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目的对脑动静脉畸形(BAVM)的空间构筑进行研究。方法5例BAVM均行DSA获取在体畸形血管团影像学资料,然后行血管内栓塞治疗,栓塞后手术切除畸形血管团,3例行切除标本的3D计算机辅助扫描技术(3DCast)成像,2例标本给予灌注后行扫描电镜观察。从畸形团中随机选取部分畸形血管行原子力显微镜扫描观察。正常对照脑血管的铸型及扫描电镜观察标本取自非疾病死亡尸体。灌注对照采用双侧颈动脉直接灌注法。结果BAVM由“供血单元”这一基本单位所构成,多支动脉供血的畸形血管团各供血单元之间存在细小的血管沟通;扫描电镜见畸形团内血管迂曲缠绕,血管粗细不均,变化突然,扫描电镜及原子力显微镜观察均见血管内皮表面形态不规则,高低不平,存在“火山口样”和“弹坑样”改变;正常脑血管走行具有一定的规律性,粗细变化平滑。结论BAVM是一种血管结构非常复杂的疾病,其基本组成单位为“供血单元”,各供血单元之间存在细小的血管沟通;血流湍流冲击造成畸形团内存在许多潜在的薄弱点,可能是导致BAVM出血的重要原因,部分栓塞治疗难以消除其出血风险因素。
Objective To study the spatial structure of cerebral arteriovenous malformations (BAVM). Methods 5 cases of BAVM were performed DSA in vivo imaging data of vascular degeneration group, and then treated with endovascular embolization. After embolization, the abnormal vascular group was excised. Three cases of 3DCast imaging were performed in resected specimens. Two cases Specimens were given perfusion scanning electron microscopy. Partial deformity vessels were randomly selected from the deformity group by atomic force microscopy. Normal control cerebrovascular casting and scanning electron microscopy specimens taken from non-diseased dead bodies. Perfusion control using bilateral carotid artery perfusion method. Results BAVM consisted of the basic unit of “blood supply unit”. Small blood vessels were found between the blood supply units of the multi-artery blood supply malformation vascular groups. The blood vessels were irregularly wound and deformed suddenly Scanning electron microscopy (SEM) and atomic force microscopy (AFM) showed that the morphology of the vascular endothelium was irregular and rugged. There were changes of “crater-like” and “crater-like”. The movement of normal cerebrovascular had regularity and the thickness changed smoothly. Conclusions BAVM is a very complicated vascular structure. The basic unit of BAVM is “blood supply unit” with small blood vessels communicating among blood supply units. There are many potential weak points in blood flow turbulence caused by blood flow turbulence, which may be Lead to BAVM bleeding an important reason, partial embolization treatment is difficult to eliminate the bleeding risk factors.