深部脑动静脉畸形的显微手术治疗

目的 探讨深部脑动静脉畸形(BAVM)的显微手术技巧及效果. 方法 吉林大学中日联谊医院自2001年1月至2008年6月对收治入院的70例深部BAVM患者采用显微手术治疗,其中70例患者脑部畸形血管团属小型(直径＜3 cm)31例,中型(直径3～6 cm)36例,巨大型(直径＞6 cm)3例;按Spetzler-Martin分级:Ⅰ级11例,Ⅱ级12例,Ⅲ级23例,Ⅳ级16例,Ⅴ级8例,对术中的显微手术技巧及术后疗效进行总结分析. 结果 70例患者深部畸形血管团术中均完整切除,27例复查MRI、8例复查DSA证实.1例Spetzler-MartinⅤ级患者术后发生正常灌注压突破.所有患者随访6个月～3年,均无复发及再次出血.8例术前脑疝患者术后3例重残,2例中残,3例生活能自理.10例癫痫患者术后服用抗癫痫药物症状得到控制.余患者术后未遗留明显神经功能障碍. 结论 深部BAVM血管构筑复杂,手术全切除最为彻底.高流量BAVM行术前栓塞及口服β受体阻滞剂,术中降低动脉压、延长麻醉苏醒时间,术后减少液体摄入及应用脱水疗法,可降低正常灌注压突破的发生率.

Microsurgery on deep-seated brain arteriovenous malformation

Objective To explore the skills and efficacy of microsurgery on deep-seated brain arteriovenous malformation (BAVM). Methods Seventy consecutive patients with deep-seated BAVM were treated by microsurgical resection in our hospital between January 2001 and June 2008.Thirty-one patients had the malformation with diameter of the malformed vessels less than 3 cm, 36 with that between 3 to 6 cm and 3 with that larger than 6 cm. The Spetzler-Martin grading scale was performed, showing 11 with grade Ⅰ, 12 with grade Ⅱ, 23 with grade Ⅲ, 16 with grade Ⅳ, and 8 with grade Ⅴ. Intraoperative microsurgical technique and postoperative effects were analyzed. Results All the malformations in patients with deep-seated BAVM were completely removed during the operation,which was proved by postoperative MRI in 27 patients and postoperative DSA in 8 patients. One patient with grade Ⅴ in the Spetzler-Martin scale suffered from normal perfusion pressure breakthrough (NPPB).No recurrence and re-bleeding were noted by follow-up from 6 months to 3 y. Of the 8 patients experienced preoperative herniation, severe disability was noted in 3, moderate disability in 2, and the other 3 could take care of themselves. The symptoms were controlled by taking anti-epileptic drugs in all the 10 patients with preoperative epilepsy. No neurological deficit was found in the other patients.Conclusions The angioarchitecture of deep-seated BAVM is complex and microsurgical resection is the most radical therapy. Preoperative embolization, and many other methods such as oral β-blocker,reducing the intraoperative blood pressure, prolonging the anesthesia time, reducing the fluid intake and dehydration therapy after operation can prevent the happening of NPPB.