Mattle H P, Schroth G, Seiler R W
Department of Neurology, Inselspital, 3010 Bern, Switzerland.
J Neurol. 2000 Dec;247(12):917-28. doi: 10.1007/s004150070047.
An arteriovenous malformation (AVM) consists of one or more arteries that drain through one or several small openings directly into one or more veins. The capillary system between arteries and veins is missing. The natural history of an unruptured AVM demonstrates a 1-2% bleeding rate and once ruptured a 2-4% annual risk of rebleeding. There is a risk of dying of AVM up to 1% per year, a 1% annual risk of developing de novo epilepsy, and a 1% chance of disability per year. Small AVMs are more likely to rupture than large AVMs. The goal of treatment is complete obliteration of the malformation. The risk of surgical treatment depends mainly on its size, location and drainage pattern. Size and angioarchitecture determine the risks of embolotherapy and radiotherapy. AVMs in Spetzler-Martin grades I-III should be treated by microneurosurgery or a combination of embolotherapy and microneurosurgery. They can be excised with low surgical mortality and morbidity. For AVMs in Spetzler-Martin grades IV and V staged treatment approaches such as embolotherapy followed by surgery or radiotherapy should be considered. Rarely is embolotherapy or radiotherapy alone indicated. There are AVMs in Spetzler-Martin grades IV and V that may be inaccessible for surgical or any other treatment, and that should be left alone. Prospective randomised trials on the optimal management of AVMs are lacking. All our knowledge on AVMs stems from open series and indirect comparisons.
动静脉畸形（AVM）由一条或多条动脉组成，这些动脉通过一个或几个小孔直接引流到一条或多条静脉中。动静脉之间的毛细血管系统缺失。未破裂AVM的自然病史显示出血率为1%-2%，一旦破裂，每年再出血风险为2%-4%。每年死于AVM的风险高达1%，每年新发癫痫的风险为1%，每年致残的几率为1%。小AVM比大AVM更容易破裂。治疗的目标是完全消除畸形。手术治疗的风险主要取决于其大小、位置和引流模式。大小和血管构筑决定了栓塞治疗和放射治疗的风险。Spetzler-Martin分级为I-III级的AVM应采用显微神经外科手术或栓塞治疗与显微神经外科手术联合治疗。可以将其切除，手术死亡率和发病率较低。对于Spetzler-Martin分级为IV级和V级的AVM，应考虑采用分期治疗方法，如栓塞治疗后再进行手术或放射治疗。很少单独采用栓塞治疗或放射治疗。Spetzler-Martin分级为IV级和V级的AVM中，有些可能无法进行手术或任何其他治疗，对此应不予处理。目前缺乏关于AVM最佳治疗方案的前瞻性随机试验。我们所有关于AVM的知识都来自于开放系列研究和间接比较。
