摘要
目的：探讨并总结大型脑动静脉畸形（AVM）的显微外科手术治疗策略及手术要点。方法回顾性分析71例大型 AVM病例，按照 Spetzler-Martin 分级，3级者31例，4级者25例，5级者15例，均采用显微手术治疗，其中30例有高出血风险者行术前血管内栓塞。65例全切，6例少量残留，2例残余动静脉畸形外院行伽玛刀治疗。出院行格拉斯哥预后评分（GOS）评价预后。结果1例术前持续昏迷术后轻度改善，余病例主要并发症有偏盲、轻度失语、肌力下降及癫痫等，术后均得到较好恢复。无长期昏迷及死亡病例。术后随访 GOS，恢复良好61例（85．9％），中残8例（11．2％），重残2例（2．8％）。结论大型 AVM治疗风险较高，显微外科手术是治疗 AVM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，术前血管内栓塞为 AVM的治疗提供了新思路。
Objective To analyze and summarize the microsurgical treatment strategy and key points of operation for large arteriovenous malformations（AVMs）.Method A total of 71 cases of giant AVMs were operated with the microsurgical treatment.According to Spetzler-Martin grading system,there were grade Ⅲ in 31 cases,grade Ⅳ in 25 cases,and gradeⅤ in 1 5 cases.All AVMs were removed using microsurgical techniques.Among them,30 cases with a high risk for bleeding used endovascular treatment before the operation.There were 65 cases of total resectionof AVMs,and 6 cases of subtotal resection.Two cases with residueswere treated with gamma knife after operation.And GOS was used to evaluate progno-sis.Results One case with persistent coma before operation was improved.And other cases were welly recovered.Major complications included hemianopia,mild aphasia,degenerated muscle strength,andepi-lepsy.None of the patients had longterm coma or death.According to the GOS score,61 patients（85.9%） was welly recovered,8 cases（1 1 .2%）had mild disability,and 2 cases（2.81 %）had severe disability. Conclusion The treatmentoflarge AVMs is highly risky.Microsurgical resection of the AVMs is an effec-tive method to cure the disease.Accurate preoperative assessment and skilled microsurgical technique play important roles in a successful surgery and preoperative endovascularembolization provides a new idea for large AVMs.
出处
《临床外科杂志》
2015年第6期428-430,共3页
Journal of Clinical Surgery
关键词
大型脑动静脉畸形
显微手术
血管内栓塞
large arteriovenous malformation
microsurgical operation
endovascularemboli-zation
