CAJ | 학술논문

目的：探讨在杂交手术室条件下显微外科联合血管介入手术治疗复杂脑动静脉畸形的临床经验。方法分析2012年6月至2013年6月间福建医科大学附属泉州第一医院收治的8例复杂脑动静脉畸形患者的临床资料。其中Spetzler分级Ⅲ级2例、Ⅳ级6例。8例中脑动静脉畸形（ AVM）合并颅内动脉瘤3例，位于运动区、基底节区各2例。 AVM出血急诊联合手术[一期全脑血管造影（ DSA）＋术中栓塞＋血肿清除＋AVM切除＋术中DSA]5例，AVM栓塞联合AVM切除、动脉瘤夹闭术2例，AVM栓塞＋γ刀治疗＋AVM切除1例。结果8例患者包括术中DSA在内的所有手术操作均在同一杂交手术室完成，其间没有交换手术体位，无手术死亡病例。5例AVM出血患者急诊联合术后DSA检查示，AVM病灶无残留。术后意识障碍好转，无新出现神经功能障碍，肢体瘫痪2例，术后3个月恢复至轻瘫，视野模糊患者术后有所改善1例。2例择期联合手术患者术后DSA栓塞AVM病灶完全切除。结论在杂交手术室实行血管内和外科联合手术治疗复杂脑动静脉畸形提供了一个外科治疗途径，该手术方法可简化过去多次手术和检查的操作过程，并可在AVM切除后即刻DSA评估是否达到完全切除。
목적：탐토재잡교수술실조건하현미외과연합혈관개입수술치료복잡뇌동정맥기형적림상경험。방법분석2012년6월지2013년6월간복건의과대학부속천주제일의원수치적8례복잡뇌동정맥기형환자적림상자료。기중Spetzler분급Ⅲ급2례、Ⅳ급6례。8례중뇌동정맥기형（ AVM）합병로내동맥류3례，위우운동구、기저절구각2례。 AVM출혈급진연합수술[일기전뇌혈관조영（ DSA）＋술중전새＋혈종청제＋AVM절제＋술중DSA]5례，AVM전새연합AVM절제、동맥류협폐술2례，AVM전새＋γ도치료＋AVM절제1례。결과8례환자포괄술중DSA재내적소유수술조작균재동일잡교수술실완성，기간몰유교환수술체위，무수술사망병례。5례AVM출혈환자급진연합술후DSA검사시，AVM병조무잔류。술후의식장애호전，무신출현신경공능장애，지체탄탄2례，술후3개월회복지경탄，시야모호환자술후유소개선1례。2례택기연합수술환자술후DSA전새AVM병조완전절제。결론재잡교수술실실행혈관내화외과연합수술치료복잡뇌동정맥기형제공료일개외과치료도경，해수술방법가간화과거다차수술화검사적조작과정，병가재AVM절제후즉각DSA평고시부체도완전절제。
Objective To summarize the clinical experiences of microsurgical and endovascular treatments of complicated arteriovenous malformation ( AVM) in the conditions of hybrid operating room. Methods The clinical data were collected and analyzed for 8 patients of complex AVM between June 2012 to June 2013.There were Spetzler gradeⅢ(n=2) and gradeⅣ(n=6).And the lesions were complicated with intracranial aneurysms ( n=3 ) and located in motor area ( n=2 ) and basal ganglia ( n=2 ) .Five cases of AVM with cerebral hemorrhage underwent emergency surgery, including digital subtraction angiography ( DSA) plus intraoperative embolization plus surgical resection of AVM plus intraoperative DSA ( iDSA).Two cases underwent embolization plus aneurysm surgery while another had AVM embolization plus AVM resection andγknife treatment.Results All surgical procedures, including iDSA, were completed in the same hybrid operating room.There was no change of surgical position or intraoperative mortality.Five patients of AVM hemorrhage undergoing emergency hematoma evacuation had no residue of AVM on iDSA. Their postoperative consciousness improved without neurological dysfunction.Two patients of limb paralysis recovered to paresis at 3 months postoperation.One case with blurry vision improved somewhat.Two cases undergoing elective surgery had a complete resection of AVM after embolization.Conclusion Surgery plus endovascular treatment in hybrid operating room is efficacious for complex cerebral AVM.It avoids multiple surgeries and inspections.And any lesion residue may be assessed immediately with postoperative DSA.