复合手术在脑动静脉畸形治疗中的应用

目的 总结一站式复合手术在治疗脑动静脉畸形中的临床经验。方法 回顾性分析2014年4月至2017年11月采取复合手术治疗的24例脑动静脉畸形的临床资料，术前Spetzler-Martin分级Ⅲ级8 例，Ⅳ级14例，V级2例。14例术中先做治疗性供血动脉栓塞再进行手术切除，另10例直接行手术切除；全部病人均在切除病灶后行术中造影以评估切除程度。结果 24例畸形血管团全切除。20例术后恢复良好，4例术前昏迷病人术后意识障碍改善。没有死亡病人，未发生与介入相关的并发症。24例术后随访6个月至2年，16例行DSA、8例CTA检查；除1例存在部分病灶残留外，其余23例均无病灶残留或复发；日常生活能力分级Ⅰ级16例，Ⅱ级2例，Ⅲ级2例，Ⅳ级4例。结论 复合手术为脑动静脉畸形提供了一个新的外科治疗方案；该技术可简化多次介入以及显微手术的治疗过程，并且能够实时地对切除情况进行精准地评估，是一项安全有效的治疗方式。

Hybrid surgery for cerebral arteriovenous malformations (report of 24 cases)

Objective To summarize the clinical experience in treating cerebral arteriovenous malformations (AVM) by hybrid surgery. Methods The clinical data of 24 patients with cerebral AVMs treated from April, 2014 to November, 2017, were analyzed retrospectively. According to Spetzler-Martin classification of cerebral AVMs, 8 cases were grade Ⅲ, 14 grade Ⅳ and 2 grade Ⅴ. Fourteen patients underwent endovacular embolization of AVMs before surgical resection of AVMs. All the patients underwent intraoperative angiography to evaluate the extent of removal of cerebral AVMs. Results The cerebral AVMs were totally removed in 24 patients (100%). Of these 24 patients, 20 were recovered well and 4 with preoperative coma had some improvement of their consciousness after the operation. No patients died from the surgery and no complications related to intervention occurred in all the patients. All the patients were followed up from 6 months to 2 years. There was residual lesion in 1 patients. According to activities of daily living grade, of 24 patients, 16 belonged in grade Ⅰ, 2 in grade Ⅱ, 2 in grade Ⅲ and 4 in grade Ⅳ. Conclusions Hybrid surgery provides a safe, effective and new method to treat cerebral AVMs. This technique can be simply regarded as the process of multiple interventions and surgical treatments, and can accurately assess the situation of resection of the malformed blood vessels in real time.