高级别颅内动静脉畸形的治疗策略及并发症防治

目的探讨高级别颅内动静脉畸形（arteriovenous malforation，AVM）的治疗策略及并发症防治。方法回顾性分析13例高级别AVM病人的临床资料，采用显微手术为主结合介入和（或）放射治疗。术中均应用自体血回吸收技术，2例术前行AVM部分栓塞．1例行分次手术，2例术后病变残留病人行伽马刀治疗。结果无死亡病例；1例术前持续昏迷，术后轻度改善；其余病例均得到较好恢复。AVM全切除11例，次全切除2例。随访11—59个月，GOS评分：5分10例，4分2例，3分1例。结论娴熟的显微神经外科技术、科学的个体化治疗方案的制定是取得高级别AVM良好疗效的重要因素。术前辅助行栓塞技术，术中应用自体血回收技术，术后放射治疗，可以降低并发症的发生。

Treatment strategies and prevention of complication for high-grade intracranial arteriovenous malformation

Objective To investigate the treatment strategy and prevention of complications in patients with high-grade intracranial arteriovenous malformation （AVM）. Methods The clinical data of 13 patients with high-grade intracranial AVM treated by microsurgery combined with embolization and/or radiosurgery were analyzed retrospectively. Intraoperative autologous blood transfusion was performed in all the patients. Preoperative embolization was done in 2 cases. Two-step procedure was conducted in 1 case. Gamma knife was used in 2 patients who were found having residual nidus after the operation. Results No death occurred. One patient with persistent coma before the operation recovered a little. And the other patients recovered well. The total remove of AVM was achieved in 11 patients and subtotal remove in 2. During a follow-up period of 11-59 months, Glasgow Outcome Scale （GOS） was 5 in 10 cases, 4 in 2 and 3 in 1 case. Conclusions To obtain good effects in treatment of high-grade intracranial AVM, skilled neurosurgery technique and well individualized plan are very important. Skilled neurosurgical technique and scientific personalized medicine are important factors for good therapeutic efficacy of high-grade intracranial AVM. Preoperative embolization, intraoperative autologous blood transfusion, postoperative radiotherapy can reduce the incidence of complication.