Della Puppa Alessandro, Scienza Renato
Department of Neurosurgery, University Hospital of Padova, Padova, Italy.
Acta Neurochir Suppl. 2016;123:141-5. doi: 10.1007/978-3-319-29887-0_20.
The authors report their personal experience with brain arterio-venous malformations (bAVMs) surgery with a multimodal flow-assisted approach.
Data from patients who consecutively underwent bAVM resection with the assistance of indocyanine green video-angiography (ICG-VA), micro-flow probe flowmetry, and temporary arterial clipping test under intra-operative monitoring, were retrospectively analyzed.
Twenty seven patients were enrolled in the study. Re-operation for residual nidus was needed in one case (3 %). Average mRS change 1 month after surgery was +0.02. In our experience, the multimodal flow-assisted approach enabled surgeons to shift from one technique to another, according to the stage of resection, AVM location, or specific issues to be addressed. Before resection, the value of ICG-VA and flowmetry in showing AVM angio-architecture and guiding surgical strategy was related to AVM features. The temporary arterial clipping-test presented a 100 % sensitivity to differentiate between an AVM feeder and a transit artery to the sensi-motor area. At the final stage of resection, flowmetry was more effective than ICG-VA in detecting residual nidus missed at dissection.
Multimodal flow-assisted approach in AVM surgery proved a feasible, safe, and reliable methodology to achieve AVM resection with high radicality and low morbidity rate.
作者报告他们采用多模式血流辅助方法进行脑动静脉畸形（bAVM）手术的个人经验。
回顾性分析连续接受bAVM切除术患者的数据，术中借助吲哚菁绿视频血管造影（ICG-VA）、微流量探头血流测定法以及临时动脉夹闭试验并进行术中监测。
27例患者纳入研究。1例（3%）患者因残留病灶需要再次手术。术后1个月改良Rankin量表（mRS）平均变化为+0.02。根据我们的经验，多模式血流辅助方法使外科医生能够根据切除阶段、AVM位置或需要解决的特定问题从一种技术转换到另一种技术。在切除前，ICG-VA和血流测定法在显示AVM血管结构和指导手术策略方面的价值与AVM特征有关。临时动脉夹闭试验在区分AVM供血动脉和感觉运动区的过路动脉方面敏感性为100%。在切除的最后阶段，血流测定法在检测解剖时遗漏的残留病灶方面比ICG-VA更有效。
AVM手术中的多模式血流辅助方法被证明是一种可行、安全且可靠的方法，能够实现高彻底性且低发病率的AVM切除。
