中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2013年
5期
426-430
,共5页
蒋宇钢%张明铭%李奇%周倩
蔣宇鋼%張明銘%李奇%週倩
장우강%장명명%리기%주천
颅内动静脉畸形%栓塞%多普勒超声%神经电生理监测%显微神经外科
顱內動靜脈畸形%栓塞%多普勒超聲%神經電生理鑑測%顯微神經外科
로내동정맥기형%전새%다보륵초성%신경전생리감측%현미신경외과
Intracranial arteriovenous malformation%Embolization%Doppler ultrasonography%Neurophysiological monitoring%Microneurosurgery
目的 分析86例颅内动静脉畸形(AVM)患者临床特征,探讨显微手术治疗颅内动静脉畸形的策略及方法. 方法 回顾性分析2010年1月至2013年1月86例行颅内动静脉畸形显微手术治疗患者的临床资料.术前采用3 D-CTA、DSA,充分评估动静脉畸形的位置、大小、供血动脉及回流静脉情况,联合Spet-zler-Martin分级、首发症状等制定详细的显微手术方案.术中应用神经电生理监测评价手术前后神经功能保留和损害的程度；通过微血管多普勒超声的定性和定量分析联合术中荧光造影评定血管畸形供血动脉和引流静脉以及周围邻近功能血管的血液流速及位置.手术采用术前巨大AVM栓塞、术中供血动脉控制性夹闭等技术联合显微外科技术治疗. 结果 显微外科手术切除颅内动静脉畸形86例,其中Spetzler-Martin分级Ⅰ～Ⅲ级37例,Ⅲ级23例,Ⅳ级17例,Ⅴ级9例,术后恢复良好70例,出现轻残9例,重残5例,死亡2例.DSA复查血管畸形均全部切除.远期随访仍在进行中. 结论 术前制定详细的方案,显微手术联合应用多种技术方式能有效治疗脑动静脉畸形,减少手术风险.
目的 分析86例顱內動靜脈畸形(AVM)患者臨床特徵,探討顯微手術治療顱內動靜脈畸形的策略及方法. 方法 迴顧性分析2010年1月至2013年1月86例行顱內動靜脈畸形顯微手術治療患者的臨床資料.術前採用3 D-CTA、DSA,充分評估動靜脈畸形的位置、大小、供血動脈及迴流靜脈情況,聯閤Spet-zler-Martin分級、首髮癥狀等製定詳細的顯微手術方案.術中應用神經電生理鑑測評價手術前後神經功能保留和損害的程度；通過微血管多普勒超聲的定性和定量分析聯閤術中熒光造影評定血管畸形供血動脈和引流靜脈以及週圍鄰近功能血管的血液流速及位置.手術採用術前巨大AVM栓塞、術中供血動脈控製性夾閉等技術聯閤顯微外科技術治療. 結果 顯微外科手術切除顱內動靜脈畸形86例,其中Spetzler-Martin分級Ⅰ～Ⅲ級37例,Ⅲ級23例,Ⅳ級17例,Ⅴ級9例,術後恢複良好70例,齣現輕殘9例,重殘5例,死亡2例.DSA複查血管畸形均全部切除.遠期隨訪仍在進行中. 結論 術前製定詳細的方案,顯微手術聯閤應用多種技術方式能有效治療腦動靜脈畸形,減少手術風險.
목적 분석86례로내동정맥기형(AVM)환자림상특정,탐토현미수술치료로내동정맥기형적책략급방법. 방법 회고성분석2010년1월지2013년1월86례행로내동정맥기형현미수술치료환자적림상자료.술전채용3 D-CTA、DSA,충분평고동정맥기형적위치、대소、공혈동맥급회류정맥정황,연합Spet-zler-Martin분급、수발증상등제정상세적현미수술방안.술중응용신경전생리감측평개수술전후신경공능보류화손해적정도；통과미혈관다보륵초성적정성화정량분석연합술중형광조영평정혈관기형공혈동맥화인류정맥이급주위린근공능혈관적혈액류속급위치.수술채용술전거대AVM전새、술중공혈동맥공제성협폐등기술연합현미외과기술치료. 결과 현미외과수술절제로내동정맥기형86례,기중Spetzler-Martin분급Ⅰ～Ⅲ급37례,Ⅲ급23례,Ⅳ급17례,Ⅴ급9례,술후회복량호70례,출현경잔9례,중잔5례,사망2례.DSA복사혈관기형균전부절제.원기수방잉재진행중. 결론 술전제정상세적방안,현미수술연합응용다충기술방식능유효치료뇌동정맥기형,감소수술풍험.
Objective To analyse clinical features of 86 cases of intracranial arteriovenous malformation (AVM) and explore strategies and methods of the microsurgical treatment of intracranial arteriovenous malformations.Methods The clinical data of 86 intracranial arteriovenous malformation from January 2010 to January 2013 were retrospectively reviewed.For diagnosis,computed tomography (CT) with angiography (CTA),and DSA were used,which could provide real size,location,feeding arteries and draining veins of AVM,and apply NEPM to evaluate the nerve function,assess the qualitative and quantitative flow rate of AVM and surrounding blood vessels by Doppler ultrasonography and fluorescein angiography,and reveal opography of AVM.Operative techniques were used including embolization,feeding artery control.Results Eighty-six cases of AVM were resected successfully under mutitechnology.Following-up demonstrated excellent neurological outcomes in 70 cases,nine case had mild disability,five cases had severe disability,two dead cases.DSA shows resected completely,and long-term follow-up was still in progress,conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intracranial arteriovenous malformations.
