CAJ | 학술논문

目的：探讨血管内栓塞联合手术切除治疗Spetzler－Martin Ⅲ级脑动静脉畸形（ arteriovenous malformations，AVM）不同亚型的安全性及有效性。方法回顾性分析29例Spetzler－MartinⅢ级AVM患者的临床资料，分为4个亚型，分别如下：T1＝S1E1V1，T2＝S2E1V0，T3＝S2E0V1，T4＝S3E0V0（S＝大小，E＝功能区，V＝深静脉引流）。全部患者行血管内栓塞，于术后7～14 d行显微外科手术，病灶完全切除。结果显微外科手术完全切除畸形血管团，总体手术相关并发症率13．8％，T1型和T2型并发症率高于T3、T4型，其中血管栓塞相关并发症1例，无手术死亡，手术相关并发症3例。术后平均随访16个月，影像学检查未见AVM复发及再出血。结论血管内栓塞加显微外科手术切除是治疗Spetzler－Martin Ⅲ级出血性AVM安全有效的方法，AVM位于功能区的T1、T2型手术风险较高。
목적：탐토혈관내전새연합수술절제치료Spetzler－Martin Ⅲ급뇌동정맥기형（ arteriovenous malformations，AVM）불동아형적안전성급유효성。방법회고성분석29례Spetzler－MartinⅢ급AVM환자적림상자료，분위4개아형，분별여하：T1＝S1E1V1，T2＝S2E1V0，T3＝S2E0V1，T4＝S3E0V0（S＝대소，E＝공능구，V＝심정맥인류）。전부환자행혈관내전새，우술후7～14 d행현미외과수술，병조완전절제。결과현미외과수술완전절제기형혈관단，총체수술상관병발증솔13．8％，T1형화T2형병발증솔고우T3、T4형，기중혈관전새상관병발증1례，무수술사망，수술상관병발증3례。술후평균수방16개월，영상학검사미견AVM복발급재출혈。결론혈관내전새가현미외과수술절제시치료Spetzler－Martin Ⅲ급출혈성AVM안전유효적방법，AVM위우공능구적T1、T2형수술풍험교고。
Objective To investigate the safety and effectiveness of endovascular embolization combined microsurgical resec-tion in treating Spetzler-MartinⅢgrade cerebral arteriovenous malformations(AVM) between different subtypes.Methods A retro-spective analysis was used in 29 cases of patients with Spetzler-MartinⅢAVM.They were divided into four subtypes, S=size, E=functional area, V=deep venous drainage, then T1=S1E1V1, T2=S2E1V0, T3=S2E0V1 , T4=S3E0V0.All patients underwent microsurgical complete resection after 1 to 2 weeks with endovascular embolization.Results Nidus was completely removed after mi-crosurgery resection.Overall procedure-related complication rate was 13.8%, of complications rate in T1 and T2 types was higher than T3, T4 types and endovascular embolization related complications was 1 case, surgery-related complications was 3 cases and there was no death.After follow-up with16 months, radiographic examination showed no AVM recurrence and rehemorrhage.Conclusion En-dovascular embolization combined microsurgical resection in Spetzler-MartinⅢhemorrhagic AVM is safe and effective, but T1 and T2 type have higher surgical risk due to locate eloquent cortex.