脊髓和脑动脉静脉畸形血管构筑及其异同研究进展

脊髓AVM由多条动脉供血,多条静脉引流,位于颈段的AVM还可通过脑静脉窦回流。脊髓AVM最早发生在胎龄3周前,据血管构筑学可细分为终末型供血型、穿支供血型、动静脉直接交通、AVM伴有动脉瘤及AVM伴有静脉动脉瘤样扩张五类,根据不同类型选择相应治疗方法。脑AVM的供血动脉及回流静较少,神经外科对脑AVM常用SpetzlerMartin分类法,在放射学领域则采取其它分类。极少数患者出现畸形团的自发闭塞,但未能排除闭塞畸形团再通的可能,故对这些患者还须定期随访。今后当加强脊髓AVM的血管构筑学研究,更新理念。血管构筑学并非只依赖解剖、放射等学科的形态学,还应重视流动血液与周围组织的影响,与血液流变学、血流动力学等结合,改进观察手段,变单维为多维,变静态为动态,并开展前瞻随机对照研究,成为一门动态的、更完善、更明确的学科。

The advances of angioarchitecture variety ofspinal and cerebral arteriovenous malformation

Spinal arteriovenous malformations(SAVMs) are feed by multiple arteries,and drain through multiple veins,the ones in the cervical segment can also drain through cerebral venous sinuses.The earliest spinal cord arteriovenous malformation occurs 3 weeks before gestational age,according to angioarchitecture,it can be divided into terminal supply,perforation branch,direct arteriovenous shunt,AVM associated aneurysm and AVM associated venous pouch,and treated by relative therapies.Supply arteries and drain veins are relatively fewer in cerebral arteriovenous malformations(CAVMs),in neurosurgery,they are usually typed in Spetzier Martin grade,and in radiosurgery and interventional radiology,they are typed in other grades.Rare patients can occur spontaneous obliteration,but recanalize still can't be eliminated,follow up is necessary.In the future we should put more importance to the angioarchitecture of SAVMs and renew our conception.Angioarchitecture is not only depend on human anatomy or radiology but also should consider the effect of blood flow and peripheral tissue,and combine with hemorheology and hemodynamics,improve observing methods,turn monodimension into multidimension,turn static into development,and carry out prospective random control test,to develop as a developing,more consummate and clearer subject.