脑动静脉畸形显微手术及其选择性治疗(附73例报告)

目的探讨脑ＡＶＭ显微手术、血管内栓塞及放射外科治疗的选择。方法以综合分级标准分级，对７３例脑ＡＶＭ治疗分析。显微直视手术脑ＡＶＭ６７例；其中行脑ＡＶＭ切除术６０例，畸形血管电凝夹闭术７例。对重要功能区的脑ＡＶＭ分别行血管内栓塞和γ－刀治疗各３例。结果　术后死亡１例，脑ＡＶＭ切除后５９例经造影复查（复查率９８％），见ＡＶＭ血管团消失。栓塞的病例经ＤＳＡ复查，显示畸形血管１例消失、２例缩小５０％；３例γ－刀治疗半年后复查，畸形血管团染影变淡、缩小。全组随访０．５～１０年，恢复原工作及可做轻工作者６８例占９３％。２例可生活自理。２例Ⅳ级者未能手术切除因再次出血而死亡。结论迄今，脑ＡＶＭ的显微手术仍是不能以其它治疗完全替代的主要方法。血管内栓塞是主要而获显效的方法之一，对大型、复杂的ＡＶＭ栓塞与手术结合是较佳方案。γ－刀治疗对脑ＡＶＭ是行之有效的，特别对小型、深部、功能区难以切除及不能接受手术或栓塞者更具有治疗适应证。

Microsurgical and selective treatment of cerebral AVM (report of 73 cases)

Objective To discuss selective treatment of cerebral arteriovenous malformation (AVM), including microsurgery, endovascular embolization and Gamma knife Methods Depending on the standard gradinganalysis has ben made of the of 73 patients with cerebral AVM. Among the 67 cases operated microsurgically sixtyme were treated by AVM resection, of whom 59 cases of grad I-III, and I case of grad III-IV, six patients with AVM located in main functional areas were treated by endonvascular embolization and Gamma knife ,each of 3 Gamma knife, each of 3 respectivelyResults After Opertion, one patient died (1.66% ). After AVM resection, angiography showed disappearance of AVM nidus in all cases. To cases of embolism, reexamination of DSA manifested disappearance of AVM nidusin 1 case and reductied of 50% in 2 cases. After 6 months, reexamination of the other 3 cases treated by Gammaknife showed that AVM nidus became maddy and reducted. FOolow-up all cases ranged from 6 months to 10 years.Excellent or po result were achieved in 68 patients (93.0% ), 2 patients could self independnt 2 inoperable cases ofgrad IV died of rebleeding. Conclusions Microsurgery could not be replaced by other therapy. To large and complexAVM, combine embolaztion and resection is relatively a good plan. To Patients with small AVM and located in deepor functional areas, which were unsuitable for resection or embolzation, Gamma knife is better indicated.