Morgan M K, Johnston I
Department of Neurosurgery, Royal Alexandra Hospital for Children, Camperdown, NSW.
Med J Aust. 1988 Jan 18;148(2):65-8.
A consecutive series of 107 patients with an intracranial arteriovenous malformation who were considered for surgical treatment over the 11-year period between 1974 and 1985 is analysed. In 71 (66.4%) patients complete obliteration (which in some cases was combined with pre- or peroperative embolization) by surgery was attempted and was achieved in all but two patients. Five patients were treated by embolization alone and three patients by radiotherapy alone. Twenty-eight patients were managed conservatively for one of four reasons: an expectation of a good outcome without treatment (six patients); the refusal of recommended surgical treatment (five patients); poor condition at presentation (eight patients); or the risks of operative treatment were thought to be too great (nine patients). There was a 9.9% mortality in the surgically-treated series and significant morbidity in 16 (22.3%) patients. In all but two of these 16 patients, morbidity was related directly to the initial intracerebral haemorrhage. The one-year mortality in the group that did not undergo operation was significantly higher than in those patients who were treated surgically. Some general guide-lines for the management of intracranial arteriovenous malformations are proposed.
分析了1974年至1985年这11年间连续收治的107例考虑接受手术治疗的颅内动静脉畸形患者。71例（66.4%）患者尝试通过手术完全闭塞（在某些情况下结合术前或术中栓塞），除2例患者外均成功实现。5例患者仅接受栓塞治疗，3例患者仅接受放射治疗。28例患者因以下四个原因之一接受保守治疗：预期未经治疗会有良好结果（6例患者）；拒绝推荐的手术治疗（5例患者）；就诊时病情较差（8例患者）；或认为手术治疗风险太大（9例患者）。手术治疗组的死亡率为9.9%，16例（22.3%）患者出现明显并发症。在这16例患者中，除2例患者外，并发症均与最初的脑出血直接相关。未接受手术治疗组的1年死亡率显著高于接受手术治疗的患者。提出了一些颅内动静脉畸形治疗的一般指导原则。
