Embolization of cerebral arteriovenous malformations .2. Aspects of complications and late outcome
Embolization of cerebral arteriovenous malformations .2. Aspects of complications and late outcome
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DOI：
10.1097/00006123-199609000-00005
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发表时间：
1996-09-01
期刊：
影响因子：
4.8
通讯作者：
Svendsen, P
中科院分区：
文献类型：
--
作者：
Lundqvist, C;Wikholm, G;Svendsen, P
目的：从1987年到1993年，我们对150例脑动静脉畸形（AVM）患者进行了栓塞治疗。患者年龄范围为5 - 70岁（35.5 ± 14.8岁，平均值±标准差），由斯堪的纳维亚的神经外科医生选择。我们分析了并发症的风险和后期结果有一个更好的基础上的决定，执行embolization.METHODS：后续是一个人的所有幸存的患者的神经科医生的临床检查。结果：34例患者中，单纯栓塞（20例）或辅助手术（14例）消除了AVM。在66例患者中，AVM栓塞至适合补充立体定向放射的尺寸。这100例患者的临床病程稳定。另一组50例接受栓塞的患者仅接受了部分治疗，作为一组，这些患者的结局不太理想。导致诊断的表现或症状与其他研究一致。在AVM已消除的患者和仅接受部分治疗的患者中，头痛和癫痫对治疗有积极反应。脑出血史不影响复发性出血的预后。相反，存在供血动脉或病灶动脉瘤的AVM与出血风险增加相关。如果有一个大的，部分治疗AVM的患者出血的历史，预后的生存率降低。结论：治疗的适应症增加与AVM相关动脉瘤的发生。对于大型AVM患者，出血史证明了更积极的治疗方法是合理的。在研究的最后几年，并发症风险降低也增加了栓塞的适应症。
OBJECTIVE: From 1987 through 1993, we performed embolizations on 150 patients with cerebral arteriovenous malformations (AVMs) at Sahlgrenska University Hospital. The patients ranged in age from 5 to 70 years (35.5 +/- 14.8 yr, mean +/- standard deviation) and were selected by neurosurgeons in Scandinavia. We analyzed the risk of complications and late outcome to have a better basis for the decision to perform embolization.METHODS: The follow-up was a personal clinical examination of all surviving patients by a neurologist. Files for all patients were also studied.RESULTS: In 34 patients, the AVMs were eliminated by embolization alone (20 patients) or by supplementary surgery (14 patients). In 66 patients, the AVMs were embolized to a size suitable for supplementary stereotactic radiation. The clinical course was stable for those 100 patients. Another group of 50 patients who had undergone embolization was only partially treated, and as a group, those patients had less favorable outcomes. The manifestations or symptoms leading to diagnosis were in concordance with other studies. Headache and epilepsy showed a positive response to treatment in patients whose AVMs had been eliminated as well as in those who received only partial treatment. A history of cerebral bleeding did not influence the prognosis of recurrent bleeding. Conversely, AVMs with feeder or nidus aneurysms were related to an increased risk of bleeding. If there was a history of bleeding in a patient with large, partially treated AVMs, the prognosis for survival was diminished.CONCLUSION: The indication for treatment increases with the occurrence of AVMs with associated aneurysms. For patients with large AVMs, a history of bleeding justifies a more aggressive approach to treatment. The reduced risk of complications during the last years of the study also increases the indication for embolization.