术中血管造影在脑动静脉畸形手术中的应用

目的:研究脑动静脉畸形(arteriovenous malfermation,AVMs)手术中脑血管造影的应用价值.方法:对41例AVMs患者在手术中进行脑血管造影.其中,男23例,女18例,年龄3～56岁[平均(34±8)岁].畸形血管团2～8 cm,其中巨大AVMs(直径≥6 cm)10例(24%).患者气管插管全麻后,经右侧股动脉插管,使导管到达手术涉及的颅内动脉.病灶处理完毕,进行血管造影.结果 :41例中有10例急性颅内出血患者手术前未造影,手术中经过血管造影证实为AVMs.39例(95%)经过造影证实病变处理满意,1例(2.4%)运动功能区AVMs有残留,1例(2.4%)后颅窝AVMs残存,此2例经过继续手术切除残余AVMs.本组无手术死亡,无造影相关并发症发生.术中血管造影需要时间25～130 min[平均(53±22) min].结论 :术中脑血管造影有助于医师及时发现残余AVMs,对小的AVMs进行定位,避免生理性供血动脉闭塞;立即修正技术缺陷,避免再次手术,降低手术后合并症发生率.

Intraoperative angiography in the surgery of brain arteriovenous malformations

OBJECTIVE: To evaluate the effect of intraoperative angiography in the surgery of brain arteriovenous malformations(AVMs). METHODS: Between July 2003 and February 2006, 41 consecutive patients of brain AVMs (18 female and 23 male patients, mean age 34 years) underwent cerebrovascular surgery assisted with intraoperative angiography in our institute. The nidus diameters of AVMs were from 2 cm to 8 cm, including 10 cases of large AVMs (diametre >or=6cm) which accounted for 24%. After intubation was achieved and general anesthesia was administrated, the patient's right femoral artery was catheterized successfully with catheter reaching the intracranial artery during the surgery. When the AVMs were resected, the intraoperative angiography was performed. RESULTS: Ten of 41 were patients underwent emergency operation because of acute intracranial hemorrhage without preoperative angiography, who were estimated as AVMs assisted with intraoperative angiography. The nidus had been totally resected in 39 of the 41 (95%) patients confirmed by intraoperative angiography, with 1 patient (2.4%) of motor dominant zone AVMs and 1 patient (2.4%) of posterior fossa AVMs had residual AVMs, which had been noted and resected. There was no operation mortality, no complication attributable to angiography. Intraoperative angiography consumed 25 to 130 minutes with mean time of 53 minutes. CONCLUSION: Intraoperative angiography can detect the location of small AVMs and unexpected residual AVMs nidus, help surgeons modify technical faults to prevent from re-operation, and decrease complication of cerebrovascular surgery.