Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Neurol India. 2009 Nov-Dec;57(6):749-55. doi: 10.4103/0028-3886.59471.
Intracranial arteriovenous malformations (AVM) are being increasingly managed by multimodality approach. This changing scenario encouraged us to study the present state of surgery in intracranial AVMs and the outcomes.
Of a total of 868 patients evaluated for suspected or known AVMs between January 2000 and July 2008, 790 had intracranial AVMs. The clinical characteristics and surgical outcomes of the 111 operated patients were analyzed.
Of the 111 patients, 73 were males. Clinical features included: Headache (70%), loss of consciousness (48%) and seizures (32%). The commonest AVM grade was Spetzler-Martin (SM) grade II (41%), 7% had AVM > 6 cm and 78% had evidence of bleed. In total 143 surgeries were performed and 22% of patients required multiple interventions. The types of surgical interventions included elective excision of AVM in 23%, emergency surgery (either AVM excision or evacuation of hematoma) in 55%, surgery following radiosurgery/embolization in 5% and palliative non-definitive surgeries (e.g. shunt) in 15%. Post-operative angiography was done in 67% of patients. Obliteration rates for elective excision of AVM in Spetzler Martin Grade I, II, IIIa, IIIb and IV were 100%, 71%, 33%, 50% and 67% respectively (mean follow-up:31.6 months). Of 39 patients with residual AVMs, 33 received gamma knife and four underwent embolization. Outcome was modified Rankin scale (mRS) grade 1 in 34% of patients and the overall favorable outcome was 83% and there were six deaths.
In our patients' cohort one in every eight patients required surgery. In intracranial AVMs, surgery still plays an important role. In developing countries like India it may be beneficial to electively excise Grade I and II AVMs if cost is a consideration.
颅内动静脉畸形（AVM）越来越多地采用多模态方法进行治疗。这种变化的情况促使我们研究目前颅内 AVM 的手术现状和结果。
在 2000 年 1 月至 2008 年 7 月期间，对总共 868 例疑似或已知 AVM 患者进行评估，其中 790 例为颅内 AVM。分析了 111 例接受手术治疗的患者的临床特征和手术结果。
111 例患者中，男性 73 例。临床特征包括头痛（70%）、意识丧失（48%）和癫痫发作（32%）。最常见的 AVM 分级为 Spetzler-Martin（SM）分级 II 级（41%），7%的 AVM 直径>6cm，78%有出血证据。总共进行了 143 次手术，22%的患者需要多次干预。手术干预的类型包括 AVM 切除术（23%）、紧急手术（AVM 切除术或血肿清除术）（55%）、放射外科/栓塞后手术（5%）和姑息性非确定性手术（如分流术）（15%）。67%的患者进行了术后血管造影。Spetzler Martin 分级 I、II、IIIa、IIIb 和 IV 级 AVM 切除术的闭塞率分别为 100%、71%、33%、50%和 67%（平均随访 31.6 个月）。39 例有残余 AVM 的患者中，33 例接受了伽玛刀治疗，4 例接受了栓塞治疗。改良 Rankin 量表（mRS）评分 1 级的患者占 34%，整体预后良好率为 83%，有 6 例死亡。
在我们的患者队列中，每 8 例患者中就有 1 例需要手术。在颅内 AVM 中，手术仍然起着重要作用。在像印度这样的发展中国家，如果考虑成本，选择性切除 I 级和 II 级 AVM 可能是有益的。
