15例脑动静脉畸形的手术治疗

目的讨论手术切除治疗脑动静脉畸形（AVM）。方法回顾性分析我院自2006年5月～2009年12月间显微手术治疗的15例脑AVM。结果本组术后无死亡病例。术后1天内出现残腔血肿1例,占本组的6.7%,3天内局部脑肿胀2例,占本组的13.3%,以上3例均经加强脱水降颅压、控制血压等治疗而好转。术后患者无再次癫痫发作病例。其余12例（占本组的80.0%）恢复良好,复查DSA均显示脑动静脉畸形已全切除。本组15例随访DSA3年,均无脑动静脉畸形复发病例。结论开颅手术切除是治疗大中型脑AVM的有效手段。在治疗时,应该积极防治正常灌注压突破出血及其他并发症,通过精细的显微手术操作以获得更好的治疗效果。     

颅内动静脉畸形14例手术治疗分析

目的：探讨颅内动静脉畸形（AVM）外科治疗的临床疗效。方法：采用开颅手术切除畸形血管团方法治疗颅内AVM14例。结果：14例中治愈13例，术后死亡1例。存活13例，11例获随访1月-10年，术后未出现新的神经功能障碍，术后未见癫痫再发作，头痛症状消失或明显减轻。结论：颅内动静脉畸形急性出血期以手术治疗为主，未出血者或病情允许的情况下，外科手术联合介入治疗疗效更佳。     

MR定位：伽玛刀治疗颅内动静脉畸形的评价

73例颅内动静脉畸形(AVM),MR定位、伽玛刀治疗和术后随访。全部定位图像病灶边缘清晰,距离检测精确度100％。其中11例(15％)头架固定点局部颅皮和颅骨信号消失;5例(7％)局部脑组织边缘出现浅弧样高或低信号影;余57例(78％)无伪影。按Spetzler-Martin法分类。术后6～23个月的过程中,AVM病巢闭塞率为:Ⅱ度83％,Ⅲ度54％,Ⅳ度35％,Ⅴ度25％,Ⅵ度50％。术后病灶周围水肿32例,患者无死亡。认为,MR定位是伽玛刀治疗颅内AVM安全、有效的方法。     

脑动静脉畸形4例报告

目的探讨脑动静脉畸形（AVM）的临床特征、治疗方式的选择及操作技巧。方法回顾分析4例脑动静脉畸形患者的临床资料。结果右额脑动静脉畸形1例，左额脑动静脉畸形1例，右颞脑动静脉畸形1例，左颞脑动静脉畸形1例。其中1例为外伤后无意中发现，其余3例均以脑出血为首发表现。4例均经过手术治疗完全切除，均无任何后遗症。结论治疗AVM的基本目标是降低自发性出血的风险。对于已经出血的AVM可以积极手术治疗，对于无症状的巨大AVM，在条件允许的情况下手术切除仍是最根本的治疗方法。     

多发性肺动静脉畸形

患者女性,19岁.腹痛发热3天,除了2周前因扁桃体炎行扁桃体摘除术外无医疗问题,体查发现,患者发热,右上腹触痛,WBC计数13430/mm3,多核细胞79％,C反应蛋白升高,为97mg/L.尿液分析、肝功、胰腺功能均无异常.腹部超声发现肝右叶有一病灶,螺旋CT增强显示肝脏内有一直径为3cm的肝脓肿(见图A).肺CT肺窗显示     

提议一个动静脉畸形放疗的分级方法

目的　放射外科对经适当选择的动静脉畸形患者是一种有效的治疗手段 ,目前用来预测动脉畸形切除后结果的分级方法 ,不能很好用来预测 AVM放射治疗结果。方法与结果　第一组 1987- 1991年共 2 2 0例 AVM患者 ,经放射治疗后 ,通过对该组患者数据资料用多因素分析方法 ,形成一个预测 AVM放疗结果的分级方法。患者有优良的治疗结果是 AVM完全消失 ,而没有新的神经功能缺损。这个分级方法被另一个治疗中心使用在 1990 - 1996年的另外 13 6例 (第二组 ) AVM患者治疗过程中。第一组有 15 1(5 5 % )例有优良的结果 ,多因素分析表明 ,有 5个因…     

血管内介入治疗脑动静脉畸形

目的 探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性．方法 应用血管内栓塞治疗脑AVMll例，栓塞剂为NBCA，栓塞后3例行手术切除，3例行γ-刀治疗．结果 1例完全栓塞，5例栓塞70％—90％，3例栓塞50％—70％，2例栓塞小于50％．生活、工作完全正常治愈5例，症状明显改善4例，症状无改善2例．结论 血管内栓塞治疗脑AVM的方法是相对安全的，可治愈部分脑AVM，对于大型、重要功能区的脑AVM，血管内栓塞联合手术或放疗可提高治愈率，降低致残率和死亡率．     

Chiari畸形Ⅰ型手术治疗的显微解剖基础

目的探讨研究Chiari畸形I型手术治疗的显微解剖基础。方法选取中山大学附属第一医院神经外科共31例Chiari畸形Ⅰ型患者分析随访。结果术中发现Chiari畸形Ⅰ型患者具有显微解剖异常,以此指导手术治疗取得较好效果。结论充分深入了解Chiari畸形Ⅰ型的显微解剖基础是获得良好治疗效果的保证。     

颅内动静脉畸形患儿血管内栓塞术后出血的危险因素分析

目的探究颅内动静脉畸形(cAVM)行血管栓塞治疗术后出血发生率及相关危险因素。方法选取2013年8月至2018年8月于我院脑外科行血管内栓塞治疗的cAVM患者180例为研究对象,观察其术后1周颅内出血发生情况,比较出血及未出血患者临床资料及畸形血管团特点,采用Logistic回归分析法探究cAVM栓塞术后出血的危险因素。结果cAVM栓塞术后出血发生率为17.78%,多于术后3 d内发生,以脑实质出血最常见。单因素分析显示,高血压史、出血史、畸形血管直径、深静脉引流、合并动脉瘤、栓塞体积、引流静脉栓塞及术后血压未达标与术后出血有关(P<0.05),而性别、年龄、癫痫史、畸形血管位置、S-M分级、栓塞时间及术后使用脱水剂与术后出血无关(P>0.05);多因素分析显示,出血史、深静脉引流及引流静脉栓塞是血管内栓塞术后颅内出血的独立性危险因素(P<0.05)。结论出血史、深静脉引流及引流静脉栓塞是cAVM栓塞术后出血的独立性危险因素,正确认识并在手术过程中采取相应的防范措施有利于降低栓塞出血并发症的发病率。     

Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization

Purpose

To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM).

Materials and Methods

Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies.

Results

A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure-related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term.

Conclusion

Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.     

Arteriovenous malformation phenotype resembling congenital hemangioma contains KRAS mutations

Extracranial arteriovenous malformation (AVM) is most commonly caused by a somatic mutation in MAP2K1. We report two patients with vascular anomalies that had an unclear clinical diagnosis most consistent with either an AVM or congenital hemangioma. Lesions were cutaneous, reddish-purple with telangiectasias, present at birth, and had defined borders. Histopathology indicated AVM and both lesions contained somatic KRAS mutations. A rare AVM phenotype exists that shares clinical features with congenital hemangioma.     

105例脑动静脉畸形并出血的外科治疗

目的探讨脑动静脉畸形及合并出血后外科治疗方法的选择。方法105例病人根据脑动静脉畸形的分级、出血的部位、出血量的大小及病人的状况等选择手术、栓塞或栓塞后手术等方法治疗。结果手术组60例,全切除55例,占92%;部分切除5例,占8%。血管内治疗40例,一次全部栓塞的15例,占37%;分次全部栓塞的18例,占45%;部分栓塞的7例,占18%。血管内治疗后手术5例,全切除3例,占60%;部分切除2例,占40%。治愈91例,治愈率为86%;好转6例,占6%;死亡8例,占8%。结论手术治疗和血管内治疗是目前治疗脑动静脉畸形并出血的有效方法。     

血管内介入治疗脑动静脉畸形

目的探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性. 方法应用血管内栓塞治疗脑AVM 11例,栓塞剂为NBCA,栓塞后3例行手术切除,3例行γ-刀治疗.结果 1例完全栓塞,5例栓塞70%～90%,3例栓塞50%～70%,2例栓塞小于50%.生活、工作完全正常治愈5例,症状明显改善4例,症状无改善2例.结论血管内栓塞治疗脑AVM的方法是相对安全的,可治愈部分脑AVM,对于大型、重要功能区的脑AVM,血管内栓塞联合手术或放疗可提高治愈率,降低致残率和死亡率.     

Systemic-to-pulmonary vascular malformation of lung visualized by computer-assisted 3-D reconstruction

 

Aims:

While a growing number of cases with pulmonary arteriovenous malformation (PAVM) have been reported, detailed analysis has yet to be found on the relation of abnormal vessels with the whole lung vasculature and airways. To gain more insight into the structure–function interrelation of this disease, we attempted to visualize the vessels in and around the arteriovenous malformation, resorting to computer-aided 3-D reconstruction.  

Methods and results:

The material was the upper lobe of the right lung from a 44-year-old man resected for recurrent haemoptysis. On pre-surgical selective angiography, an arteriovenous communication was suggested to exist between a tributary of the right 3rd intercostal artery and pulmonary vein. Semi-serial sections were prepared from the material and submitted to 3-D reconstruction of blood vessels and airways. In 3-D images, branches of the 3rd intercostal artery proved to be forming a plexus of abnormally dilated, thin-walled vessels in the subepithelial layer of a membranous bronchiole, a situation clearly explaining the mechanism of haemoptysis. There was no capillary bed interventing between the afferent arteries and draining vessels leading to the pulmonary vein.  

Conclusions:

This presents the first overall visualization of PAVM, allowing comparison of 2-D microscopy with the corresponding 3-D morphology.     

Cecal Polypoid Arteriovenous Malformations Removed by Endoscopic Biopsy

Colonic arteriovenous malformation (AVM) is one of the causes of lower gastrointestinal bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or elevated bright red lesion. Herein, we report a case of non-solitary and small cecal AVMs which were removed by endoscopic biopsy. A 66-yr-old woman was referred for routine gastrointestinal cancer screening. She was suffering from diabetes, hypertension, end-stage renal disease, and anemia of chronic disease. On colonoscopic finding, three semi-pedunculated polyps, less than 5 mm in size, were noticed near to the appendiceal orifice. Since the lesions revealed normal-looking epithelium with converging folds on the cecal base, lesions were diagnosed as inflammatory polyps on gross finding. Three biopsies were taken from each lesion. Bleeding from the biopsied site ceased spontaneously. Histopathologic evaluation demonstrated intramucosal hemorrhage and dilated submucosal vessels which were consistent with polypoid colonic AVMs.     

Arteriovenous anastomoses of major crural vessels in humans

Arteriovenous anastomoses of the major crural vessels were studied postmortem. The revealed anastomoses were examined by histological technique. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 7, pp. 111–112, July, 2004