血管内治疗脑动静脉畸形的疗效分析

目的分析脑动静脉畸形(BAVM)血管内治疗的效果及安全性，探讨BAVM血管内治疗的方法及疗效。方法回顾性分析安徽医科大学第一附属医院2018年6月—2021年6月收治的BAVM患者的临床资料。通过术前CTA、DSA分析BAVM构筑，联合Spetzler-Martin分级制定血管内治疗的策略。血管内治疗采用分次治疗、静脉入路、高压锅技术等提高手术栓塞率、降低术后并发症的概率。 结果本组49例诊断为BAVM患者接受血管内治疗，其中Ⅰ级13例，Ⅱ级14例，Ⅲ级18例，Ⅳ-Ⅴ级4例。术后GOS评分良好44例，不良4例，死亡1例，畸形团分次栓塞 5例，治愈性栓塞27例，大部分栓塞17例，部分栓塞5例。结论对于Ⅰ-Ⅲ级BAVM，血管内治疗是一种安全有效的治疗方式，而高级别BAVM血管内治疗难度高，应针对具体患者综合治疗。

ObjectiveTo analyze the effect and safety of endovascular treatment of brain arteriovenous malformations(BAVM) and to explore the methods and strategies related. MethodsThe clinical data of patients with BAVM admitted to The First Affiliated Hospital of Anhui Medical University from June 2018 to June 2021 were analyzed retrospectively. The BAVM construction were analyzed by preoperative CTA and DSA, and the strategy of endovascular treatment was formulated by combining Spetzler-Martin grading. Endovascular treatment was performed by fractionated treatment, venous access and autoclave technique to improve surgical embolization rate and reduce the probability of postoperative complications. ResultsForty-nine patients diagnosed with BAVM in this group received endovascular treatment, of whom 13 were grade Ⅰ, 14 were grade Ⅱ, 18 were grade Ⅲ, and 4 were grade Ⅳ-Ⅴ. The postoperative GOS score was good in 44 patients, poor in 4 patients, and 1 died. The malformation mass was fractionally embolized in 5, curatively embolized in 27 patients, mostly embolized in 17 patients, and partially occluded in 5 patients. ConclusionFor grade Ⅰ-Ⅲ BAVM, intravascular therapy is a safe and effective treatment method, while for high-grade BAVM, the difficulty of intravascular therapy is high and comprehensive treatment should be indivisualized for specific patients.