经静脉途径治疗脑动静脉畸形的研究进展

doi:10.3877/cma.j.issn.2095-5782.2018.02.018

脑动静脉畸形（AVMs）是胎儿期脑血管形成异常的先天性疾病。传统的手术治疗方法包括微创外科、立体放射外科、经动脉血管内栓塞，以解决引起脑出血的病灶，同时尽可能不损害正常的供血动脉和引流静脉为治疗原则。近年来随着经静脉途径介入治疗硬脑膜动静脉瘘和外周血管畸形的成功实施，经静脉途径介入治疗技术逐渐被运用于AVMs的治疗。虽然仍具有挑战和风险，但是已有多个中心相继报道成功案例。本文主要对经静脉途径治疗脑动静脉畸形的文献进行回顾性分析，综述该方法在治疗AVMs方面的研究进展。

关键词: 脑动静脉畸形, 经静脉途径, 脑出血, 引流静脉

Intracranial arteriovenous malformations (AVMs) are congenital anomalies of the blood vessels. Three traditional methods of AVMs therapy have evolved to treat AVMs: microsurgery, stereotactic radiosurgery and transarterial embolization. The principle of treatment involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and drainage venous of the brain. More recently, The transvenous approach in treating AVMs was popularized by successful treatment models for dural arteriovenous fistulas and peripheral vascular malformations. Although this novel technique has its challenges and perils, successful treatment of cerebral arteriovenous malformations has been reported in several centers. In this artical, we reviewed the literature of AVMs treated by transvenous endovascular approaches, and summarized the progress of this method in the treatment of AVMs.

Key words: Intracranial arteriovenous malformations, Transvenous approach, Intracranial hemorrhages, Drainage venous

表1 经静脉入路治疗AVMs文献汇总

年份	研究者	例数	单一引流静脉（例）	深引流静脉（例）	深的位置（例）	直径小于3 cm（例）	单一静脉入路（例）	术前出血（例）	随访时间	治愈率(%)	并发症（例）
2010	Nguyen等^[10]	1	1	0	1	1	1	1	3周	95	0
2011	Kessler等^[11]	5	5	3	4	3	3	4	6月	80	0
2011	Cooke等^[12]	1	1	1	1	1	0	0	6月	100	0
2012	Consoli等^[13]	5	4	5	5	5	2	5	6月	100	0
2013	Pereira等^[14]	1	1	1	1	1	1	1	6月	100	0
2014	Trivelato等^[15]	1	1	0	1	1	1	1	-	100	0
2014	Mario等^[16]	1	1	1	1	1	0	1	6月	100	0
2014	Iosif等^[17]	20	17	16	15	17	12	20	6月	95	3
2015	Orlov等^[18]	1	1	1	1	1	0	1	6月	100	0
2015	Renieri等^[19]	4	2	1	1	4	3	2	6月	100	0
2016	Mendes等^[20]	9	9	9	9	7	8	8	12月	100	0
2017	Viana等^[21]	12	10	3	3	9	11	9	6月	91.7	0
2017	白卫星等^[22,23]	2	2	0	0	0	2	2	6月	100	0

表1 经静脉入路治疗AVMs文献汇总

年份	研究者	例数	单一引流静脉（例）	深引流静脉（例）	深的位置（例）	直径小于3 cm（例）	单一静脉入路（例）	术前出血（例）	随访时间	治愈率(%)	并发症（例）
2010	Nguyen等^[10]	1	1	0	1	1	1	1	3周	95	0
2011	Kessler等^[11]	5	5	3	4	3	3	4	6月	80	0
2011	Cooke等^[12]	1	1	1	1	1	0	0	6月	100	0
2012	Consoli等^[13]	5	4	5	5	5	2	5	6月	100	0
2013	Pereira等^[14]	1	1	1	1	1	1	1	6月	100	0
2014	Trivelato等^[15]	1	1	0	1	1	1	1	-	100	0
2014	Mario等^[16]	1	1	1	1	1	0	1	6月	100	0
2014	Iosif等^[17]	20	17	16	15	17	12	20	6月	95	3
2015	Orlov等^[18]	1	1	1	1	1	0	1	6月	100	0
2015	Renieri等^[19]	4	2	1	1	4	3	2	6月	100	0
2016	Mendes等^[20]	9	9	9	9	7	8	8	12月	100	0
2017	Viana等^[21]	12	10	3	3	9	11	9	6月	91.7	0
2017	白卫星等^[22,23]	2	2	0	0	0	2	2	6月	100	0

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Research progress on the treatment of cerebral arteriovenous malformations by intravenous approach

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Research progress on the treatment of cerebral arteriovenous malformations by intravenous approach