摘要
目的比较颅内高级别动静脉畸形（AVM）手术和非手术治疗效果并探讨影响其手术后神经功能恶化的临床因素；同时回顾性累计其年出血率。方法回顾性分析142例高级别（Spetzler—Martin Ⅳ级、Ⅴ级、Ⅵ级）AVM病例临床资料。142例中手术组98例，非手术组44例，应用Glasgow结果量表分别对两组患者在出院时（早期）、术后半年（晚期）随访情况进行神经功能评价；同时回顾性累计其年出血率。对手术组患者的临床因素与手术后早期、晚期神经功能缺失发生率进行差异统计学意义检验。结果142例高级别AVM年出血率为2．1％。手术组晚期总的致残率和病死率为10．1％，而非手术组则为25．0％。与手术后早期、晚期神经功能缺失显著相关的因素有AVM大小、AVM邻近脑功能区、Spetzler—Martin分级、深穿支供血动脉、术中出血量等。Logistic回归分析表明，与手术后早期及晚期神经功能缺失最显著相关的因素是Spetzler-Martin分级、深穿支供血动脉。结论高级别AVM年出血率与以往报道的年出血率相似；手术总体治疗效果优于非手术总体治疗效果。高级别AVM手术后神经功能恶化的最重要临床因素是Spetzler—Martin分级、深穿支供血动脉。
Objective To compare the effects of surgical and non-surgical treatments for high-grade intracranial arteriovenous malformation （AVM） , identify the determinants of neurological function deterioration after surgery, and calculate the annual hemorrhage rate. Methods 98 high-grade intracranial AVM patients underwent surgery, and 44 high-grade intracranial AVM patients underwent conservative treatment. Follow-up was conducted on 141 of these 142 patients for （54 ± 36） （6 - 118） months. MRI and DSA were conducted before and/or after treatment on most of the patients. Glasgow outcome score （GOS） was used to evaluate the neurological functions early and more then 6 months after discharge. The clinical data of these 142 patients were retrospectively analyzed. The annual hemorrhage rate associated with these lesions was calculated. Results The annual hemorrhage rate of these 142 patients was 2. 1%. The integrated rate of late disability and mortality of the operative group was 10.1% , remarkably higher than that of the non-operative group （25.0%）. AVM size, adjacent brain functional region, Spetzler-Martin grade, deep perforating arterial supply, and intra-operative bleeding volume were significantly correlated with early and permanent neurological function deficits. Conclusion The long-term outcome of operatively managed intracranial high-grade AVMs is superior to that of the non-operatively treated ones. Spetzler-Martin grade and deep arterial perforating supply are the most important determinants of neurological deficit after microsurgical resection of AVM.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第9期606-609,共4页
National Medical Journal of China
关键词
脑动静脉畸形
出血风险
神经外科手术
神经功能缺失
因素分析
Cerebral arteriovenous malformations
Hemorrhage risk
Neurosurgical procedures
Neurological deficits
Factor analysis
