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目的 探讨弥漫型颅内动静脉畸形(AVM)的临床特点、影像学特征、病理改变及 治疗方法。 方法 回顾分析8例经脑血管造影证实为弥漫型颅内动静脉畸形患者的临床及影像 资料。 结果 8例弥漫型脑AVM的脑血管造影影像不同于典型的脑AVM,可见多条供血动脉和 弥漫的异常血管染色,边界不清,染色不匀,没有明显的畸形血管团边界,有数条引流静脉。手 术治疗的4例中,2例畸形团全部切除,1例先栓塞后切除畸形团,术后复查仍有残留,1例因位 于重要功能区未能全部切除。术中及组织病理学检查发现,在异常的动静脉血管间有正常脑组织 存在。另4例中,2例再出血死亡,2例未做治疗。 结论 弥漫型脑AVM在脑血管造影和组织 病理学上不同于典型的AVM,其病变范围可能存在一个局限病灶到弥漫性损害的发展变化过程。 对于非重要功能区的患者可以考虑手术切除,但是全部切除比较困难。
Objective To investigate the clinical features, imaging features, pathological changes and treatment of diffuse intracranial arteriovenous malformations (AVM). Methods Retrospective analysis of 8 cases of cerebrovascular angiography confirmed diffuse intracranial arteriovenous malformations in patients with clinical and imaging data. Results Cerebral angiography of 8 patients with diffuse brain AVM was different from that of typical brain AVM. There were multiple blood supply arteries and diffuse abnormal blood vessels with unclear border, uneven dyeing, no obvious deformity vascular border and several drainage vein. In 4 cases of surgical treatment, 2 cases of deformity group were all excised, 1 case of first removal of malformation group after embolization, there was still residual after the operation and 1 case was not able to be excised because of being located in the important functional area. Intraoperative and histopathological examination found that there is normal brain tissue between abnormal arteriovenous vessels. In the other 4 cases, 2 died of rebleeding and 2 did not receive treatment. Conclusions Diffusion-type brain AVM is different from typical AVM in cerebral angiography and histopathology. There may be a developmental process of focal lesion to diffuse lesion in diffuse brain AVM. Surgical resection may be considered for patients with non-important functional areas, but total removal is more difficult.