Lundqvist C, Wikholm G, Svendsen P
Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
Neurosurgery. 1996 Sep;39(3):460-7; discussion 467-9. doi: 10.1097/00006123-199609000-00005.
From 1987 through 1993, we performed embolizations on 150 patients with cerebral arteriovenous malformations (AVMs) at Sahlgrenska University Hospital. The patients ranged in age from 5 to 70 years (35.5 +/- 14.8 yr, mean +/- standard deviation) and were selected by neurosurgeons in Scandinavia. We analyzed the risk of complications and late outcome to have a better basis for the decision to perform embolization.
The follow-up was a personal clinical examination of all surviving patients by a neurologist. Files for all patients were also studied.
In 34 patients, the AVMs were eliminated by embolization alone (20 patients) or by supplementary surgery (14 patients). In 66 patients, the AVMs were embolized to a size suitable for supplementary stereotactic radiation. The clinical course was stable for those 100 patients. Another group of 50 patients who had undergone embolization was only partially treated, and as a group, those patients had less favorable outcomes. The manifestations or symptoms leading to diagnosis were in concordance with other studies. Headache and epilepsy showed a positive response to treatment in patients whose AVMs had been eliminated as well as in those who received only partial treatment. A history of cerebral bleeding did not influence the prognosis of recurrent bleeding. Conversely, AVMs with feeder or nidus aneurysms were related to an increased risk of bleeding. If there was a history of bleeding in a patient with large, partially treated AVMs, the prognosis for survival was diminished.
The indication for treatment increases with the occurrence of AVMs with associated aneurysms. For patients with large AVMs, a history of bleeding justifies a more aggressive approach to treatment. The reduced risk of complications during the last years of the study also increases the indication for embolization.
1987年至1993年期间，我们在瑞典哥德堡大学萨赫尔格伦斯卡学院附属医院为150例脑动静脉畸形（AVM）患者实施了栓塞治疗。患者年龄在5岁至70岁之间（平均35.5±14.8岁，均值±标准差），由斯堪的纳维亚半岛的神经外科医生挑选。我们分析了并发症风险和远期疗效，以便为栓塞治疗决策提供更好的依据。
对所有存活患者由神经科医生进行个人临床检查随访。同时研究了所有患者的病历档案。
34例患者的AVM通过单纯栓塞（20例）或辅助手术（14例）得以消除。66例患者的AVM被栓塞至适合辅助立体定向放射治疗的大小。这100例患者的临床病程稳定。另一组50例接受栓塞治疗的患者仅得到部分治疗，总体而言，这些患者的预后较差。导致诊断的表现或症状与其他研究结果一致。头痛和癫痫在AVM已消除的患者以及仅接受部分治疗的患者中对治疗均呈现阳性反应。脑出血病史不影响复发出血的预后。相反，带有供血动脉或瘤巢动脉瘤的AVM与出血风险增加相关。对于大型、仅得到部分治疗的AVM且有出血史的患者，生存预后较差。
伴有相关动脉瘤的AVM出现时，治疗指征增加。对于大型AVM患者，出血史表明应采取更积极的治疗方法。研究最后几年并发症风险的降低也增加了栓塞治疗的指征。
