Department of Neurosurgery, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8011, New Zealand.
University of Aberdeen, Scotland, United Kingdom.
J Clin Neurosci. 2020 Mar;73:74-79. doi: 10.1016/j.jocn.2020.01.035. Epub 2020 Feb 13.
Treatment of intracranial arteriovenous malformations is complex and multidisciplinary. This article presents the treatment model utilized in Christchurch, New Zealand which provides cerebrovascular surgery and interventional neuroradiology to the entire south island (approximate population of 1.1 million). A total of 40 patients treated over a 10 year period (2004-2014) are analysed here. Nine patients were managed surgically and complete resection was achieved in 100% of cases. Permanent mortality was 0% and permanent morbidity was 22% however median mRS improved from 3.0 preoperatively to 1.0 at follow up. Embolisation was utilized in 31 patients (mean age 40), of which 45% presented with haemorrhage, 39% with seizures, 10% with a headache only, and 6% with a deficit. None were found incidentally. The Spetzler-Martin grade 1 cases accounted for 10% of the cohort, 23% were grade II, 42% grade III, 23% grade IV and 3% grade V. A single aneurysm was present in 42% of cases, and multiple in 13%. The nidus was obliterated in 9.6% of cases with a morbidity rate of 6.5% and mortality rate of 3%. Modified Rankin scale improved marginally from 0.9 at diagnosis to 0.88 at final follow up (mean 22 months). There were no cases of recanalization. The total nidus obliteration rate using our algorithm of surgery alone for small accessible lesions, then staged embolization for larger lesions with adjuvant radiosurgery reserved for cases with residual nidus, was 50%.
颅内动静脉畸形的治疗是复杂的，需要多学科参与。本文介绍了新西兰克赖斯特彻奇的治疗模式，该模式为整个南岛（约 110 万人口）提供脑血管外科和介入神经放射学服务。本文分析了在此治疗模式下，在过去 10 年（2004-2014 年）治疗的 40 名患者。其中 9 名患者接受了手术治疗，100%的患者达到了完全切除。无永久性死亡率，22%的患者有永久性并发症，但中位数 mRS 从术前的 3.0 分改善至随访时的 1.0 分。31 名患者（平均年龄 40 岁）接受了栓塞治疗，其中 45%因出血就诊，39%因癫痫就诊，10%仅因头痛就诊，6%因神经功能缺损就诊。无一例患者为偶然发现。Spetzler-Martin 分级 1 级的患者占队列的 10%，23%为 2 级，42%为 3 级，23%为 4 级，3%为 5 级。单发动脉瘤占 42%，多发动脉瘤占 13%。9.6%的患者病灶完全闭塞，并发症发生率为 6.5%，死亡率为 3%。改良 Rankin 量表评分从诊断时的 0.9 分略有改善至最终随访时的 0.88 分（平均随访时间为 22 个月）。无再通病例。单纯手术治疗小而可接近病变，分期栓塞较大病变，保留残余病灶的放射外科治疗，根据我们的算法，总的病灶闭塞率为 50%。
