摘要
目的探讨血管内栓塞在复合手术切除高级别颅内动静脉畸形(AVM)中的作用。方法回顾性分析2016年1月至2019年11月首都医科大学附属北京天坛医院神经外科(16例)和北京大学国际医院神经外科(6例)行复合手术治疗的22例高级别(Spetzler-Martin分级Ⅳ、Ⅴ级)AVM患者的临床资料。所有患者术中根据供血动脉的具体情况先行畸形血管团栓塞术,然后再行切除术。患者围手术期及术后随访时的神经功能情况采用改良Rankin量表评分(mRS)评估;影像学随访采用头颅CT血管成像或数字减影血管造影检查。结果22例患者的畸形血管团均影像学全切除。手术时长为(447.5±152.1)min(270~905 min);术中的中位失血量为700 ml(100~6000 ml)。围术期并发症的发生率为31.8%(7/22),其中5例出现肢体活动障碍(包括2例术后血肿导致的肌力下降),1例出现缄默症状,1例出现短暂性失语。22例患者的随访时间为(28.2±7.1)个月(14.8~38.3个月),其中19例(86.4%)患者预后良好(mRS≤2分),余3例(13.6%)患者预后不良(mRS≥3分)。14例(63.6%)患者获得影像学随访,随访时间为(22.8±18.6)个月(3.4~62.4个月),至末次随访未见病灶复发的患者。结论血管内栓塞辅助开颅手术治疗高级别AVM,不仅可以减少术中出血、降低并发症的发生率,而且可以提高病变的清除率,从而改善患者的预后。
Objective To invetigate the role of endovascular embolization in hybrid surgical resection of high-grade arteriovenous malformations(AVM).Methods A retrospective analysis was conducted on the clinical data of 22 patients with high-grade(Spetzler-Martin gradeⅣ、Ⅴ)AVM who.underwent hybrid surgery(endovascular embolization+lesion resection)from January 2016 to November 2019 in the Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University(16 cases)and the Neurosurgery Department of Peking University International Hospital(6 cases).According to the specific conditions of the supplying arteries,all patients underwent embolization of the malformed vascular mass first,and then resection.The neurological function of the patients during the perioperative period and postoperative follow-up was evaluated by modified Rankin scale(mRS).Imaging follow-up was performed by head CT angiography(CTA)or digital subtraction angiography(DSA).Results The malformed vascular mass was completely obliterated in 22 patients.The operation time was 447.5±152.1 min(270-905 min)and the mean intraoperative blood loss was 700 ml(range:100-6000 ml).The incidence of perioperative complications was 31.8%(7/22),which included 5 cases of limb movement impairment(including 2 cases of postoperative muscle weakness caused by hematoma),1 case of mutism,and 1 case of transient aphasia.The follow-up time of 22 patients was 28.2±7.1 months(14.8-38.3 months),of which 19 patients(86.4%)had good outcomes(mRS≤2 points),and the remaining 3 patients(13.6%)had poor outcomes(mRS≥3 points).Fourteen patients(63.6%)received imaging follow-up and the follow-up time was 22.8±18.6 months(3.4-62.4 months).No recurrence of AVM was identified in the last follow-up.Conclusion Endovascular embolization assisted microsurgical resection in the treatment of high-grade AVM can not only reduce intraoperative bleeding,reduce the incidence of complications,but also increase the obliteration rate of lesions,thereby improving the outcomes of patients.
作者
赵雅慧
陈玉
苑可欣
王昊
陈晓霖
赵元立
Zhao Yahui;Chen Yu;Yuan Kexin;Wang Hao;Chen Xiaolin;Zhao Yuani(Department of Neurosurgery,Bejing Tiantan Hospital,Capital Medical University,Bejing 100070,China;Department of Neurosurgery,Peking University International Hospial,Bejing 102206,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2022年第4期368-372,共5页
Chinese Journal of Neurosurgery
基金
国家重点研发计划(2020YFC2004701)
国家自然科学基金(82071302)。
关键词
颅内动静脉畸形
血管内操作
显微外科手术
治疗结果
Intracranial arteriovenous malformations
Endovascular procedures
Microsurgery
Treatment outcome
