AVM的诊断及治疗

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,AVM,的诊断及治疗,何 爽,一、定义,是一种先天性局部脑血管发生学上的变异。在病变部位脑动脉和脑静脉之间缺乏毛细血管团，致使动脉与静脉直接相通，形成动静脉之间的短路。,二、病因,胚胎期血管生成调整机制发生障碍所致。,原始动、静脉仅有两层内皮细胞隔开，发育特殊使动静脉不经过毛细血管网而直接相通。,三、流行病学,动静脉畸形的患病率约为 50/100，000。随着影像学技术的进展，未裂开动静脉畸形的检出率逐年上升，而裂开动静脉畸形的发病率始终维持稳定。动静脉畸形常发生在 20-40 岁之间的年轻人群中。,四、病理生理,1有一条或者多条供血动脉、畸形血管团、一条或多条引流静脉构成,2供血动脉和畸形血管团可形成动脉瘤8-12%，可见动静脉瘘,3畸形血管团内血流缓慢易形成血栓，管壁发育不良易出血，管壁,钙化，反复出血使病灶增大,4局部脑组织软化、出血、钙化、萎缩、胶质增生,五、常见临床表现,1.出血,多发生于年龄较小者，可表现为蛛网膜下腔出血、脑内出血或硬膜下出血，常于体力活动或心情波动后突然消逝猛烈头痛、呕吐、意识丧失。,2.癫痫,可见于40%50%的患者，约半数为首发病症，多见于较大的、有大量“脑盗血”的动静脉畸形者。,3.头痛,60%的患者有长期头痛史，多局限于一侧，出血时头痛的性质发生转变。,六、影像学诊断,a、CT,未出血者：不规章稍高、低或混杂密度影，动静脉钙化、软化灶。,出血者：脑实质血肿、SAH、脑室内积血,增加可见供血动脉、血管巢、引流静脉强化,无特异性，结合患者年龄、高血压病史、家族史、其他部位血管瘤病史，进一步完善检查。,需要和高血压脑出血、淀粉样变性脑出血等做出鉴别。,CTA,优点：时间快,MR,团状、条索状、蜂窝状的血管流空影。无出血时首选,3D-TOF,。,MRA,DSA,七、治疗,a、切除手术 优点：可去除血肿,b、介入栓塞 优点：可保存功能区,c、伽马刀,CASE,A 16-year-old girl presented with sudden headache on the morning of 2023,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 ventricles.,CTA demonstrated left frontal lobe AVM,feeded by the branch of left anterior cerebral artery,but the venous drainage was not very clear,.,The patient was transferred to our hospital for further treatment,recheck CT and angiography were performed which showed more details,.,3D-DSA provided more details to identify the feeders and program the roads for microcatheter approaching.,The patient was taken to the hybrid operation room,underwent preoperative embolization to minimize the risk of bleeding during the operation,.The majority part of the nidus was embolized with Onyx 18.,THANKS,