【摘要】 目的 总结分析功能区、深部复杂动静脉畸形的显微手术疗效。方法 回顾4年来收治的18例功能区及深部动静脉畸形患者，根据MR、CTA、DSA等影像资料设计手术方案，进行显微手术治疗。结果 18例脑动静脉畸形患者，畸形血管团全切除14例，选择性夹闭主要供血动脉4例。无手术引发的神经功能缺失。结论 功能区和深部复杂动静脉畸形通过MR、CTA、DSA等影像资料设计手术方案，细致完成显微手术，能够获得满意的疗效。
【关键词】 颅内动静脉畸形;显微外科;脑功能区
Microsurgy of complicated intracranial arteriovenous malformations:
clinical analysis of 18 cases
ZHU Yufu, YU Zhengquan*, LI Zhongling, LIU Yong, CHEN Chen, MIAO Fa′an
(Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221002, China)
Abstract:Objective To summarize and analyze micrurgy therapeutic effect of complicated intracranial arteriovenous malformations in brain functional region and/or profound parts.Methods 18 cases with complicated intracranial arteriovenous malformations were retrospectively analyzed in the past 4 years. All the 18 patients were treated with designed individualization of microsurgery operations based on MR, CTA and DSA.Results All the malformed blood vessel were perfectly resected in 14 patients. Main feeding arteries of vascular malformations were clipped in 4 patients.Conclusion The complicated intracranial arteriovenous malformations in brain domain and/or profound part brain could be satisfactorily cured by designed individualization of microsurgery operations based on MR, CTA and DSA.
Key words: intracranial arteriovenous malformations; microsurgery; brain functional region
颅内动静脉畸形手术治疗是神经外科难点，特别是大脑功能区和深部的复杂动静脉畸形手术治疗效果差异大，术后常残留功能损害[1-3]。本组对4年来收治的18例脑功能区和深部动静脉畸形患者成功进行了显微手术治疗,现报道如下。
1 资料和方法
1.1 一般资料 2003年12月至今收治18例动静脉畸形患者。年龄5～61岁，平均27.3岁，女10例，男8例。额顶叶和侧裂基底节功能区动静脉畸形(AVM)9例，小脑近脑干侧AVM 3例，脑室壁及颞枕深面脑干外侧AVM 6例。其中1例AVM γ刀放射治疗7年后再出血，1例并发脑积水。症状以头痛、癫疒间、一侧肢体肌力减退或丧失、失语、意识障碍、颅高压为著。术前昏迷3例，朦胧、嗜睡4例。
1.2 影像学检查 均经CT检查，检出脑出血12例，破入脑室4例，其中3例影像学表现为多次出血。全部病例经CTA筛检和DSA全脑血管造影检查。畸形血管团直径3～6.5 cm。
1.3 手术方法 所有病例均行显微手术治疗。小脑动静脉畸形采用枕下后正中入路，深部颞枕叶AVM选用翼点、颞下联合入路，基底节区用翼点入路，其余的动静脉畸形均用病灶体
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