AVM的診斷及治療

1、AVM的診斷及治療,何 爽,1,.,一、定義,是一種先天性局部腦血管發(fā)生學上的變異。在病變部位腦動脈和腦靜脈之間缺乏毛細血管團，致使動脈與靜脈直接相通，形成動靜脈之間的短路。,2,.,二、病因,胚胎期血管生成調(diào)節(jié)機制發(fā)生障礙所致。 原始動、靜脈僅有兩層內(nèi)皮細胞隔開，發(fā)育異常使動靜脈不經(jīng)過毛細血管網(wǎng)而直接相通。,3,.,三、流行病學,動靜脈畸形的患病率約為 50/100，000。隨著影像學技術的發(fā)展，未破裂動靜脈畸形的檢出率逐年升高，而破裂動靜脈畸形的發(fā)病率一直維持穩(wěn)定。動靜脈畸形常發(fā)生在 20-40 歲之間的年輕人群中。,4,.,四、病理生理,1有一條或者多條供血動脈、畸形血管團、一條或多條引

2、流靜脈構成 2供血動脈和畸形血管團可形成動脈瘤（8-12%），可見動靜脈瘺 3畸形血管團內(nèi)血流緩慢易形成血栓，管壁發(fā)育不良易出血，管壁 鈣化，反復出血使病灶增大 4局部腦組織軟化、出血、鈣化、萎縮、膠質(zhì)增生,5,.,五、常見臨床表現(xiàn),1.出血 多發(fā)生于年齡較小者，可表現(xiàn)為蛛網(wǎng)膜下腔出血、腦內(nèi)出血或硬膜下出血，常于體力活動或情緒波動后突然出現(xiàn)劇烈頭痛、嘔吐、意識喪失。 2.癲癇 可見于40%50%的患者，約半數(shù)為首發(fā)癥狀，多見于較大的、有大量“腦盜血”的動靜脈畸形者。 3.頭痛 60%的患者有長期頭痛史，多局限于一側(cè)，出血時頭痛的性質(zhì)發(fā)生改變。,6,.,六、影像學診斷,a、CT 未出血者：不規(guī)則

3、稍高、低或混雜密度影，動靜脈鈣化、軟化灶。 出血者：腦實質(zhì)血腫、SAH、腦室內(nèi)積血 增強可見供血動脈、血管巢、引流靜脈強化,7,.,無特異性，結(jié)合患者年齡、高血壓病史、家族史、其他部位血管瘤病史，進一步完善檢查。,需要和高血壓腦出血、淀粉樣變性腦出血等做出鑒別。,8,.,9,.,CTA 優(yōu)點：時間快,10,.,MR 團狀、條索狀、蜂窩狀的血管流空影。無出血時首選3D-TOF。,11,.,MRA,12,.,DSA,13,.,七、治療,a、切除手術 優(yōu)點： 可清除血腫 b、介入栓塞 優(yōu)點：可保留功能區(qū) c、伽馬刀,14,.,CASE,A 16-year-old girl presented wit

4、h sudden headache on the morning of 2016, June 30. Prior to the admittance to the local hospital, she was given analgesic drug by her patients and no relief followed by and she progressively turned into lethargy. CT scan showed the left frontal lobe hematoma break into left ventricle, 3rd and 4th ve

5、ntricles.,15,.,CTA demonstrated left frontal lobe AVM, feeded by the branch of left anterior cerebral artery, but the venous drainage was not very clear.,16,.,The patient was transferred to our hospital for further treatment, recheck CT and angiography were performed which showed more details.,17,.,3D-DSA provided more details to identify the feeders and program the roads for microcatheter approaching.,18,.,The patient was taken to the hybrid operation room, underwent preoperative embolization to minimize the risk of bleeding during