首页|急性出血性高流量脑血管畸形的复合手术平台救治

急性出血性高流量脑血管畸形的复合手术平台救治

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目的 初步探索一站式复合手术平台治疗急性出血性高流量脑血管畸形的安全性和有效性.方法 筛选复合手术治疗脑血管畸形的前瞻性、多中心外科队列(NCT03209804)中首都医科大学附属北京天坛医院神经科学中心2019年1月至2024年4月连续入组的急性出血性高流量脑血管畸形患者.所有患者均在复合手术平台接受诊断性术中数字减影血管造影及不同模式的外科治疗.对患者的功能预后(以改良Rankin量表评分评估)进行分析,明确复合手术平台治疗急性出血性高流量脑血管畸形的安全性和有效性.结果 共纳入急性出血性高流量脑血管畸形患者56例,包括颅内动静脉畸形破裂出血患者47例(83.9％)、硬脑膜动静脉瘘患者8例(14.3％)、软脑膜动静脉瘘患者1例(1.8％).56例患者中,行动静脉畸形或动静脉瘘切除+血肿清除术33例,血管内栓塞辅助动静脉畸形或动静脉瘘切除+血肿清除术15例,单纯动静脉畸形或动静脉瘘治愈性栓塞术6例,动静脉畸形或动静脉瘘治愈性栓塞术+血肿清除术2例.术后1个月内患者的全因病死率为3.6％(2/56).出院时、术后3个月、术后6个月存在严重神经功能障碍(改良Rankin量表评分＞3分)患者的比率分别为46.4％(26/56)、16.1％(9/56)和8.9％(5/56).结论 基于复合手术平台的一站式诊疗模式可安全、有效地用于治疗急性出血性高流量脑血管畸形.
Treatment of acute hemorrhagic high-flow cerebral vascular malformations using a hybrid surgical platform
Objective To initially explore the safety and effectiveness of a one-staged hybrid surgical platform in the treatment of acute hemorrhagic high-flow cerebral vascular malformations(HFVMs).Methods Patients with acute hemorrhagic HFVMs who were consecutively enrolled from January 2019 to April 2024 were screened from a prospective,multi-center surgical cohort of hybrid surgical treatment of cerebral vascular malformations(NCT03209804).All patients underwent diagnostic intraoperative digital subtraction angiography(DSA)and different modes of surgical treatment on a hybrid surgical platform.The patients'functional outcomes(assessed by the modified Rankin scale score)were analyzed to clarify the safety and effectiveness of the hybrid surgical platform in the treatment of acute hemorrhagic HFVMs.Results A total of 56 patients with acute hemorrhagic HFVMs were included,including 47 patients(83.9％)with intracranial arteriovenous malformation rupture and bleeding,8 patients(14.3％)with dural arteriovenous fistula,and 1 patient(1.8％)with pial arteriovenous fistula.Among the 56 patients,33 patients underwent arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation,15 patients underwent endovascular embolization-assisted arteriovenous malformation or arteriovenous fistula resection plus hematoma evacuation,6 patients underwent curative embolization of arteriovenous malformation or arteriovenous fistula,and 2 cases were treated with curative embolization of arteriovenous malformation or arteriovenous fistula plus minimally invasive hematoma evacuation.The all-cause mortality rate of patients within 1 month after surgery was 3.6％(2/56).The rates of patients with severe neurological dysfunction(modified Rankin score＞3 points)at discharge,3 months after surgery,and 6 months after surgery were 46.4％(26/56),16.1％(9/56),and 8.9％(5/56),respectively.Conclusion The one-staged diagnosis and treatment model based on the hybrid surgical platform can be safely and effectively used to treat acute hemorrhagic HFVMs.

Central nervous system vascular malformationsIntracranial hemorrhageEmer-gency treatmentTreatment outcomeSafetyHybrid operation

王明泽、葛培聪、焦玉明、邓晓峰、于嵩林、江裕华、仇汉诚、李智、陈晓霖、王硕、曹勇、赵继宗

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首都医科大学附属北京天坛医院神经外科学中心,北京 100070

国家神经系统疾病临床研究中心,北京 100070

北京脑重大疾病研究院卒中中心,北京 100070

脑血管病转化医学北京市重点实验室,北京 100070

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中枢神经系统血管畸形 颅内出血 急诊处理 治疗结果 安全性 复合手术

国家重点研发计划国家重点研发计划北京市医院管理中心"登峰"计划

2021YFC25011002016YFC1301800DFL20220501

2024

10.3760/cma.j.cn112050-20240801-00232

中华神经外科杂志
中华医学会

中华神经外科杂志

CSTPCD北大核心
影响因子：1.107
ISSN：1001-2346
年,卷(期)：2024.40(10)
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