Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases
Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases
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DOI：
10.3171/jns.1998.88.2.0285
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发表时间：
1998-02-01
影响因子：
4.1
通讯作者：
Takakura, K
中科院分区：
文献类型：
--
作者：
Sasaki, T;Kurita, H;Takakura, K
Object.由于基底节和丘脑的动静脉畸形（AVM）难以治疗，作者进行了一项回顾性研究，以确定这些病变的最佳治疗策略。作者回顾了1971年至1995年间接受治疗的101例AVM患者的治疗和结局。在15例保守治疗的患者中，出血发生率为71.4%（年发生率为11.4%），平均随访6.6年，发病率和死亡率分别为7.1%和42.9%。在15例患者中进行了全显微手术切除，未导致死亡，但其中3例（20%）的运动功能永久性恶化。术后发病率与AVM的位置和术前运动功能密切相关。在无运动无力的晶状体AVM病例中，术后运动功能下降明显比其余患者更常见。在术前有运动无力的患者中，成功切除了丘脑或尾状核中的AVM。在66例接受伽玛刀放射外科治疗的患者中，3例患者出现永久性放射性神经功能缺损，另外3例患者出现出血（1例新发出血，2例再出血）。治疗相关的发病率为6.7%，2.5年时完全闭塞的精算率为85.7%。在5例仅接受栓塞治疗的患者中，与手术或出血相关的发病率和死亡率分别为40%和20%。前伽玛刀时代的发病率和死亡率分别为22.2%和22.2%，而后伽玛刀时代的发病率和死亡率分别为10.4%和1.5%。这些结果表明，保守治疗的AVM更容易出血，因此患者死亡率较高。包括放射外科、显微外科和栓塞在内的多模式治疗通过成功治疗困难病例而改善了临床结局。
Object. Because arteriovenous malformations (AVMs) in the basal ganglia and thalamus are difficult to treat, the authors conducted a retrospective study to determine the best management strategy for these lesions.Methods. The authors reviewed the management and outcome in 101 patients with AVMs treated between 1971 and 1995. In 15 conservatively treated patients, hemorrhage occurred in 71.4% (annual rate 11.4%), and the morbidity and mortality rates were 7.1% and 42.9%, respectively, during a mean follow-up period of 6.6 years. Total microsurgical resection was performed in 15 patients with no mortality resulting, but motor function deteriorated permanently in three of them (20%). Postoperative morbidity correlated well with the location of the AVM and with preoperative motor function. In cases of lenticular AVMs without motor weakness, a postoperative decrease in motor function was significantly more common than in the remaining patients. In patients with motor weakness before surgery, AVMs in the thalamus or caudate nucleus were successfully resected. Among 66 patients treated with gamma knife radiosurgery, three had permanent radiation-induced neurological deficits, and three others experienced bleeding (new bleeding in one case and rebleeding in two). The treatment-associated morbidity rate was 6.7%, and the actuarial rate of complete obliteration was 85.7% at 2.5 years. In five patients treated with embolization alone, the morbidity and mortality rates associated with the procedure or bleeding were 40% and 20%, respectively. The morbidity and mortality rates in the pre-gamma knife era were 22.2% and 22.2%, whereas those for the post-gamma knife era are currently 10.4% and 1.5%, respectively.Conclusions. These results indicate that conservatively treated AVMs are more likely to bleed and thus produce a high incidence of patient mortality. Multimodal treatment including radiosurgery, microsurgery, and embolization improved clinical outcomes by making it possible to treat difficult cases successfully.