目的:总结显微外科手术治疗的21例高级别脑动静脉畸形的手术经验,探讨高级别脑动静脉畸形诊治要点.方法:回顾分析直接显微手术治疗的高级别动静脉畸形21例的临床资料,按Spetzler-Martin分级:Ⅳ级14例,Ⅴ级7例.术前行MRI、CTA或/和DSA检查,术后常规行CT、CTA或/和DSA复查.定期随访,以格拉斯哥预后评分(GOS)评价疗效.结果:17例(85％)病灶获全切,3例(15％)畸形血管团残余.术后死亡1例(4.8％),残疾3例(15％),重残1例(5％).20例随访3～52月,GOS评分5分17例(85％),4分2例(10％),3分1例(5％).随访期间无死亡及再出血患者.结论:显微外科手术切除是高级别动静脉畸形行之有效的治疗方法,术前准确诊断,术中精确定位,尤其是精准耐心细致的显微操作是手术成功的关键.%Objective: To explore the main points of the diagnosis and treatment of high-grade cerebral arteriovenous malformations (AVM) by analyzing the experience in microsurgical treatment of 21 cases of high-grade cerebral AVM. Methods: 21 cases of high-grade cerebral AVM treated with direct microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, 14 cases were grade IV and 7 cases were grade V. Magnetic resonance imaging, computed tomography angiography (CTA), and/or digital subtraction angiography (DSA) were performed before surgery; conventional computed tomography, CTA, and/or DSA were performed after surgery. Followup was performed on a regular basis, and the therapeutic efficacy was assessed according to the Glasgow Outcome Score (GOS). Results: Seventeen (85％) patients had total resection of lesions, and 3 (15％) patients had residual tangles of abnormal blood vessels. There was 1 case of mortality (4.8％), 3 cases of disability (15％), and 1 case of severe disability (5％) after surgery. Twenty cases had a follow-up period from 3 to 52 months. The GOS was 5 in 17 cases (85％), 4 in 2 cases (10％), and 3 in 1 case (5％). No case of rebleeding or death was observed during the follow-up period. Conclusion: Microsurgical resection is an effective treatment for high-grade cerebral AVM. Accurate preoperative diagnosis and intraoperative localization and particularly careful and precise operation are the key factors for a successful surgery.
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