标题：出血性高级别脑动静脉畸形血管内治疗的临床疗效分析

      作者：邵哲 1，陈健龙 1，郭大闯 1，冯基高 2，吕久一 2，彭浩 1    1.海南省人民医院/海南医科大学附属海南医院神经外科，海南 海口 570311；2.海南医科大学第二附属医院神经外科，海南 海口 570216

      卷次： 2024年35卷14期

      【摘要】 目的 观察出血性高级别脑动静脉畸形(BAVM)血管内治疗的临床疗效。方法 回顾性分析2017年1月至2023年1月海南省人民医院采用血管内治疗的37例高级别脑动静脉畸形患者的临床资料。所有患者术前均行CT血管造影(CTA)、数字减影血管造影(DSA)分析脑动静脉畸形血管的构筑。血管内治疗采用动脉入路、静脉入路、分次治疗、高压锅等技术，未完全栓塞患者术后行放射治疗。术后定期随访3个月，行CT、CTA或DSA复查，并进行格拉斯哥预后评分(GOS)以评估神经功能的恢复情况。结果 按Spetzler-Martin分级，37例高级别脑动静脉畸形患者中Ⅳ级 25例和Ⅴ级 12例；单支动脉供血 10例，多支动脉供血 27例，畸形团单次栓塞 6例，分次栓塞31例。治愈性栓塞29.7% (11/37)，大部分栓塞54.1% (20/37)，部分栓塞16.2% (6/37)；术后随访3个月，按GOS评分评价预后，其中恢复良好56.8% (21/37)，轻度残疾21.6% (8/37)，重度残疾10.8% (4/37)，植物生存8.1% (3/37)，死亡2.7% (1/37)。结论 血管内介入技术治疗出血性高级别脑动静脉畸形临床疗效可靠。
      【关键词】 脑出血；高级别颅内动静脉畸形；血管内治疗；栓塞；疗效
      【中图分类号】 R651.1 【文献标识码】 A 【文章编号】 1003—6350（2024）14—2012—05

Clinical effect of intravascular treatment of hemorrhagic high-grade brain arteriovenous malformation.
SHAO Zhe 1,CHEN Jian-long 1, GUO Da-chuang 1, FENG Ji-gao 2, LYU Jiu-yi 2, PENG Hao 1. 1.Department of Neurosurgery, HainanGeneral Hospital/Hainan Hospital Affiliated to Hainan Medical University, Haikou 570311, Hainan, CHINA; 2. Departmentof Neurosurgery, the Second Affiliated Hospital of Hainan Medical University, Haikou 570216, Hainan, CHINA
【Abstract】 Objective To observe the clinical effect of intravascular treatment of hemorrhagic high-grade brainarteriovenous malformation. Methods The clinical data of 37 patients with high-grade brain arteriovenous malforma-tion who received endovascular therapy in Hainan General Hospital from January 2017 to January 2023 were retrospec-tively analyzed. All patients underwent CT angiography (CTA) and digital subtraction angiography (DSA) before surgeryto analyze the vascular construction of brain arteriovenous malformations (BAVM). Intravascular therapy was performedby arterial approach, venous approach, fractional treatment, pressure cooker, and other techniques, and postoperative radio-therapy was performed for patients with incomplete embolization. CT, CTA or DSA were performed regularly during thefollow-up of 3 months, and Glasgow prognostic Score (GOS) was used to evaluate the recovery of neurological function.Results According to Spetzler-Martin classification, there were 25 cases of grade Ⅳ and 12 cases of grade Ⅴ in 37 pa-tients with high-grade cerebral arteriovenous malformations. There were 10 cases of single artery blood supply, 27 cases ofmultiple artery blood supply, 6 cases of single embolization of malformation, and 31 cases of multiple embolization. Cura-tive embolism accounted for 29.7% (11/37), most embolism 54.1% (20/37), partial embolism 16.2% (6/37). The prognosiswas evaluated by GOS score at 3 months after the operation, including good recovery of 56.8% (21/37), mild disability of21.6% (8/37), severe disability of 10.8% (4/37), plant survival of 8.1% (3/37), death of 2.7% (1/37). Conclusion The clini-cal efficacy of endovascular interventional technology in the treatment of hemorrhagic high-grade brain arteriovenous mal-formations is reliable.
      【Key words】 Intracerebral hemorrhage; High-grade brain arteriovenous malformations; Endovascular treatment;Embolization; Curative effect