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目的:探讨脑动静脉畸形(AVM)治疗中显微手术、放射外科治疗及血管内介入治疗的选择。方法:对1996年1月-2003年1月问我科收治的157例脑AVM按S-M分级进行分析,Ⅰ级22例,Ⅱ级53例,Ⅲ级59例,Ⅳ级23例。显徼手术72例,镜下AVM全切除61例,输入动脉切断术11例;X-刀39例,其中8例由于再次出血手术治疗;血管内介入治疗46例,其中9例残余血管另行X刀治疗、13例介入治疗后行手术治疗。所有患者均经随访1-8年。结果:术后因并发症死亡2例,手术切除后59例经造影复查AVM消失,余11例补充行X刀治疗;X刀治疗8例再次行手术治疗,余31例半年后复查,畸形血管团缩小,2年后复查13例完全消失,18例缩小50%以上;单纯介入治疗11例完全消失,13例缩小50%以上;介入治疗后再行手术治疗或X刀者22例,2年后复查畸形团均消失。全组病例恢复原工作或轻体力劳动者126例,生活自理29例。结论:显微外科手术仍是治疗脑AVM的主要方法,放射外科治疗和介入治疗对于不适合或不能接受手术者也是行之有效的方法,与手术结合的方法可取得更好的疗效。
Objective: To explore the options of microsurgery, radiosurgery and endovascular intervention in the treatment of cerebral arteriovenous malformations (AVM). Methods: From January 1996 to January 2003, 157 cases of brain AVM admitted to our department were analyzed by S-M classification. There were 22 cases of grade Ⅰ, 53 of grade Ⅱ, 59 of grade Ⅲ and 23 of grade Ⅳ. 72 cases showed obvious operation, AVM underwent total resection in 61 cases, 11 cases underwent arteriotomy, 39 cases with X-knife, of which 8 cases were treated by re-bleeding; 46 cases were treated with endovascular intervention, of which 9 cases were treated with X Knife treatment, 13 cases of surgical intervention after intervention. All patients were followed up for 1-8 years. Results: Two patients died of complications due to complications. Fifty-nine patients underwent angiography and AVM disappeared after surgical resection, and 11 patients were treated with X-knife. Eight patients underwent X-knife surgery and another 31 patients were reviewed after six months. Malformations 13 cases completely disappeared in 2 years and 18 cases reduced more than 50%. Only 11 cases completely disappeared and 13 cases reduced more than 50%. After interventional treatment, 22 cases were treated with operation or X knife, and 2 cases After reviewing deformity groups are disappeared. All patients recovered the original work or 126 cases of light manual workers, living in 29 cases. Conclusion: Microsurgery is still the main method for the treatment of brain AVM. Radiation and interventional radiosurgery are also effective methods for patients who are unsuitable or unable to accept surgery. Combining with surgery, better results can be obtained.