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ID:19892981
大小:4.10 MB
页数:38页
时间:2018-10-07
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1、ArteriovenousmalformationofthebrainDiagnosisandtreatmentDevelopment3rdweekofpregnancyprimitivevesselsdonotdevelopintonormalvasculatureformationofanarteriovenousshuntSymptomsHemorrhagehistoryofsuddenheadacheageusually25–35yearshemorrhagelessseverethanSAHnovasospa
2、smrisk2–3%peryearSeizuresoftenfocal,butmaygeneralizeoftenbetterafteroperationNeurologicaldeficitduetoischaemiaofsurroundingbraindevelopswithincreasingageespeciallyinlargeAVM’sDiagnosishistoryandneurologicalexaminationCT-scanMRIandMRAangiographyEvaluationsizedrai
3、ningveins(deep)arterialfeederslocalizationinbrainassociatedaneurysmsdefinebleedingsourceTreatmentconservativeclosingoffeederarteriesexcisionendovascularradiotherapyConservativetreatmentcontrolofepilepsycontrolofhypertensionlife-styleadviceClosingfeederarteriesre
4、ductioninbloodflowshortlivedeffectcollateralswilldevelopnoriskreduction!Excisionsizelocalisationnumberoffeedersvenousdrainage±75%canbeexcisedonly100%effectivetreatment!dependsonEndovascularballoonocclusionocclusionofthenidusidentifybleedingsourceonlyindicatedif1
5、00%eliminationmaybecombinedwithsurgicaltreatmentRadiotherapycauseshyperplasiaofintimasecondarythrombosisfordeep-seatedAVM’s<3cmocclusionrate80%effectaftertwoyearslife-longfollow-upnecessary?OperativetechniqueBP<100mmHgmoderatecoolingstartonthearterialside!observ
6、enaturalshapeofAVMocclusionofveinsaslaststepkeepBPlowpostop.keeppatientsedated24–48hoursProblemsoedemaseizuresperfusionpressurebreakthroughre-bleed(onlyifexcisionincomplete!)Example#1Example#2Whattodo?
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