复杂脑动静脉畸形的显微外科手术治疗效果分析.

Objective To explore the diagnosis and treatment of complex cerebral arteriovenous malformations by microsurgery. Methods The clinical data of 38 patients with complex cerebral arteriovenous malformations treated by simple microsurgery and combined surgery in the neurosurgery department of the First Affiliated Hospital of Soochow University from January 2011 to January 2021 were analyzed retrospectively, with 24 cases of grade Ⅲ, 9 cases of grade Ⅳ, and 5 cases of grade Ⅴ, according to Spetzler-Martin classification. The mean size of the malformed vascular mass was 5.9 cm (3.5-12.3 cm), located in the functional area in 27 cases and the non-functional area in 11 cases. CTA, DSA, and MRI were performed preoperatively, and CT, CTA or DSA were performed postoperatively. The neurological deficits were evaluated by the Glasgow prognostic score (GOS) at regular follow-up. Results In all cases, 28 underwent combined surgical treatment, and 10 underwent simple microsurgical resection. Postoperative imaging showed total resection in 35 (92.1%) and a significant reduction from a preoperative level in 3 (7.9%) . Postoperative follow-up was 6-79 months, with good recovery in 34 (GOS=4~5 points), moderate disability in 2 (GOS=3 points), severe disability in 1 (GOS=2 points), and death in 1 (GOS=1 point) . Conclusions Microsurgical resection is one of the effective methods for the treatment of complex cerebral arteriovenous malformations. The combination of preoperative imaging, preoperative supply artery embolization, intraoperative navigation, electrophysiological monitoring, and fine intraoperative microscopic manipulation is the key to successful surgery. [ABSTRACT FROM AUTHOR]