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首页> 外文期刊>Neurosurgery >The management of patients with arteriovenous malformations and associated intracranial aneurysms.
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The management of patients with arteriovenous malformations and associated intracranial aneurysms.

机译：动静脉畸形及相关颅内动脉瘤患者的治疗。

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OBJECTIVE: Few published studies have focused specifically on the unique management issues encountered in treating patients with arteriovenous malformations (AVMs) and associated intracranial aneurysms. The primary objective of this study was to retrospectively review the clinical and radiographic features of these patients. METHODS: Medical records of all patients seen at Stanford University Hospital between 1988 and 1996 with a diagnosis of AVMs were retrospectively reviewed. Aneurysms were identified by conventional angiography and characterized by size, number, and location relative to the AVMs. AVMs were graded according to the Spetzler-Martin scale. Odds ratios were calculated for the risk of intracranial hemorrhage. Variables included age, sex, number of aneurysms, and AVM grade. RESULTS: Forty-five of 600 patients (7.5%) were identified as having coexisting intracranial aneurysms. All 45 patients had high-flow malformations, and 58% had AVMs of Spetzler-Martin Grade IV or higher. A majority of patients had multiple aneurysms. There was a statistically significant increase in AVM hemorrhage in female patients (odds ratio, 8.53 [1.87-38.98]; P < 0.005). There was no statistically significant correlation between the development of hemorrhage and either age, AVM grade, or the number of aneurysms. Twenty-three patients (51%) presented with intracranial hemorrhage: bleeding occurred from the AVMs in 15 and from ruptured aneurysms in 5, and the source of the bleeding could not be determined in 3. Overall, nine patients (20%) bled from ruptured aneurysms: five at presentation, two during or within 3 weeks of AVM treatment, and two from new aneurysms. Two of these nine patients died as a direct result of aneurysmal subarachnoid hemorrhage. Five patients (11%) developed new aneurysms. CONCLUSION: Aneurysms associated with AVMs are at risk for rupture before, during, and immediately after treatment of the AVMs. New aneurysms may arise in patients with high-flow AVMs. The risk of intracranial hemorrhage from either source is higher in female patients. To reduce the complications of intracranial hemorrhage in these patients, we recommend a management protocol designed to treat the aneurysms by surgical or endovascular means before administering definitive therapy for the AVMs. Meticulous intraoperative blood pressure control and fluid management during aneurysm surgery is critical to avoid hemorrhage from the AVMs.
机译：目的：很少有已发表的研究专门针对动静脉畸形（AVM）和相关颅内动脉瘤患者的治疗中遇到的独特管理问题。这项研究的主要目的是回顾性审查这些患者的临床和影像学特征。方法：回顾性分析了1988年至1996年间在斯坦福大学医院就诊的所有诊断为AVM的患者的病历。通过常规的血管造影术可以识别动脉瘤，并以相对于AVM的大小，数量和位置为特征。 AVM根据Spetzler-Martin量表进行分级。计算颅内出血风险的几率。变量包括年龄，性别，动脉瘤数量和AVM等级。结果：600例患者中有45例（7.5％）患有颅内动脉瘤并存。所有45例患者均出现高血流畸形，其中58％的患者具有Spetzler-Martin IV级或更高的AVM。大多数患者患有多发性动脉瘤。女性患者的AVM出血有统计上的显着增加（比值比为8.53 [1.87-38.98]; P <0.005）。出血的发展与年龄，AVM分级或动脉瘤数目之间无统计学意义的相关性。 23例（51％）发生颅内出血：15例中AVM发生出血，5例中因动脉瘤破裂而出血，3例中无法确定出血源。总体而言，9例患者（20％）出血动脉瘤破裂：在就诊时出现5个，在AVM治疗期间或3周内出现2个，新出现的动脉瘤2个。这9例患者中有2例是由于动脉瘤性蛛网膜下腔出血直接导致的死亡。五名患者（11％）出现了新的动脉瘤。结论：与AVM相关的动脉瘤在治疗前，治疗中和治疗后有破裂的危险。高流量AVM患者可能会出现新的动脉瘤。女性患者中任一来源发生颅内出血的风险较高。为了减少这些患者的颅内出血并发症，我们建议设计一种治疗方案，该方案设计为在对AVM进行彻底治疗之前通过外科手术或血管内手段治疗动脉瘤。为了避免AVM出血，在动脉瘤手术期间认真进行术中血压控制和液体管理至关重要。

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