CAJ | 학술논문

目的评价外科手术治疗巨大动静脉畸形(AVM)的效果和新进展,以及影响手术效果的因素.方法回顾46例经手术治疗的巨大动静脉畸形患者的临床资料,术前评估包括临床症状、MRI、脑血管造影(DSA)、Spetzler-Martin分级.男25例,女21例,平均年龄30.6岁.主要症状有癫痫、头痛、出血和神经功能缺陷.Spetzler-Martin分级:Ⅲ级8例,Ⅳ级22例,Ⅴ级16例.所有患者都进行了显微外科手术治疗,术后1周复查DSA,对术后短期和随访后患者的生活质量进行KPS评分.结果术后DSA示1例病变有残留.9例出现严重并发症,1例死亡.并发症包括偏瘫(15例)、失语(6例)、偏盲(9例)、颅神经功能缺陷(5例)和癫痫(5例).6例患者出现正常灌注压突破(NPPB).共随访41例患者,时间6～108个月,4例死亡(2例与手术有关),33例患者生存质量较好.结论巨大动静脉畸形的治疗致残率和致死率较高,尤其是Spetzler-Martin Ⅴ级的病例.因此术前评估和治疗策略对患者的预后具有重要的影响.
목적 평개외과수술치료거대동정맥기형(AVM)적효과화신진전,이급영향수술효과적인소.방법 회고46례경수술치료적거대동정맥기형환자적림상자료,술전평고포괄림상증상、MRI、뇌혈관조영(DSA)、Spetzler-Martin분급.남25례,녀21례,평균년령30.6세.주요증상유전간、두통、출혈화신경공능결함.Spetzler-Martin분급:Ⅲ급8례,Ⅳ급22례,Ⅴ급16례.소유환자도진행료현미외과수술치료,술후1주복사DSA,대술후단기화수방후환자적생활질량진행KPS평분.결과 술후DSA시1례병변유잔류.9례출현엄중병발증,1례사망.병발증포괄편탄(15례)、실어(6례)、편맹(9례)、로신경공능결함(5례)화전간(5례).6례환자출현정상관주압돌파(NPPB).공수방41례환자,시간6～108개월,4례사망(2례여수술유관),33례환자생존질량교호.결론 거대동정맥기형적치료치잔솔화치사솔교고,우기시Spetzler-Martin Ⅴ급적병례.인차술전평고화치료책략대환자적예후구유중요적영향.
Objective To review surgical outcomes in treating intracranial Giant arteriovenous malformations (AVMs). To find out the prognosis factors of surgical treatment. Methods We collected 46consecutive cases of giant AVMs treated at Beijing Tiantan Hospital, reviewed the radiological and SpetzlerMartin grading. 25 of the patients selected were male (54%), and 21 were female (46%), with a mean age of 30. 6. The major presenting symptoms were seizures, headaches, hemorrhage and neurological deficits. According to the Spetzler-Martin Grading, 8 patients were Grade Ⅲ, 22 were Grade Ⅳ, and 16were Grade Ⅴ. All patients received surgical treatment and postoperative DSA were performed. Clinical results and long term follow-up (KPS) were gathered for analysis. Results One of the 35 patients who received postoperative DSA revealed residual AVMs. Among all patients, severe complications were observed in 9 patients, and 1 patient died in the hospital. Complications included hemiparalysis ( 15 cases), aphasia (6 cases), hemianopia (9 cases), cranial nerve dysfunction (5 cases), and seizure (5 cases). Normal perfusion pressure breakthrough (NPPB) was observed in 6 patients. After 6-108 months of follow-up, 33of 37 survived follow-up patients presented normal function or minimal symptoms and ability to work or study, 4 patients died (2 were surgical-related). Conclusion Pre-surgical evaluation of every candidates and treatment choice are the determining factors in giant AVMs therapy. Microsurgery remains one of the most effective ways for eliminating giant cerebral AVMs, and the complication rate was acceptable. For giant cerebral AVMs located superficially or do not involve critical components, a good outcome can be expected through surgical resection.