RELATIONSHIP OF PERFUSION-PRESSURE AND SIZE TO RISK OF HEMORRHAGE FROM ARTERIOVENOUS-MALFORMATIONS
RELATIONSHIP OF PERFUSION-PRESSURE AND SIZE TO RISK OF HEMORRHAGE FROM ARTERIOVENOUS-MALFORMATIONS
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DOI：
10.3171/jns.1992.76.6.0918
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发表时间：
1992-06-01
影响因子：
4.1
通讯作者：
ZIMMERMAN, RS
中科院分区：
文献类型：
--
作者：
SPETZLER, RF;HARGRAVES, RW;ZIMMERMAN, RS
动静脉畸形（AVM）的大小与其出血倾向之间的关系尚不清楚。尽管病灶体积相对于AVM直径呈几何级数增加，但与大型AVM相比，小型AVM中的血管扩张至少同样常见。作者前瞻性评估了92例AVM的病灶大小、血肿大小和动脉供血压，以确定这些变量是否影响出血倾向，小AVM（直径小于或等于3 cm）出血的发生率明显高于大AVM（直径> 6 cm）（p < 0.001），发生率分别为82%和21%。在该系列的92例患者中，24例记录了主供血血管的术中动脉压：10例出现出血，14例出现其他神经症状。在已闭塞的AVM中，平均动脉血压和供血动脉压之间的平均差为6.5 mm Hg（范围2 - 15 mm Hg）。在未破裂的AVM中，该差异为40 mm Hg（范围17 - 63 mm Hg）。较小的AVM的供血动脉压力明显高于较大的AVM（p < 0.05），并且与较大的AVM相关。这表明，动脉供血压的差异可能是负责AVM的大小和出血的频率和严重程度之间的关系。
The relationship between the size of an arteriovenous malformation (AVM) and its propensity to hemorrhage is unclear. Although nidus volume increases geometrically with respect to AVM diameter, hemorrhages are at least as common, in small AVM's compared to large AVM's. The authors prospectively evaluated 92 AVM's for nidus size, hematoma size, and arterial feeding pressure to determine if these variables influence the tendency to hemorrhage.Small AVM's (diameter less-than-or-equal-to 3 cm) presented with hemorrhage significantly more often (p < 0.001) than large AVM's (diameter > 6 cm), the incidence being 82% versus 21%. Intraoperative arterial pressures were recorded from the main feeding vessel(s) in 24 of the 92 patients in this series: 10 presented with hemorrhage and 14 presented with other neurological symptoms. In the AVM's that had hemorrhaged, the mean difference between mean arterial blood pressure and the feeding artery pressure was 6.5 mm Hg (range 2 to 15 mm Hg). In the AVM's that did not rupture, this difference was 40 mm Hg (range 17 to 63 mm Hg). Smaller AVM's had significantly higher feeding artery pressures (p < 0.05) than did larger AVM's, and they were associated with large hemorrhages. It is suggested that differences in arterial feeding pressure may be responsible for the observed relationship between the size of AVM's and the frequency and severity of hemorrhage.