Aminoff M J
Neurology. 1987 May;37(5):815-9. doi: 10.1212/wnl.37.5.815.
The presence of a cerebral AVM is a potential risk to a patient's life or quality of life. Pharmacologic maneuvers or partial obliteration of an AVM by non-operative means will help most of its nonhemorrhagic manifestations but do not influence the threat of intracranial bleeding, which is the major cause of morbidity and mortality. This risk is eliminated if the AVM is removed. Surgical treatment, however, also carries a risk, and it is therefore important to determine how this risk compares to that of conservative management before surgery is recommended in patients with unruptured AVMs. The present analysis suggests that the surgical mortality and morbidity, although considerably reduced in recent years, still generally precludes surgery for unruptured AVMs. The most favorable figures for surgery are properly applicable to small, superficial AVMs located in clinically silent areas of the brain in young and otherwise well patients who are to be operated upon by surgeons especially experienced in treating AVMs. Even using these favorable figures, however, there is no clear advantage to surgical excision over conservative management over a 20-year period unless AVMs have ruptured once, following which the risks of further episodes of hemorrhage are increased.
脑动静脉畸形（AVM）的存在对患者的生命或生活质量构成潜在风险。药物治疗或通过非手术手段部分闭塞AVM有助于缓解其大多数非出血性表现，但不会影响颅内出血的风险，而颅内出血是发病和死亡的主要原因。如果切除AVM，则可消除这种风险。然而，手术治疗也有风险，因此在建议对未破裂AVM患者进行手术之前，确定这种风险与保守治疗的风险相比如何非常重要。目前的分析表明，尽管近年来手术死亡率和发病率大幅降低，但总体上仍不适合对未破裂AVM进行手术。最有利的手术数据适用于位于脑内临床无症状区域的小型、浅表AVM，患者为年轻且其他方面健康的人群，由在治疗AVM方面经验丰富的外科医生进行手术。然而，即使使用这些有利数据，在20年的时间里，手术切除与保守治疗相比也没有明显优势，除非AVM已经破裂一次，此后再次出血的风险会增加。
