《脑动静脉畸形》PPT课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,CEREBRAL,ARTERIOVENOUS MALFORMATIONS,AVM:a TLA for the CNS,Incidence,0.52%,at autopsy,Slight male preponderance(1.09 to 1.94),Congenital lesions(although rarely familial),Embryology,First half of third week of gestation,epiblastic,cells migrate to form mesoderm,mesodermal,cells differentiate to arterial and venous vessels on the surface of the embryonic nervous system,Embryology,First half of third week of gestation,epiblastic,cells migrate to form mesoderm,mesodermal,cells,differentaite,to arterial and venous vessels on the surface of the embryonic nervous system,Seventh gestational week,vessels sprout branches&penetrate developing brain,reach the gray-white interface,either loop back to,pial,surface or traverse entire neural tube,thus,epicerebral,&,transcerebral,circn,eventually connect arterial and venous systems by around the twelfth week,Pathology&Pathophysiology,absence of normal capillary system,Pathology&Pathophysiology,absence of normal capillary system,usual function displaced,Pathology&Pathophysiology,absence of normal capillary system,usual function displaced,asymptomatic at birth,Pathology&Pathophysiology,absence of normal capillary system,usual function displaced,asymptomatic at birth,vessels change with time,may develop aneurysms,parenchymal,changes within and around the lesion,Pathology&Pathophysiology,absence of normal capillary system,usual function displaced,asymptomatic at birth,vessels change with time,may develop aneurysms,parenchymal,changes within and around the lesion,site frequency is proportional to brain volume,Pathology&Pathophysiology,absence of normal capillary system,usual function displaced,asymptomatic at birth,vessels change with time,may develop aneurysms,Clinical presentation,95%,have symptoms by age of 70 years,Clinical presentation,95%,have symptoms by age of 70 years,peak presentation second to fourth decade,Clinical presentation,95%,have symptoms by age of 70 years,peak presentation second to fourth decade,high output failure,neonate,vein of Galen,hydrocephalus,first decade,headache,hemorrhage,seizures,2nd&3rd,Clinical presentation,factors contributing to symptoms,vessel walls,flow and pressures,Clinical presentation,factors contributing to symptoms,vessel walls,flow and pressures,enlargement and encroachment,Clinical presentation,factors contributing to symptoms,vessel walls,flow and pressures,enlargement and encroachment,dural,sinuses,Clinical presentation,factors contributing to symptoms,vessel walls,flow and pressures,enlargement and encroachment,dural,sinuses,ischaemia,Clinical presentation,factors contributing to symptoms,vessel walls,flow and pressures,enlargement and encroachment,dural,sinuses,ischaemia,cardiac output,Clinical presentation,Hemorrhage,AVM,rupture not a function of size,Aneurysm,rupture related to aneurysm size,Hemorrhage,AVM,rupture not a function of size,no marked increase with exercise,pregnancy,trauma,Aneurysm,rupture related to aneurysm size,increase with trauma exercise,end pregnancy,Hemorrhage,AVM,rupture not a function of size,no marked increase with exercise,pregnancy,trauma,arteriovenous,therefore less severe,Aneurysm,rupture related to aneurysm size,increase with trauma exercise,end pregnancy,arterial,therefore more severe,Hemorrhage,AVM,rupture not a function of size,no marked increase with exercise,pregnancy,trauma,arteriovenous,therefore less severe,mortality 6 to 13.6%,Aneurysm,rupture related to aneurysm size,increase with trauma exercise,end pregnancy,arterial,therefore more severe,mortality 30-50%,Hemorrhage,AVM,rupture not a function of size,no marked increase with exercise,pregnancy,trauma,arteriovenous,therefore less severe,mortality 6 to 13.6%,lower,rebleed,mortality rate(1%),Aneurysm,rupture related to aneurysm size,increase with trauma exercise,end pregnancy,arterial,therefore more severe,mortality 30-50%,higher,rebleed,mortality rate(13%),Hemorrhage,AVM,rupture not a function of size,no marked increase with exercise,pregnancy,trauma,arteriovenous,therefore less severe,mortality 6 to 13.6%,lower,rebleed,mortality rate(1%),vasospasm rare,Aneurysm,rupture related to aneurysm size,increase with trauma exercise,end pregnancy,arterial,therefore more severe,mortality 30-50%,higher,rebleed,mortality rate(13%),vasospasm common,Hemorrhage-AVM,Nonetheless,risk of major,incapacitating,or fatal hemorrhage in untreated lesion is 40 to 50%,Hemorrhage-AVM,Nonetheless,risk of major,incapacitating,or fatal hemorrhage in untreated lesion is 40 to 50%,Yearly risk of initial hemorrhage 3%,Rebleed,in first subsequent year 6-18%,reducing to 3%again thereafter,Pediatric prognosis worse than adult,Spetzler&Martin Grading System,Criteria,Score,Size of Nidus,Small(6cm),3,Eloquence of Adjacent Brain,No,0,Yes,1,Deep Vascular Component,No,0,Yes,1,Treatment Options,Surgical Resection,Treatment Options,Surgical Resection,Endovascular,E