在复合手术室治疗脑动静脉畸形的初步探讨

目的 总结在复合手术室治疗脑动静脉畸形的经验。方法 2013年12月至2014年12月在复合手术室治疗27例脑动静脉畸形患者，均行手术切除，术中造影判断畸形团是否残留，其中3例一期行切除术和血管内栓塞术。结果 27例中，4例（14.8%）术中血管造影显示畸形团残留，再次切除后行术中造影，显示畸形团消失；一期行切除术和血管内栓塞术3例（均为Spetzler-Martin分级Ⅲ级以上），术中出血明显减少，均完全切除畸形团。所有患者无造影相关的并发症。术后24例随访6个月至1年，失访3例；其中19例恢复良好，5例有轻度神经功能障碍。结论 在复合手术室治疗脑动静脉畸形能够提高疗效，降低手术相关并发症，为脑动静脉畸形治疗提供了一个新的安全有效的平台。

A preliminary study of hybrid operation for cerebral arteriovenous malformations

Objective To summarize the experience in treating cerebral arteriovenous malformations (AVMs) in the hybrid operating room. Method Twenty seven patients with cerebral AVMs were treated in hybrid operating room from December, 2013 to December, 2014. Microsurgery for resection of AVM was performed in all the patients. AVMs remnants were detected by intraoperative angiography. Three patients received endovascular embolization and AVMs surgical treatment at one-stage operation. Twenty four patients were post operatively followed up from 6 to 12 months. Results The intraoperative angiography showed that the AVM remnants disappeared after the second operation was performed in 4 patients in whom the intraoperative agiography showed AVMs remnants after the first operation. The AVMs were totally resected and the intraoperative bleeding was significantly reduced in 3 patients receiving both the endovascular embolization and microsurgery. All the patients had no complications related to the DSA. Of 24 patients followed up from 6 to 12 months, 19 recovered well and 5 had mild neurological defect according to modified Rankin Scale. Conclusions Hybrid operation provides a safe and effective Method for treatment of cerebral AVMs. The incidence of surgical complications may be reduced and the curative effect may be improved by surgery in the hybrid operating room.