Usually, blood nutrition will be exchanged between arteries and veins through the normal capillary network. Cerebral arteriovenous malformation (AVM) refers to the abnormal vascular passage between cerebral arterioveins, which is directly connected with veins for developmental reasons. Cerebral arteriovenous malformation consists of feeding artery, malformation group and drainage vein.
Second, how did the cerebral arteriovenous malformation occur? 1. Congenital causes: Most cerebral arteriovenous malformations are caused by abnormal vascular development in the embryonic period, that is, they are formed in the mother's stomach. However, cerebral arteriovenous malformation is not a genetic disease.
2. Acquired factors: brain injury
Third, people who are prone to cerebral arteriovenous malformation are congenital diseases, so it is possible to get sick at any age. However, the age with higher incidence rate is common in children, adolescents and young people, and the age is about 12-40. The prevalence rate of men is slightly higher than that of women.
Fourth, the symptoms of cerebral arteriovenous malformation If the cerebral arteriovenous malformation is small or located in the non-functional area of the brain, there may be no symptoms when it does not rupture. Common symptoms of cerebral arteriovenous malformation are:
1, cerebral hemorrhage: About 50% patients with cerebral arteriovenous malformation have cerebral hemorrhage for the first time, which is also the most common reason for seeing a doctor. At this time, many people know that they have "cerebral arteriovenous malformation". When cerebral hemorrhage is severe, there will be severe headache, vomiting and coma.
2, epilepsy: patients with cerebral arteriovenous malformation without rupture, of which 20-25% will have epilepsy, commonly known as epilepsy.
3. Accompanying symptoms:
Headache or fatigue: Some people will have a headache for a long time, which is often confined to one side. A few people will feel weak or impaired.
Developmental retardation and mental retardation: less common. This happens in patients with huge or diffuse cerebral arteriovenous malformations. There is also the strength and physical development caused by taking antiepileptic drugs for a long time because of epilepsy.
Verb (abbreviation of verb) Screening and diagnosis of cerebral arteriovenous malformation 1, magnetic resonance imaging (MR): It is the first choice for screening arteriovenous malformation, through which abnormal blood vessels and neuropathy can be found. In order to clearly understand the situation of cerebrovascular malformation, MRI and MRA should be examined in detail.
2. CT examination: enhanced CT can see the abnormal group; When you have a sudden headache, you can see the bleeding by ordinary CT examination.
3. Cerebral angiography: accurate diagnosis and interventional therapy. It is a traumatic examination that requires hospitalization and is performed by a neurosurgeon/physician.
Classification of cerebral arteriovenous malformations The classification of cerebral arteriovenous malformations can be divided into six grades. The standard of scoring is the sum of the scores of three aspects.
Grade = vascular malformation volume+drainage vein situation+functional area situation. The higher the level, the greater the difficulty and the higher the risk.
1, abnormal mass volume: 1 min: less than 3 cm; 2 points: 3-6 cm; 3 points: greater than 6cm.
2. Partial or total introduction of drainage vein into deep vein: 1: Yes; 0: None.
3. Whether it is located in the functional areas of the brain (functional areas mainly include sensory, motor, language functions, vision, thalamus and hypothalamus, internal capsule area, brain stem, cerebellar peduncle and deep cerebellar nucleus): 1: Yes; 0: No.
Grade I: product 1 min.
Grade II: product 1 min.
Level 3: 3 points.
Level 4: 4 points.
Level 5: 5 points.
Grade ⅵ: The giant cerebral arteriovenous malformation located in the functional area or the giant cerebral arteriovenous accumulated in the hypothalamic brainstem is divided into 6 grades.
Seven, the treatment of cerebral arteriovenous malformation The treatment of cerebral arteriovenous malformation is more complicated, and comprehensive treatment measures need to be taken according to the specific conditions of patients.
Minimally invasive interventional embolization;
Puncture femoral artery or vein at the root of thigh, and transport embolic material into the deformed lump through blood vessel, so that the deformed lump is filled.
Advantages: less trauma to patients, quick recovery after operation, and discharge in 5-7 days.
Common postoperative complications include headache, cerebral hemorrhage, residual focus, epilepsy and puncture point bleeding caused by normal perfusion pressure breakthrough.
Scope of application: bAVM with Spetzler-Martin classification of 1-2 can achieve curative embolism. For the high-grade bAVM, the operational risk is greater. Usually, only the structures that are easy to bleed inside the malformation are treated, such as embolization of aneurysms on the feeding artery or embolization of malformed internal fistula.
Craniotomy treatment:
Treatment: after craniotomy, block the blood supply artery, then block the drainage vein, and remove the deformed artery and vein.
Scope of application: For those superficial and low-grade cerebral arteriovenous malformations, radical resection can be achieved. However, arteriovenous malformations with deep location, many functional areas and high grade can not be completely removed because of the difficulty of operation, and the incidence of complications is high.
Main complications: postoperative bleeding, intracranial infection, etc.
Gamma knife radiotherapy;
Treatment: Stereotactic method was used to destroy the deformed group with gamma rays.
Scope of application: It is effective for small cerebral arteriovenous malformations, but the treatment effect is slow, generally effective in 2-4 years. Moreover, the bleeding risk of cerebral arteriovenous malformation did not decrease during this period. This treatment is suitable for patients with deep deformity and difficulty in operation or interventional therapy.
Combination therapy (combination therapy)
Treatment: according to the patient's condition, combined with the above treatment methods.
Scope of application: embolization before surgical resection of arteriovenous malformation with rich blood supply; The deformity group was treated with gamma knife after operation or embolization. Generally, cerebral arteriovenous malformations of grade 3 and above need to be treated by various methods.
Advantages of Dong Lei Brain Department in cerebral arteriovenous malformation embolization: Onyx cerebral arteriovenous malformation embolization technology is currently used for cerebral arteriovenous malformation embolization. Professor Song, the founder of Brain Department, is the first doctor in the field of Onyx interventional therapy in China to obtain the permission of interventional qualification. It is no exaggeration to say that many doctors who can perform Onyx interventional therapy at home and abroad are students of Professor Song. During 20/200515, he was invited to give keynote speeches, training courses or surgical demonstrations in China, Hongkong, Taiwan Province Province, Korea, Australia, France, Germany, the United States and other regions and countries. He has accumulated rich on-the-spot and theoretical experience, and can be called the first person in "Onyx Interventional Therapy" in China.
VIII. Prevention of Cerebral Arteriovenous Malformation Cerebral Arteriovenous Malformation is a congenital disease and cannot be effectively prevented. Once you have a headache, epilepsy, or weakness of hands and feet, it is very important to seek medical examination and treatment in time.
For patients who have been found to have cerebral arteriovenous malformation and are in the follow-up period, the following points should be done:
1, daily prevention: control blood pressure, avoid strenuous exercise and extreme exercise, keep a happy mood, and don't get angry or angry;
2, diet control: control the intake of fat, fried food, etc. Eat more fruits and vegetables and coarse grains;
3. Regular follow-up: check regularly according to the doctor's advice every 3-6 months.