大型脑动静脉畸形直接显微手术治疗的效果分析

目的通过总结大型脑动静脉畸形的显微手术经验，探讨脑动静脉畸形显微手术的效果以及正常灌注压突破对显微手术的影响。方法回顾性分析93例采用显微外科手术治疗的大型脑动静脉畸形病例，按照Spetzler—Martin分级，3级者37例，4级者35例，5级者21例。结果术后出现再出血及急性脑肿胀者3例（3．2％），死亡2例。术后对91例患者进行随访，根据GOS分级，恢复良好82例（90．1％），中残7例（7．7％），重残2例（2．2％）。结论显微外科手术是治疗大型脑动静脉畸形的有效手段，术前精确的判断及术中精细的操作是手术成功的关键。正常灌注压突破对大型脑动静脉畸形直接显微手术无显著影响。

Effect of direct microsurgical treatment of giant cerebral arteriovenous malformation

Objective To explore the effect of direct microsurgical treatment of giant cerebral AVM and the impact of normal perfusion pressure breakthrough （NPPB） on mierosurgery by analyzing the mierosurgical experiences of giant cerebral arteriovenous malformation （AVM）. Methods A total of 93 cases of giant cerebral AVM treated with microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, there were 37 cases of grade Ⅰ, 35 cases of grade Ⅱ, and 21 cases of grade Ⅲ. Results Postoperative bleeding and acute brain swelling occurred in 3 cases and 2 patients died. Among 91 cases followed-up after operation, good recovery was achieved in 82 cases （90. 1% ）, moderate morbidity in 7 eases （7.7%）, and severe morbidity in 2 eases （2.2%） according to GOS evaluation. Conclusion Microsurgery is an effective means for the treatment of giant cerebral AVM. Accurate preoperative assessment and good intraoperative operation play an important role in the treatment. There is no direct relation between NPPB and microsurgery of giant cerebral AVM.