Andoh T, Sakai N, Yamada H, Deguchi K, Hirata T, Kondoh H, Tanabe Y, Funakoshi T, Takada M, Ohkuma A
Department of Neurosurgery, Gifu University, School of Medicine, Japan.
No To Shinkei. 1990 Apr;42(4):367-76.
During the past 20 years, we have treated 187 cases with cerebral arteriovenous malformations (AVMs). These 134 patients were treated surgically and the remaining 53 patients were managed non-surgically. The purpose of this study is to clarify the surgical indications of AVMs, based on a comparison of the long-term follow-up results between the surgical and nonsurgical groups. Consequently, good results were obtained in the surgical group: the operative mortality was 7.5% and the morbidity was 12.7%. The long-term follow-up results were as follows: Of the 124 followed cases in the surgical group, there were 16 cases with improvement of neurological deficits (13%) and 3 cases with neurological aggravation (2%). Of the 47 followed cases in the nonsurgical group, there were 5 cases with improvement of neurological deficits (11%) and 6 cases with neurological aggravation (13%). As for the incidence of AVM hemorrhage, there were 8 cases with hemorrhage in the nonsurgical group including 4 cases (3 rebleeding cases) which were fatal (11%), in contrast to one case (subtotal resection) in the surgical group. On follow-up angiography, the size of AVMs were unchanged in the majority of cases in the nonsurgical group, with the exception of 2 cases in which there were slight regressions. In the surgical group, on the other hand, enlargement in 2 cases and spontaneous regression in 3 of residual AVM occurred following incomplete resection. Particularly in 2 cases involving unresectable AVMs, a newly formed aneurysm was discovered in the follow-up angiography, emphasizing the fact that serious follow-up angiography is required in cases of untreated AVMs.
在过去20年里，我们共治疗了187例脑动静脉畸形（AVM）患者。其中134例接受了手术治疗，其余53例采用非手术治疗。本研究的目的是通过比较手术组和非手术组的长期随访结果，明确AVM的手术指征。结果显示，手术组取得了良好的效果：手术死亡率为7.5%，发病率为12.7%。长期随访结果如下：手术组124例随访病例中，神经功能缺损改善者16例（13%），神经功能加重者3例（2%）。非手术组47例随访病例中，神经功能缺损改善者5例（11%），神经功能加重者6例（13%）。关于AVM出血发生率，非手术组有8例出血，其中4例（3例再出血）死亡（11%），而手术组仅有1例（次全切除）出血。在随访血管造影中，非手术组大多数病例的AVM大小无变化，仅有2例略有缩小。另一方面，手术组在不完全切除后，有2例残留AVM增大，3例自发缩小。特别是在2例无法切除的AVM病例中，随访血管造影发现了新形成的动脉瘤，强调了未治疗的AVM病例需要进行严格随访血管造影的事实。
