脑动静脉畸形急性出血的诊断和治疗

【目的】探讨脑动静脉畸形（AVM ）破裂出血患者急性期的诊断、治疗经验及疗效。【方法】回顾性分析本院1999年5月至2013年1月48例脑 AVM 破裂出血患者急性期的不同治疗方案的临床资料和疗效。【结果】本组48例病例中,Ⅰ期血肿清除＋AVM显微切除术23例,Ⅰ期血肿清除＋Ⅱ期AVM显微切除术12例,非手术治疗＋AV M畸形团切除术8例,非手术治疗（或单纯血肿清除）＋γ刀治疗2例;单纯血肿清除术3例。本组2例死亡,5例重残,其余41例患者神经功能较术前均有不同程度改善。【结论】掌握脑AVM破裂出血的手术策略和显微外科技巧,Ⅰ期清除血肿同时切除病灶预后较好。     

小型脑动静脉畸形出血35例

我科 1988年 1月至 1999年 10月共收治经 CAG、CT、MRI及手术证实脑动静脉破裂急性出血 35例 ,其中手术治疗 34例、γ刀治疗 1例 ,效果满意 ,报告如下。1　临床资料1.1　一般资料 :本组 35例 ,男 2 4例 ,女 11例 ,年龄 7～ 6 5岁 ,平均 2 1.5岁。小于 30岁 34例 ,大于 31岁 1例。有高血压病史 1例 ,外伤史 4例。有头痛、头晕病史 15例 ,肢体麻木3例。1.2　临床表现 :突然剧烈头痛 35例 ,呕吐 10例 ,肢体麻木 3例 ,癫发作 2例。深昏迷 3例 ,浅昏迷 15例 ,嗜睡 10例 ,清醒 7例。单侧瞳孔散大 7例 ,双侧瞳孔散大 1例 ,偏瘫或轻瘫13例 ,颈…     

脑动静脉畸形破裂出血的急诊显微手术治疗

笔者科室自2000年1月-2008年12月对破裂出血的脑动静脉畸形（anlerioventus malformation,AVM）患者51例实施急诊手术治疗,效果满意,报告如下。     

127例脑动静脉畸形破裂出血的危险因素分析

目的探讨分析脑动静脉畸形破裂出血的相关危险因素。方法回顾性分析127例脑动静脉畸形患者的临床资料,破裂出血患者(71例)作为出血组,未发生破裂出血患者(56例)为对照组。对两组患者的临床资料进行因素分析。结果单因素分析显示,出血组与对照组的畸形血管团位置、畸形血管团大小、供血动脉位置、引流静脉的方向、合并动脉瘤及所合并动脉瘤大小比较差异有统计学意义(P<0.05);非条件多因素Logistic回归分析结果显示,位于深部的小于3cm血管团、深部引流静脉、合并动脉瘤与脑血管畸形是破裂出血的危险因素(P<0.05,OR>1)。结论对于深部血管团小于3cm、深部引流静脉、合并动脉瘤的脑血管畸形患者,应尽早实施手术治疗。     

脑动静脉畸形并发颅内血肿21例临床分析

分析２１例脑动脉畸形并发颅内出血，并对其出血相关因素及治疗进行探讨。     

X-刀治疗颅内疾患26例

目的 探讨Ｘ－刀治疗颅内疾患之特点与疗效评价。方法 总结２６例Ｘ－刀治疗计划，分析Ｘ－刀术后随访情况。结果 早期综合有效率８８．２７％，无严重并发症。结论Ｘ－刀引起的生物学效应是一个复杂、长期的过程，评价其确切效果需经多年的随访观察，治疗计划的优化常受到靶周神经结构的制约，有时甚至影响适应证的选择；大体积肿瘤不太适合Ｘ－刀；Ｘ－刀可作为脑胶质瘤综合治疗的一个手段。     

血管内栓塞治疗在脑动静脉畸形治疗中的作用

目的：评价血管内栓塞在脑动静脉畸形治疗中的意义。方法：1999－03／2001－03采用血管内栓塞治疗脑动静脉畸形148例,其中栓塞后87例采用显微外科手术切除,9例建议行政放射外科治疗。根据Spetzler-Martin计分标准。Ⅰ级18例,Ⅱ级20例,Ⅲ级21例,Ⅳ级50例,Ⅴ级35例,Ⅵ级4例。治疗主要采用血管内栓塞治疗,及栓塞后显微外科切除和г－刀或X－刀治疗。结果：148例血管内栓塞治疗的脑AVM,100％闭塞33例（22．3％）,75％以上闭塞66例（44．6％）,闭塞50－75％26例（17．6％）,闭塞小于50％23例（15．5％）,栓塞后并发症4例（2．7％）。87例栓塞后接受显微外科手术切除,病灶完全切除82例（94％）,次全或大部切除5例（6％）,术后4例出现并发症（4．6％）。9例接受放射外科治疗的患,3例照射后2a随访造影显示病灶完全闭塞,无照射相关的并发症。结论：包括显微神经外科手术,血管内栓塞和放射外科在内的综合治疗是治疗脑AVM的安全、有效的手段,单纯栓塞除可治愈部分病例外,通过栓塞可使大部分AVM病灶减少,适合于手术切除和放射外科治疗,成功率高,并发症低。     

伽玛刀治疗脑动静脉畸形长期疗效分析

我院自1995年8月1日开始利用Leksell伽玛刀（γ-刀）治疗颅内各种疾病，至今已10年余，其中脑动静脉畸形394例，现对2002年12月31日前接受γ-刀治疗的脑动静脉畸形（cAVM）并且随访资料完全的341例进行统计分析，进一步探讨γ-刀治疗cAVM的疗效及其影响因素。     

脑动静脉畸形并发颅内血肿21例临床分析

分析２１例脑动脉畸形并发颅内出血，并对其出血相关因素及治疗进行探讨。     

脑动静脉畸形急性出血的手术治疗分析

目的 探讨脑动静脉畸形破裂急性出血的手术治疗方法.方法 回顾性总结2003～2008年该科收治的36例脑动静脉畸形(AVM)急性破裂出血患者行手术治疗的病例.结果 36例均行手术治疗,术后优良27例,痛残7例,死亡2例.结论 脑动静脉畸形破裂出血急性期及时的外科手术治疗安全有效,后遗症较少,应成为脑AVM合并出血患者治疗的最佳选择,是其首选方法.     

脑动静脉畸形手术治疗体会

目的讨论颅脑动静脉畸形的临床特征和临床治疗方法,以及治疗新进展。方法分析该病的临床表现、影像学特征、探讨其治疗方法,通过两例典型的病例进行讨论。结果手术全切除59例,占92％,部分切除5例,占8％。结论手术治疗是目前治疗脑动静脉畸形并出血的有效方法。     

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects

Background Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations （BAVMs）. Ethylene vinyl alcohol copolymer （Onyx） is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique. Methods From September 2003 to November 2007, 115 patients （43 women and 72 men, with a mean age of 29 years） with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment： type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed. Results The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients （26.1%）, near-total （〉80% of the original volume） occlusion was obtained in 35 patients （39.8%） and partial occlusion （〈80% of the original volume） was obtained in 30 patients （34.1%） using embolization as the sole therapeutic technique. Mean volume reduction was 72% （range 30%-100%） in 115 patients. Thirty four patients （38.6%, 34/88） underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients （16.5%, 19/115）, leading to death in one patient （mortality 0.9%） and permanent disabling in 3 patients （morbidity 2.6%）. Conclusions Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.     

Onyx in treatment of large and giant cerebral aneurysms and arteriovenous malformations

Onyx, a novel embolization material, is a mixture of ethylene-vinyl alcohol copolymer ( EVOH ), dimethyl sulfoxide (DMSO), and micronized tantalum. The polymer is dissolved in DMSO and is prepared in different concentration. Onyx HD-500 for aneurysm embolization contains 20% copolymer and 80% DMSO. Onyx-18 for arteriovenous malformations ( AVMs ) embolization contains 6.0% copolymer and 94. 0% DMSO. When Onyx comes in contact with water or blood, the copolymer precipitates because of rapid diffusion of the DMSO solvent. It possesses stronger cohesiveness, but less likely to entrap the microcatheter. From September 2003,     

Onyx in treatment of large and giant cerebral aneurysms and arteriovenous malformations

Onyx, a novel embolization material, is a mixture of ethylene-vinyl alcohol copolymer (EVOH), dimethyl sulfoxide (DMSO), and micronized tantalum. The polymer is dissolved in DMSO and is prepared in different concentration. Onyx HD-500 for aneurysm embolization contains 20% copolymer and 80% DMSO. Onyx-18 for arteriovenous malformations (AVMs) embolization contains 6.0% copolymer and 94.0% DMSO. When Onyx comes in contact with water or blood, the copolymer precipitates because of rapid diffusion of the DMSO solvent. It possesses stronger cohesiveness, but less likely to entrap the microcatheter. From September 2003, we have used Onyx to treat large and giant cerebral aneurysms and AVMs successfully in 10 patients. Here we report our preliminary experience with the Onyx technique.     

Clinical and pathological changes in cerebral arteriovenous malformations after stereotactic radiosurgery failure

Background Stereotactic radiosurgery is an altemative to resection of intracranial cerebral arteriovenous malformations （AVMs）, while it will fail in some cases. This study aimed to evaluate the changes after stereotactic radiosurgery for AVMs.
Methods Nineteen cases with cerebral AVMs had failure after stereotactic radiosurgery therapy. The symptoms and angiography were assessed. All patients underwent microsurgery. Pathologic examination was performed for all cases and electron microscopic examination was carried out in 6 patients.
Results Seven cases had hemorrhage from 12 to 98 months after stereotactic radiosurgery, 5 had headache, 4 had refractory encephalon edema, 2 had epilepsy as a new symptom and 1 had a pressure cyst 5 years after radiosurgery. Angiography in 18 cases, 8-98 months after radiation therapy, demonstrated no significant changes in 5 cases, slight reduction in 9, near complete obliteration in 1 and complete obliteration in 3. An abnormal vessel was found on pathologic examination in 17 cases, even one case had obliterated in angiography. Electron microscopy examination showed vessel wall weakness, but the vessels remained open and blood circulated. One case died because of a moribund state before surgery. The other 18 cases had no new neurological deficiencies, seizure control and no hemorrhage occurred after microsurgery at an average follow-up of 3 years.
Conclusion Stereotactic radiotherapy for AVMs should have a long period follow-up. If serious complications occur, microsurgery can be performed as salvage treatment.     

脑动静脉畸形手术前和放射外科治疗前的栓塞治疗

目的：探讨脑动静脉畸形手术前和放射外科治疗前栓塞方法的特点和效果。方法：21例在术前或放射外科治疗前均以α-氰基丙烯酸正丁酯（NBCA）进行栓塞,其中2例先以真丝线段栓塞以减慢血流,再以NBCA栓塞。结果：7例拟行手术患和14例拟行放射外科治疗患栓塞后畸形血管团体积均有不同程度缩小。结论：手术前和放射外科治疗前行畸形血管团的栓塞,可明显提高脑动静脉畸形手术和放射外科治疗的效果。     

术中血管造影在脑动静脉畸形手术中的应用

目的:研究脑动静脉畸形(arteriovenous malfermation,AVMs)手术中脑血管造影的应用价值.方法:对41例AVMs患者在手术中进行脑血管造影.其中,男23例,女18例,年龄3～56岁[平均(34±8)岁].畸形血管团2～8 cm,其中巨大AVMs(直径≥6 cm)10例(24%).患者气管插管全麻后,经右侧股动脉插管,使导管到达手术涉及的颅内动脉.病灶处理完毕,进行血管造影.结果 :41例中有10例急性颅内出血患者手术前未造影,手术中经过血管造影证实为AVMs.39例(95%)经过造影证实病变处理满意,1例(2.4%)运动功能区AVMs有残留,1例(2.4%)后颅窝AVMs残存,此2例经过继续手术切除残余AVMs.本组无手术死亡,无造影相关并发症发生.术中血管造影需要时间25～130 min[平均(53±22) min].结论 :术中脑血管造影有助于医师及时发现残余AVMs,对小的AVMs进行定位,避免生理性供血动脉闭塞;立即修正技术缺陷,避免再次手术,降低手术后合并症发生率.     

脑动静脉畸形血管内栓塞的影响因素及治疗进展

血管内栓塞治疗已成为治疗脑动静脉畸形(BAVM)的主要方法之一,随着微导管技术及栓塞材料不断完善,对BAVM的认识逐步提高,疗效也越来越好。本文总结了BAVM血管内栓塞的影响因素及治疗进展。     

侧裂区动静脉畸形的手术治疗

目的 探讨侧裂区动静脉畸形(AVM)的手术治疗效果.方法 回顾性分析2000年1月至2009年3月于北京天坛医院神经外科脑血管病区手术治疗的94例侧裂区AVM患者临床资料.根据畸形血管巢与侧裂的解剖学相对位置关系对其进行分类,同时记录术后神经系统并发症及恢复情况.结果 94例侧裂区AVM可分为侧裂前、侧裂后、侧裂深部、侧裂上以及单纯侧裂AVM 5类.所有患者均全切病灶并经术后脑血管造影(DSA)证实.术后神经系统并发症多为一过性,包括偏瘫8例(合并失语5例),单纯失语1例.另有2例(2.1%)术后分别出现手术侧硬膜外血肿及颅内出血.所有患者出院时KPS评分均高于90分.结论 侧裂区动静脉畸形可累及多个脑功能区,周围血供丰富,是目前AVM治疗的难点之一.但其治疗不应过于保守,仍建议显微手术切除作为此类颅内动静脉畸形的主要治疗手段.

Abstract：

Objective To evaluate the microsurgical treatment for sylvian fissure arteriovenous malformations (AVMs).Methods The clinical data of 94 sylvian fissure AVMs treated microsurgically was retrospectively collected.They were classified as medial, lateral, deep, anterior and simple AVMs according to the anatomic location of nidus in sylvian fissure.Results Total lesion removal was achieved in all patients and it was confirmed by postoperative digital subtraction angiography. Transient neurological deficits, including slight hemiparesis (n=5, 5.3%) and aphasia (n=4, 4.3%), were documented.Another 2 patients (2.1%) presented with a postoperative epidural and an intracranial hematoma respectively. However, an excellent outcome was observed in all patients as indicated by the Karnofsky performance scale >90.Conclusion The microsurgical treatment for sylvian fissure AVMs has been greatly restrained by the involvement of multiple brain functional regions and its anatomic complexity. A more aggressive approach is recommended.