颅内动静脉畸形的治疗选择

目的总结颅内动静脉畸形的各种治疗措施及预后,探讨颅内动静脉畸形的合理治疗选择。方法 63例颅内动静脉畸形患者,手术治疗43例,保守治疗20例。患者有放射治疗史4例,后因合并症而手术切除。手术前曾行介入栓塞治疗者2例。结果手术治疗的43例中,经过造影检查证实全切除30例,不全切除13例,死亡5例,重残生存2例,轻度残疾或完全康复36例;保守治疗的20例中(12例为IV级病例),死亡5例,重残生存3例,轻度残疾或完全康复12例,随访提示再次出血3例,继发脑积水1例。结论手术全切除是颅内动静脉畸形最有效的治疗方法。对于无法手术的病例,建议患者行放射治疗或保守治疗和随访;介入栓塞治疗可作为巨大颅内动静脉畸形手术治疗前的辅助处理;对于放射治疗后出血或放射性脑病的病例,建议患者积极手术切除病灶。

Study on treatment of cerebral arteriovenous malformation (AVM) in 63 patients and their outcome

Objective To explore the rational treatment in patients with cerebral arteriovenous malformation （AVM）. Methods Forty three cases were treated by resection of AVM, while 20 cases were treated with conservative treatment. In resection group, 4 cases of them were done by radiation therapy before their resection, two cases were treated with embolization before resection, and 37 cases were only done by resection. Results In resection group, 30 cases were done with complete resection according to their post - operative MRI or DSA, while 13 cases with subtotal resection. Out of them, 5 cases died, 2 cases suffered with severe disability, and 36 cases were good after surgery. In conservative treatment group, 5 cases died, 3 cases were with severe disability, and 12 cases recovered after treatment, but 3 patients were re - bleeding, one case complicated with secondary hydrocephalus during the follow - up period. Conclusion Total resection is the best option for AVM, while conservative treatment and follow - up would be considered to be an acceptable option for safety of patients with high grade AVM. Preoperative embolization for large AVM is helpful for complete resection. Resection should be done for those with bleeding after radiation therapy or with radiational encephalopathy.