Sugiyama Taku, Grasso Giovanni, Torregrossa Fabio, Fujimura Miki
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics, University of Palermo, Palermo, Italy.
World Neurosurg. 2022 Mar;159:314-326. doi: 10.1016/j.wneu.2021.07.106. Epub 2021 Jul 30.
Brain arteriovenous malformations (bAVMs) are unusual vascular pathologies characterized by the abnormal aggregation of dilated arteries and veins in the brain parenchyma and for which the absence of a normal vascular structure and capillary bed leads to direct connections between the arteries and veins. Although bAVMs have long been believed to be congenital anomalies that develop during the prenatal period, more recent studies have shown that inflammation is associated with AVM genesis, growth, and rupture. The interventional treatment options include microsurgery, stereotactic radiosurgery, and endovascular embolization, and management often comprises a multidisciplinary combination of these modalities. The appropriate selection of patients with bAVMs for interventional treatment requires balancing the risk of treatment complications against the risk of hemorrhage during the natural course of the pathology. However, no definitive guidelines have been established for the management of bAVMs. We have comprehensively reviewed the current basic and clinical studies of bAVMs and discussed the contemporary status of multidisciplinary management of bAVMs.
脑动静脉畸形（bAVM）是一种特殊的血管病变，其特征是脑实质内扩张的动脉和静脉异常聚集，且由于缺乏正常的血管结构和毛细血管床，导致动脉和静脉之间直接连通。尽管长期以来人们一直认为bAVM是产前发育过程中出现的先天性异常，但最近的研究表明，炎症与动静脉畸形的发生、生长及破裂有关。介入治疗方法包括显微手术、立体定向放射外科手术和血管内栓塞术，治疗通常采用这些方法的多学科联合应用。对于适合介入治疗的bAVM患者进行恰当选择，需要在治疗并发症风险与该病变自然病程中的出血风险之间取得平衡。然而，目前尚未建立关于bAVM治疗的明确指南。我们全面回顾了当前关于bAVM的基础和临床研究，并讨论了bAVM多学科治疗的现状。
