经眶穿刺海绵窦建立脑动静脉畸形的动物模型

目的 评价经眶穿 刺海绵窦建立脑动静脉畸形（AVM）模型的可行性。方法 采用家猪6头,经眶用穿刺针穿刺海绵窦,在猪的颅底血管网（RMB）和海绵窦之间形成动静脉交通。临床上观察了其短期有效性。并通过微管测压观察其血流动力学特点。结果 通过穿刺可以建立RMB和海绵窦之间的动静脉交通,其血管造影特点与人类的脑AVM的特点相似。该交通多于7d内自发闭塞。结论 经眶穿刺海绵窦建立脑AVM模型方法简便、可行。     

颅内动静脉畸形动物模型制作与栓塞的实验研究

目的 探讨颅内动静脉畸形（arteriovenous mal-formation,AVM）动物模型的制作与其在栓塞研究中的应用。方法 以中国实验小型猪（Chinese Experimental Mini-pigs,CEMPs）颅底微血管网（rete mirabile,ReM）为AVM的畸形团,经右颈动静脉吻合并结扎右颈外动脉等建立AVM动物模型,用a-氢基丙烯酸正丁酯（NBCA）胶和Embosphere颗粒分别栓塞,模型建立和栓塞前后行血管造影,并取栓塞组织（ReM)、颈动静脉吻合口和脑做组织病理学检查。结合造影影像和组织病理学发现,探索模型的应用、颈动静脉吻合口的闭塞原因和模型改进方法。结果 在7只CEMPs中成功制作了AVM动物模型,该模型在血管结构、造影影像、栓塞表现和栓塞后病理改变上与人脑AVM的相似。4只动物颈动静脉吻合口血管腔内有血栓形成,其余3只吻合口血管塌陷皱缩,腔内无血栓。死亡动物脑组织病理表现为缺血性梗塞。结论 尽管本方法对于建立颅内AVM动物模型更简单可行,适用于栓塞材料的栓塞研究和介入医师的培训,但该模型仍为急性期模型,其应用十分有限。如何防止模型动静脉吻合口的闭塞和让动物能够耐受栓塞,需要进一步的研究。     

脑动静脉畸形动物模型栓塞后病理改变初步观察

猪的咽升动脉在海绵窦形成酷似人脑ＡＶＭ畸形团的微血管网（ＲｅＭ），经常被用于血管内栓塞研究。作者选用中国实验用小型猪（ＣＥＭＰ），经右颈动静脉吻合等方法，建立具有畸形团结构的脑ＡＶＭ动物模型，并进行了栓塞。首次对栓塞后ＣＥＭＰ的ＲｅＭ、颈动静脉吻合口...     

动静脉畸形动物模型的研究及应用进展

动静脉畸形（Arteriovenous malformations,AVM）是一类较少见且高风险的血管畸形。尽管目前血管内治疗、手术治疗及联合治疗已应用于该疾病的治疗,但风险较高,且效果不一。近几十年来,已有多种实验模型被用于AVM发病机制、血流动力学变化、组织学等的研究,以期加深对该疾病的认识,从而探索更有效的治疗手段。但目前仍缺乏能完美模拟人体各种动静脉畸形的动物模型。本文对近年来AVM相关动物模型的研究及其应用的优缺点进行综述。     

颈动脉海绵窦瘘血液动力学的实验与临床研究

目的 对２０例颈动脉海绵窦瘘（ＣＣＦ）患者和２０只颈动脉瘘大白兔以及８只正常大白兔颈动脉进行血液动力学的研究。方法 彩色经颅三维多普勒超声（３Ｄ－ＴＣＤ）检测。数字减影血管造影（ＤＳＡ）检查和颈内动脉血管内微导管直接测压。结果 血管内直接测压提示瘘口远，近端存在一定的压力梯度，瘘口越大，压力差越大，呈明显正相关，血气分析显示颈动脉之间ＰＨ，ＰＯ２，ＰＣＯ２，Ｏ２ｓａｔ等各项值的差别消失。栓塞治疗后     

脑动静脉畸形的治疗进展

脑动静脉畸形(AVM)是一堆结构变异的动脉和静脉交错缠绕在一起的血管团块,动静脉之间形成一至数个瘘道而无毛细血管,血液由动脉通过动静脉瘘直入静脉,再回流到静脉窦,这种异常的脑血管结构和脑血流改变可导致脑出血、脑盗血等而引起一系列脑功能障碍,因此必须进行积极治疗.     

真性动脉瘤合并假性动脉瘤动物模型的建立

我们通过建立符合疾病病理生理的犬颈总动脉真性合并假性动脉瘤(T F)动物模型,研究其形成过程、病理及影像学特点,为临床上诊断和治疗该疾病提供依据。 一、材料和方法 杂种犬15条,体重11.0～20.5kg。全麻后颈部正中作矢状切口,暴露左颈部皮下的颈外静脉(EJV),结扎EJV近、远端,取中间段长2 cm,分离出左侧颈总动脉(CCA),制作侧壁型动脉瘤(AN),待1～2周造影证实AN形成后,再行手术打开原切口,显露左侧颈总动脉。用双极电凝在左侧胸头肌中段内缘烧灼成一     

脑动静脉畸形血管内治疗前后血液动力学变化的临床和实验研究

分别通过脑动静脉畸形（ＡＶＭ）供血动脉直接测压和三维经颅多普勒超声（３Ｄ－ＴＣＤ）对３１例脑ＡＶＭ栓塞治疗前后血液动力学变化进行研究，同时在不同程度闭塞犬颈总动脉前后通过ＤＳＡ、３Ｄ－ＴＣＤ检查和病理组织学观察，对犬的头颈部解剖及脑血液动力学变化进行探索性研究，供血动脉直接测压和３Ｄ－ＴＣＤ能及时、直观和准确了解脑ＡＶＭ栓塞前后血液动力学变化，指导临床治疗。     

犬嫁接性梭形动脉瘤模型制作与血流动力学观察

梭形动脉瘤（AN）病因尚不明确。我们采用犬颈外静脉（EJV）嫁接颈总动脉（CCA）制作梭形AN模型，探讨其发生机制及最适合的治疗方法。     

慢性低灌注性脑缺血再灌注后大鼠血脑屏障通透性的改变

目的通过敏感的荧光方法,定量分析慢性低灌注性脑缺血再灌注后大鼠血脑屏障(BBB)的通透性。方法雄性Wistar大鼠35只。大鼠分为模型再灌注组(n=25),模型不灌注组(n=5)和对照组(n=5)。模型再灌注组和模型不灌注组行右侧颈总动脉和颈外静脉端端吻合,同时结扎上矢状窦,建立大鼠脑动静脉瘘的动物模型;对照组单纯行右侧颈总动脉结扎。2周后,每组大鼠实验结束前2h尾静脉注射伊文思蓝(EB)。模型再灌注组阻断右侧颈总动脉和颈外静脉吻合部位形成缺血再灌注,采用EB荧光定量的方法分别观察再灌注2、3、9、24、48h时BBB的通透性。结果再灌注2h时,脑组织EB的含量为(0.935±0.166)μg/g,与对照组(0.489±0.132)μg/g相比显著增高(P<0.05),与模型不灌注组(0.713±1.217)μg/g相比显著增高(P<0.05)。再灌注24h达高峰,为(5.231±1.183)μg/g,再灌注48h趋于平稳,为(5.522±1.124)μg/g。结论慢性低灌注性脑缺血BBB通透性2周后增高;再灌注后2hBBB的通透性增高更具明显,再灌注24h达高峰,再灌注48h趋于稳定。     

Treatment of cerebral arteriovenous malformation

The management of cerebral arteriovenous malformation (AVM) is discussed. A series of 231 cases of AVM was treated from 1961 to March 1984 in our department. The treatments of these cases are classified as total removal 169, partial removal 8, feeder clipping 14, embolization 4 and conservative 36. Results at discharge and at follow-up are analyzed and the treatments evaluated. At follow-up, no rebleeding is reported in the patients who had undergone extirpation. Cases treated with other methods showed rebleedings and either their condition worsened due to hemorrhages or they died. On the basis of these results, it is suggested that AVM should be extirpated totally. Our surgical procedure consisted of temporary occlusion of feeders using cerebral protective substances, so called Sendai Cocktail (mannitol, Vitamin E, steroid). This procedure makes complete surgery safe. Surgical results of the cases which were totally extirpated were better than those reported in previous reports: the mortality rate was 3,6%, and the morbidity rate was 5,4%. Because of this, surgical treatment was preferred, that is when the location, size of AVM, age, patient's circumstances and the surgeon's experience allow. However, there are still cases which must be treated with other therapy. These patients are withheld surgery because they have inaccessible AVM or large AVM etc., whose operation would cause neurological deficits. For the treatment of these cases we have recently attempt the chemical embolization method with conjugated estrogen. This produced good outcomes. These non-surgical treatments such as embolization and irradiation have still some unsolved problems and progress in the future is anticipated.     

Management of pancreatic arteriovenous malformation

Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage. Received: January 27, 2000 / Accepted: April 6, 2000     

Intra-articular arteriovenous malformation of the knee

Two young men with longstanding suprapatellar masses are presented. The initial clinical diagnosis was of a synovial or soft tissue tumour. Magnetic resonance imaging showed the features of an arteriovenous malformation (AVM). Surgical exploration and biopsy confirmed the diagnosis. AVMs, although rare, should be considered as a possible diagnosis of a peri-articular swelling of the knee.     

Neuromagnetic assessment of epileptogenicity in cerebral arteriovenous malformation

Magnetoencephalographic (MEG) activities were recorded in five patients with cerebral arteriovenous malformation (AVM) who presented with epilepsy and no clinical history of intracranial hemorrhage, using a 37-channel DC superconducting quantum interference device (SQUID) system. While scalp-recorded electroencephalograms (EEG) failed to reveal paroxysmal discharge, MEGs demonstrated localized high frequency magnetic activity (HFMA). Magnetic source imaging (MSI) depicted the accumulation of equivalent current dipole (ECD) originating from HFMA around the nidus, and the ECD localization agreed well with spike localization on intraoperative electrocorticography (ECoG). These areas corresponded with the areas of hypoperfusion on single photon emission tomography and the intraoperative laser Doppler flow meter. We discussed the application of MEG in estimating interictal paroxysmal activity sources in patients with AVM and addressed the questions of its reliability and validity in source localization. Received: 16 August 1999 / Accepted: 14 March 2000     

Microsurgery for cerebral arteriovenous malformation management: a Siberian experience

Cerebral vascular malformations remain among the most difficult neurosurgical entities to treat. We report a retrospective study of the outcome in 95 consecutive patients with angiographically revealed arteriovenous malformations (AVMs). Fifty-four patients underwent microsurgical total AVM removal (group I). Forty-one patients who refused open surgery (group II) were managed either by endovascular embolisation (16 cases), radiosurgery (three) or followed up with medical treatment for their symptoms. In the first group pretreatment with the non-selective -blocker propranolol before surgery, the current neuronavigation techniques, intraoperative embolisation and AVM nidus colouring in high flow AVM were used for total microsurgical excision of the lesions. All AVM patients but one survived microsurgery. The mortality rate was 1.8% for group I. Six patients with grade IV–V AVM developed new temporal neurological symptoms following surgery. Four of them recovered completely in 3–6 weeks; two patients remained with mild persistent monoparesis and with homonymous hemianopsia postoperatively. In ten of 13 epileptic patients surgery produced a cure. No patient re-bled following surgery. No postoperative normal perfusion pressure breakthrough occurred. In the second group ten patients (24%) developed intracerebral haemorrhages, six of ten patients demonstrated progressive seizures. The mortality rate in group II totalled 17% over 6 years. Microsurgical management approaches must consider preoperative correction of impaired cerebral autoregulation, neuronavigation for preoperative planning and intraoperative orientation, intraoperative embolisation and dying of the nidus for large high-flow AVMs.     

Surgical resection of a cerebral arteriovenous malformation for treatment of superficial siderosis: case report

BACKGROUND

To our knowledge, there are only two reported cases of cerebral arteriovenous malformation associated with superficial siderosis. In both cases, the patients were asymptomatic and were discovered on retrospective review of magnetic resonance imaging.

CASE DESCRIPTION

We describe a case of superficial siderosis in a 47-year-old male with a remote history of closed head injury that presented with progressive hearing loss, cerebellar ataxia, and urinary incontinence. Lumbar puncture was indicative of active subarachnoid bleeding. Cerebral angiography revealed a small vascular malformation that was resected.

RESULTS

Pathological examination confirmed the diagnosis of the arteriovenous malformation. Six months after surgery the patient is neurologically stable with no further progression of clinical signs or symptoms.

CONCLUSIONS

We report the first case of surgical resection of an intracranial arteriovenous malformation for the treatment of superficial siderosis. We emphasize the necessity of a detailed evaluation when superficial siderosis is suspected to localize and resect potential bleeding sources, because the disease is progressive and often irreversible.     

Endovascular treatment of arteriovenous malformation

Vascular anomalies are common congenital or neonatal abnormalities. According to the approved classification of vascular lesions by Glowacki and Mulliken, hemangiomas and vascular malformations are distinguishable. Hemangiomas usually appear during the first days or weeks after birth and grow faster than the whole body of the infant. They are proliferating benign tumors that often involute. The opposite of hemangiomas, vascular malformations are present at birth, grow commensurately with the patient, demonstrate normal endothelial turnover, and never involute. The case of a young woman with an arteriovenous malformation (AVM) located on the left side of her face beneath the lower lip is described. The patient did not have any specific complaints except the cosmetic effect, which was a reddish and bluish discoloration of the skin over the lesion. The AVM was embolized with polyvinyl alcohol, and no subsequent surgery was performed. Follow-up ultrasound examination after a 12-month period showed no flow within the lesion area.     

Galenic arteriovenous malformation with precocious puberty

Pineal lesions may appear with precocious puberty. In this report, a patient with precocious puberty and macrogenitosomia caused by an arteriovenous malformation in the pineal region is presented. This vascular malformation was not visualized during investigations 3 years before the present series. It appears that the vascular malformation increased considerably in size within a 3-year period. This case suggests that some arteriovenous malformations may take a malignant course, increasing rapidly in size and behaving like tumors by causing destruction and compression of surrounding structures. This case seems to be unique because, to the best of our knowledge, an arteriovenous malformation associated with precocious puberty has never been described previously.     

Polypoid arteriovenous malformation in the jejunum of a child that mimics intussusception

Polypoid arteriovenous malformations, which are localized in the colon, are extremely rare in adults, with only 7 cases published to date. Here we present the case of a 6-year-old girl with a jejunal polypoid tumor that a sonogram and a computed tomographic scan have shown to resemble intussusception. Histologically, numerous large ectatic veins intermixed with small-caliber arteries, venules, arterioles, and capillaries were observed in the intestinal wall. A retrospective computed tomographic scan 3-dimensional angiographic reconstruction demonstrated that this may be a diagnostic characteristic. Clinical and morphologic comparisons with previously reported cases were discussed.