破裂出血的脑动静脉畸形的治疗分析(附42例病例报告)

目的总结单用onyx胶栓塞或结合显微手术治疗以颅内出血为表现的动静脉畸形(AVM)的经验。方法选择2010—2013年临床表现为自发性颅内出血的42例患者,造影明确为脑动静脉畸形,单使用onyx胶栓塞或结合显微手术治疗,进行疗效及并发症分析。结果自发性颅内血肿量较少的I-II级AVM患者中17例仅使用onyx胶栓塞,获得痊愈机会。5例部分栓塞及复查显影的行Y刀治疗。10例颅内血肿量较大,在1~5 d内开颅手术的II-III级AVM患者,术前部分栓塞,降低开颅手术风险。5例IV级AVM,急性期栓塞瘤巢内动脉瘤,降低短期再出血几率,为后期续贯栓塞提供机会。结论对表现为颅内出血的AVM患者,识别血管构筑学特点,并行完全或靶向性栓塞,可获得较好临床疗效。

Analysis the effect of treat the ruptured cerebral arteriovenous malformation

Objective Summary the experience in treat the ruptured cerebral arteriovenous malformation with onyx embolization （and） microsurgery. Methods 42 patients with ruptured CAVM from 2010 -2013 were retrospectively reviewed , summary and analysis the effect and complication. Results 17 patients with Spetzler - Martin gradeI - II, the hematoma doesn＇t need surgical resection, were completely occlu- ded with onyx embolization ;5 patients part embolization and recheck reappear given Y - knife treatment. 10 patients with Spetzler - Martin grade II - III , the hematoma need surgical resection or residual nidus after embolization, preoperation embolization to lower the surgery risk. 5 patients with Spetzler - Martin grade IV , embolization the aneurysm at the nidus , lower the rebleeding , given the chance to multi - embolization by stages. Conclusion For patients with ruptured cerebral arteriovenous malformation , identification the angioarchiteetures characteristics, completely or targeting embolization is safe and feasible.