摘要
目的初步探索一站式复合手术平台治疗急性出血性高流量脑血管畸形的安全性和有效性。方法筛选复合手术治疗脑血管畸形的前瞻性、多中心外科队列(NCT03209804)中首都医科大学附属北京天坛医院神经科学中心2019年1月至2024年4月连续入组的急性出血性高流量脑血管畸形患者。所有患者均在复合手术平台接受诊断性术中数字减影血管造影及不同模式的外科治疗。对患者的功能预后(以改良Rankin量表评分评估)进行分析,明确复合手术平台治疗急性出血性高流量脑血管畸形的安全性和有效性。结果共纳入急性出血性高流量脑血管畸形患者56例,包括颅内动静脉畸形破裂出血患者47例(83.9%)、硬脑膜动静脉瘘患者8例(14.3%)、软脑膜动静脉瘘患者1例(1.8%)。56例患者中,行动静脉畸形或动静脉瘘切除+血肿清除术33例,血管内栓塞辅助动静脉畸形或动静脉瘘切除+血肿清除术15例,单纯动静脉畸形或动静脉瘘治愈性栓塞术6例,动静脉畸形或动静脉瘘治愈性栓塞术+血肿清除术2例。术后1个月内患者的全因病死率为3.6%(2/56)。出院时、术后3个月、术后6个月存在严重神经功能障碍(改良Rankin量表评分>3分)患者的比率分别为46.4%(26/56)、16.1%(9/56)和8.9%(5/56)。结论基于复合手术平台的一站式诊疗模式可安全、有效地用于治疗急性出血性高流量脑血管畸形。
ObjectiveTo initially explore the safety and effectiveness of a one-staged hybrid surgical platform in the treatment of acute hemorrhagic high-flow cerebral vascular malformations(HFVMs).MethodsPatients with acute hemorrhagic HFVMs who were consecutively enrolled from January 2019 to April 2024 were screened from a prospective,multi-center surgical cohort of hybrid surgical treatment of cerebral vascular malformations(NCT03209804).All patients underwent diagnostic intraoperative digital subtraction angiography(DSA)and different modes of surgical treatment on a hybrid surgical platform.The patients′functional outcomes(assessed by the modified Rankin scale score)were analyzed to clarify the safety and effectiveness of the hybrid surgical platform in the treatment of acute hemorrhagic HFVMs.ResultsA total of 56 patients with acute hemorrhagic HFVMs were included,including 47 patients(83.9%)with intracranial arteriovenous malformation rupture and bleeding,8 patients(14.3%)with dural arteriovenous fistula,and 1 patient(1.8%)with pial arteriovenous fistula.Among the 56 patients,33 patients underwent arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation,15 patients underwent endovascular embolization-assisted arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation,6 patients underwent curative embolization of arteriovenous malformation or arteriovenous fistula,and 2 cases were treated with curative embolization of arteriovenous malformation or arteriovenous fistula plus minimally invasive hematoma evacuation.The all-cause mortality rate of patients within 1 month after surgery was 3.6%(2/56).The rates of patients with severe neurological dysfunction(modified Rankin score>3 points)at discharge,3 months after surgery,and 6 months after surgery were 46.4%(26/56),16.1%(9/56),and 8.9%(5/56),respectively.ConclusionThe one-staged diagnosis and treatment model based on the hybrid surgical platform can be safely and effectively used to treat acute hemorrhagic HFVM
作者
王明泽
葛培聪
焦玉明
邓晓峰
于嵩林
江裕华
仇汉诚
李智
陈晓霖
王硕
曹勇
赵继宗
Wang Mingze;Ge Peicong;Jiao Yuming;Deng Xiaofeng;Yu Songlin;Jiang Yuhua;Qiu Hancheng;Li Zhi;Chen Xiaolin;Wang Shuo;Cao Yong;Zhao Jizong(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Center of Stroke,Beijing Institute for Brain Disorders,Beijing 100070,China;Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2024年第10期976-983,共8页
Chinese Journal of Neurosurgery
基金
国家重点研发计划(2021YFC2501100,2016YFC1301800)
北京市医院管理中心“登峰”计划(DFL20220501)。
关键词
中枢神经系统血管畸形
颅内出血
急诊处理
治疗结果
安全性
复合手术
Central nervous system vascular malformations
Intracranial hemorrhage
Emer-gency treatment
Treatment outcome
Safety
Hybrid operation
