摘要：

目的 探讨显微外科手术与血管内介入栓塞两种治疗方法在颅内动-静脉畸形治疗中的有效性和安全性。方法 共53 例颅内动-静脉畸形患者分别接受显微外科手术治疗（27 例）和血管内介入栓塞治疗（26 例），术后复查DSA 确认畸形血管团切除和栓塞情况，记录手术相关并发症，术后1 个月采用Glasgow 预后分级（GOS）评价临床预后。结果 27 例行显微外科手术治疗的患者中26 例畸形血管团消失，治愈率达96.30%（26/27）；术后遗留肢体运动障碍2 例（7.41%）、神经功能障碍1 例（3.70%）、癫痫持续状态1 例（3.70%），手术相关并发症发生率为14.81%（4/27）；术后1 个月GOS 评分5 分15 例（55.56%）、4 分10 例（37.03%）、3 分2 例（7.41%），预后良好率为92.59%（25/27）。26 例行血管内介入栓塞治疗的患者中8 例首次栓塞后畸形血管团消失，治愈率为30.77%（8/26）；术后遗留肢体运动障碍2 例（7.69%）、神经功能障碍2 例（7.69%），手术相关并发症发生率15.38%（4/26）；术后1 个月GOS 评分5 分17 例（65.38%）、4 分7 例（26.92%）、3 分2 例（7.69%），预后良好率为92.31%（24/26）。结论 显微外科手术是颅内动-静脉畸形安全、有效的治疗方法；对于Puerto Rico 评分≤ 3 分的患者，血管内介入栓塞治疗可以获得较好疗效；对于复杂颅内动-静脉畸形，采取多次、分期介入栓塞或介入栓塞+ 放射治疗可以有效缓解症状、改善预后。

关键词: 颅内动静脉畸形, 显微外科手术, 栓塞, 治疗性, 血管造影术, 数字减影

Abstract:

Objective  To explore the efficacy and safety of microsurgery and endovascular interventional embolization for treating intracranial arteriovenous malformation (AVM).  Methods  A total of 53 AVM patients underwent microsurgery (N = 27) and endovascular interventional embolization (N = 26). Postoperative DSA revealed the resection of malformed vessels and embolization. Surgery-related complications were recorded, and Glasgow Outcome Scale (GOS) was used to evaluate the prognosis one month after operation.  Results  In microsurgery group, postoperative re-examination revealed complete resection in 26 out of 27 cases, with the cure rate of 96.30% (26/27). After operation, limb movement disorder occurred in 2 cases (7.41% ), neurological dysfunction occurred in one case (3.70% ) and status epilepticus (SE) occurred in one case (3.70% ). The occurrence rate of postoperative complications was 14.81% (4/27). One month after operation, GOS showed 5 score in 15 cases (55.56%), 4 score in 10 cases (37.03%) and 3 score in 2 cases (7.41%). The rate of good prognosis was 92.59% (25/27). In endovascular interventional embolization group, postoperative re-examination revealed complete embolization in 8 out of 26 cases, with the cure rate of 30.77% (8/26). After operation, limb movement disorder occurred in 2 cases (7.69%) and neurological dysfunction occurred in 2 cases (7.69%). The occurrence rate of postoperative complications was 15.38% (4/26). One month after operation, GOS showed 5 score in 17 cases (65.38%), 4 in 7 cases (26.92% ) and 3 in 2 cases (7.69% ). The rate of good prognosis was 92.31% (24/26). Conclusions  Microsurgery is a safe and effective treatment for intracranial AVM. Endovascular interventional embolization can also achieve good curative effect for patients with intracranial AVM under Puerto Rico scale ≤ 3 score. Multiple and staged embolization or embolization combined with radiotherapy can effectively relieve symptoms and improve prognosis for patients with complex intracranial AVM.

Key words: Intracranial arteriovenous malformations, Microsurgery, Embolization, therapeutic, Angiography, digital subtraction