The Diagnosis And Treatment Of Cerebral Arteriovenous Malformation

Cerebral arteriovenous malformation known as cerebral vascular tumors, vascular hamartoma, is a regional cerebral vascular malformation, there was non-capillary between it' s Arteriovenous and replace it with vascular tortuosity of the group, called AVM. In embryos 3,4 week, cerebral vascular development process has been blocked, arteriovenous direct traffic between the formation of congenital diseases, Variation is a heap of the artery and vein staggered entwined vascular group. The treatment of cerebral arteriovenous malformation is still a challenging problem in neurosurgery fields. With the new non-adhesive glue embolization materials Onyx has been made, the research of cerebral arteriovenous malformation has become hot.1. Etiology and pathologyCerebral vascular origin in the mesoderm, the various parts of the brain can occur, was particularly prevalent in the cortex and white matter junction, multiple cone, base at cortex, it' s cutting-edge at the white matter or the ventricle. the incidence of AVM in intracranial tumor for the same period of about 4% , about two times the male to a female.2. AVM classificationThe grading of AVM , we use Spetzler-Martin grade usually: it was divided five grade on the lesion size, the function of the brain and venous drainage. This classification method can be used as preoperative risk assessment. Series higher postoperative neurological deficits greater the likelihood. Postoperative morbidity and mortality to the lowest I and II, III middling, and the IV-V-class.3. Clinical manifestations and diagnosisCommon clinical features include hemorrhage, epilepsy, headaches and neurological disabilities. AVM clinical diagnosis based on the following main points : subarachnoid hemorrhage; Epilepsy; Headache; The nerve dysfunction. Imaging diagnosis based on CT, MRI, DSA, and other imaging data. DSA is the gold standard of diagnosis intracranial aneurysms and arteriovenous malformation, it would reflect cerebral vascular hemodynamics.4. Natural courseAVM on the natural course of disease cases still lacks the bulk of prospective study, bleeding is the most common and serious complications of AVM. the incidence of AVM hemorrhage was 2%～4%. The incidence of AVM patients 30%～82%, AVM hemorrhage mortality rate of about 10-15%. left neurologic dysfunction were less than 50%. AVM to determine the natural course of the treatment program guide to the treatment of AVM is the principle of preoperative evaluation, Surgical treatment of patients with risk should be below the natural risks.5. Surgical treatmentNow, most scholars believe, microsurgical removal of AVM technology has become mature, it occupies an important position in the treatment of AVM, the surgery indications of AVM include :①lesions faraway from the functional areas;②Aged less than 40 years old, Lesions in language movement, the corpus callosum and other vital than its predecessor;③40 years of age and repeated life-threatening hemorrhage;④Steal serious sexual appeared light hemiplegia, mental decline;⑤repeated epileptic seizures, drugs were difficult to control. At present, the major complication of surgery include:①lntraoperative or postoperative normal perfusion pressure breakthrough②Proximal congestive.③Injury normal brain tissue and blood vessels.④Residual lesions hemorrhage after surgery.6. Endovascular treatmentAVM Endovascular treatment is one of the important measures at home and abroad for AVM. With the new non-adhesive glue embolization materials Onyx has made, the research of cerebral arteriovenous malformation has become hot. NBCA is the most commonly used embolization materials, the concentration used for 20%-33%, adhesion liquid embolic material, easy drainage vein thrombosis, adhesion micro -catheter. Onyx is a new type of plastic non-adhesive liquid embolic agents, the advantage is: not microcatheter adhesion can slow injection; have strong organizational and permeability, capillary embolization 80μm; efficient aggregation, AVM can be fully dispersed without draining vein thrombosis; Onyx AVM embolization more flexibility and shape, with the surrounding brain tissue more easily distinguish between more suitable for craniotomy preoperative embolization therapy.7. RadiotherapyRadiation therapy is the use of modern stereotactic techniques and computer functions, large dose of high-energy proton beam from various angles and directions gathered in a one-time target for the organization to achieve the destruction of the target treatment of diseases Objective. AVM is generally believed that the largest diameter of less than 3 cm in important functional areas or small lesions of deep brain, the situation can not be tolerated systemic craniotomy, Surgical resection or intravascular embolization of residual disease after treatment of this indication. Other treatment can be used as the means of an auxiliary treatment.8. Comprehensive treatmentComprehensive treatment indications :①Giant AVM;②high capacity AVM;③the AVM at the functional area;④deep, AVM complex. Comprehensive treatment can be divided into : 1, Endovascular treatment of microsurgery after treatment. suitable for giant, high flow in the cerebral cortex AVM, vascular interventional treatment for 1-3 weeks after the lesion is appropriate and necessary;2, microsurgery after radiation therapy, suited to the function at AVM surgery would not be cut, after a small residual AVM radiotherapy treatment; 3, Endovascular treatment after radiation therapy, Risk for surgery in deep brain function of the AVM, the first Endovascular treatment undergone radiotherapy. Comprehensive treatment of refractory AVM treatment has significant advantages.Outlook : The therapeutic effect of AVM is not only correlation with treatment methods, but also correlation with the complexity of the structure and individual differences, and not fully grasp AVM intraoperative and postoperative cerebral blood flow dynamics of change completely cured AVM also need more basic research and clinical practice.