[幕上动静脉畸形的显微外科治疗。第二部分——并发症]

[The microsurgical treatment of the supratentorial arteriovenous malformations. Part II--complications].

作者信息

Kunert Przemysław, Marchel Andrzej

机构信息

Katedra i Klinika Neurochirurgii Akademii Medycznej w Warszawie, ul.Banacha 1a, 02-097 Warszawa.

出版信息

Neurol Neurochir Pol. 2006 Mar-Apr;40(2):98-105.

PMID:16628505

Abstract

BACKGROUND AND PURPOSE

The aim of this study was an analysis of complications after surgical treatment of the cerebral supratentorial arteriovenous malformations (AVM), assessment of their clinical sequelae, and attempt to find factors influencing their occurrence.

MATERIAL AND METHODS

88 consecutive patients operated on for AVM in the years 1983-2000 were included in a retrospective study. In all patients microsurgical, selective removal of AVM was performed, without prior embolization. The statistical analysis was carried out by means of exact Fisher test and c2 test.

RESULTS

Complications in the postoperative period were observed in 45.5%, including short-term deterioration (27.3%) and symptoms present till the day of discharge (18.2%). Mechanisms of deterioration were as follows: significant intraoperative hemorrhage (5.7%), hemodynamic disturbances after AVM removal (20.5%) and resection of AVM in the eloquent area (19.3%). Many variables that may contribute to the complications were studied. Factors increasing the risk of significant intraoperative hemorrhage are: steal effect visible in angiography (32% vs. 10%, p<0.05), intraventricular penetration of AVM (38% vs. 11%, p<0.05). Factors increasing the risk of hemodynamic disturbances are: feeding from the medial cerebral artery (MCA) (31% vs. 8%, p=0.02) and complex venous drainage (32% vs. 14%, p=0.05).

CONCLUSIONS

The most common causes of postoperative deterioration are hemodynamic disturbances after AVM removal and manipulation in the eloquent area. Hemodynamic disturbances worsened the prognosis significantly, and were the only cause of mortality (3.4%). However, massive intraoperative hemorrhage and operation in the eloquent area did not influence the outcome significantly. Risk factors for intraoperative hemorrhage are steal effect and intraventricular penetration of AVM. Risk factors for hemodynamic disturbances are feeding AVM from MCA and complex venous drainage.

摘要

背景与目的

本研究旨在分析幕上脑动静脉畸形（AVM）手术治疗后的并发症，评估其临床后遗症，并试图找出影响其发生的因素。

材料与方法

对1983年至2000年间连续88例接受AVM手术的患者进行回顾性研究。所有患者均接受显微手术，选择性切除AVM，未进行术前栓塞。采用精确Fisher检验和卡方检验进行统计分析。

结果

术后并发症发生率为45.5%，包括短期病情恶化（27.3%）和直至出院时仍存在的症状（18.2%）。病情恶化的机制如下：术中大量出血（5.7%）、AVM切除后血流动力学紊乱（20.5%）以及在功能区切除AVM（19.3%）。研究了许多可能导致并发症的变量。增加术中大量出血风险的因素有：血管造影可见的盗血效应（32%对10%，p<0.05）、AVM穿入脑室（38%对11%，p<0.05）。增加血流动力学紊乱风险的因素有：由大脑中动脉（MCA）供血（31%对8%，p=0.02）和复杂的静脉引流（32%对14%，p=0.05）。