的OR=2.184,95%CI为1.117~4.269,(P=0.022,0.05),既往高血压病史的OR=2.184,95%CI为1.041~4.581,(P=0.039,0.05),二者是脑动静脉畸形栓塞术后颅内出血的主要危险因素。结论血管介入治疗脑动静脉畸形最严重的并发症是脑动静脉畸形,单次栓塞体积≥36.5%和既往高血压病史可增加脑动静脉畸形栓塞术后颅内出血的危险性。     

脑动静脉畸形血管生成素表达与血管超微结构的观察

目的 探讨脑动静脉畸形(cAVM)血管生成素-1(Ang-1)和血管生成素-2(Ang-2)表达及其与血管超微结构变化的关系。方法 采用免疫组织化学方法检测正常脑组织和cAVM血管内皮细胞中Ang-1和Ang-2的表达情况;透射电镜观察畸形血管壁超微结构变化。结果 正常对照组血管内皮细胞仅表达较低水平的Ang-1和Ang-2,而cAVM及其周围小血管内皮细胞Ang-2表达显著增高(P<0.05)。畸形血管的内皮细胞间隙变宽,胞浆内线粒体丰富,核糖体及粗面内质网增多;平滑肌细胞和弹力纤维减少或消失,代之以大量的胶原组织沉积。结论 血管生成素表达可能参与cAVM的发生发展过程,并与畸形血管的超微结构改变有重要关系。     

Angiographic contribution to the problem of enlargement of cerebral arteriovenous malformations

Summary From a series of 325 cases of cerebral arteriovenous malformations, seven patients are reported presenting a change in size of the malformation in the course of several years. The enlargement of the malformation is documented by four vessel cerebral angiography, and the haemodynamic and histopathological characteristics are discussed. Serial four vessel cerebral angiography is strongly indicated for accurate diagnosis, and radical excision of these malformations with the microtechnical method is advocated.Presented at the 25th Anniversary of the Neurosurgical Clinic, St. Elisabeth-Ziekenhuis (Dr. M.P.A.M. de Grood), Tilburg, The Netherlands, June 5, 1976.     

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目的探讨老年人结直肠癌的外科治疗。方法对复旦大学附属肿瘤医院1985年1月至2003年12月间手术治疗的266例年龄≥75岁的老年人结直肠癌病例资料,进行临床和病理资料的回顾性分析。结果266例中,男性151例,女性115例,年龄75~91岁。病变部位以直肠和乙状结肠多见,占69.2%,但右半结肠癌仍占22.2%。94例(35.3%)术前存在心血管疾病、糖尿病等合并症。215例(80.8%)行根治性手术,35例(13.2%)行姑息性手术治疗。术后30例(11.3%)出现肠梗阻、出血、感染等并发症,其中3例(占1.1%)手术后死亡。全组随访1个月至16年,5年存活率51.3%。结论虽然老年人结直肠癌中术前合并症和术后并发症的发生率较高,但在重视围手术期的检测和处理后手术死亡率并未增加,术后5年存活率仍可达50%以上。因此,对老年人结直肠癌积极的临床诊治不容忽视。