CAJ | 학술논문

目的：探讨脑动静脉畸形（ brain arteriovenous malformations ，AVM）伴发动脉瘤的临床特点和治疗问题。方法回顾性研究364例AVM中合并动脉瘤的38例患者的临床表现、病灶特点、治疗方法与结局等。结果出血是最多见的临床表现（60.5%），其风险大于单纯动静脉畸形（39.9%）（χ2=5.956，P<0.05），供血动脉动脉瘤为最常见的伴发动脉瘤类型（69.4%），畸形团内动脉瘤更易发生出血（χ2=8.869，P<0.05）；接受治疗的37例患者，全部有效处理了出血病灶及伴发的43个动脉瘤。34例结局良好，3例出现神经损害，6例出现并发症，无死亡病例，16例术后脑血管造影证实动静脉畸形完全消失。结论脑AVM常伴发血流相关动脉瘤，其出血风险高于单纯AVM，畸形团内动脉瘤更易发生出血；临床治疗主张优先处理出血病灶和动脉瘤。
목적：탐토뇌동정맥기형（ brain arteriovenous malformations ，AVM）반발동맥류적림상특점화치료문제。방법회고성연구364례AVM중합병동맥류적38례환자적림상표현、병조특점、치료방법여결국등。결과출혈시최다견적림상표현（60.5%），기풍험대우단순동정맥기형（39.9%）（χ2=5.956，P<0.05），공혈동맥동맥류위최상견적반발동맥류류형（69.4%），기형단내동맥류경역발생출혈（χ2=8.869，P<0.05）；접수치료적37례환자，전부유효처리료출혈병조급반발적43개동맥류。34례결국량호，3례출현신경손해，6례출현병발증，무사망병례，16례술후뇌혈관조영증실동정맥기형완전소실。결론뇌AVM상반발혈류상관동맥류，기출혈풍험고우단순AVM，기형단내동맥류경역발생출혈；림상치료주장우선처리출혈병조화동맥류。
Objective To investigate the clinical features and treatment strategy of brain arteriovenous malforma-tions(AVM) associated with arterial aneurysms. Methods The clinical manifestation, imaging data, treatment and out-come of the patients with AVM were retrospectively analyzed in 38(10.4%) of these 364 patients. Results Hemorrhage was the most common clinical manifestation (60.5%). The hemorrhage risk was higher in AVM associated with arterial an-eurysms than in single AVM(χ2=5.956,P<0.05). The most common type of associated aneurysms was feeding artery an-eurysm (69.4%). Hemorrhage more frequently occurred within the aneurysm.(χ2=8.869,P<0.05). The bleeding lesions and 43 associated aneurysms of the 37 patients were treated effectively by endovascular treatment and/or craniotomy. Thirty-four patients had excellent or good outcomes, six patients had complications, 3 patients had neurological deficits. Postoperative digital subtraction angiography (DSA) examination showed the complete disappearance of arteriovenous malformation and aneurysm in sixteen cases. Conclusions The AVM associated with aneurysms is common in patients with AVM. AVM associated with aneurysms has a higher risk of hemorrhage than single AVM. The aneurysm within AVM has a higher rate of hemorrhage. The treatment priority should be given to the bleeding lesions and aneurysms.