脑动静脉畸形出血原因分析及血管内治疗的临床研究
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摘要
研究背景
脑动静脉畸形是由于缺乏正常的毛细管床,脑的动脉血管和静脉血管之间直接形成血管篓的血管异常,在脑血管造影上,AVM多表现为扩张的供血动脉和扭曲变形的引流静脉相互缠绕紧密结合在一起的团块。动静脉异常分流,病灶引流静脉提前显影是脑动静脉畸形的特点。AVM发病的主要症状是出血、癫痫和头痛及其他局灶性神经功能障碍,可以单独存在,也可合并发生。Brown RD Jr等对特定人群的27年的研究报道,脑AVM的病人中65%首发症状表现为出血,所有出血病人中按出血人数的多少依次为脑实质出血、蛛网膜下腔出血、脑室出血或这些部位的混和性出血。C Stapf等对纽约890万人口在1996年到1999年的脑动静脉畸形诊断病例的回顾性研究的报告中,首次确诊为脑出血的脑动静脉畸形占所有病人的33%。Poyee Tung等人发现,病变一旦出血,说明病灶血管结构已处于不稳定状态,容易发生再次出血。本研究回顾性统计分析珠江医院2001-1至2012-1脑动脉畸形合并出血患者相关危险因素,采用统计学方法,明确动静脉畸形出血原因及有主要预警作用的因素,同时探讨不同治疗栓塞剂型对动静脉畸形治疗效果,及评价其疗效。
第一章脑动静脉畸形出血相关因素分析
研究背景
脑AVM最严重和最常见的症状是颅内出血,导致脑动静脉畸形出血的原因众多,可能与出血相关的临床危险因素有年龄、性别、高血压、高血脂、高血糖,与血管构筑因素相关因素有畸形部位、大小、供血动脉的来源、数量、扭曲程度、直径、供血方式、畸形团的位置、大小、形态、引流静脉的数量、直径、引流方式、引流路径、是否伴随的血管瘤等等,但目前缺乏系统性的研究分析,因此,有必要全面深入探讨脑AVM的出血危险因素。
目的
探讨临床和血管构筑相关因素对脑动静脉畸形出血的影响。
方法
珠江医院近十年以来临床资料及影像学资料齐全的诊断为脑AVM的患者共计312例,脑出血组AVM(病例组)168例,其中男性86例,女性82例,年龄12-68岁,非脑出血组(对照组,患者以癫痫、头痛、神经功能缺失为发病症状)144例,男性81例,女性63例,年龄8-71岁。分析比较两组间临床相关风险因素年龄、性别、高血压、高血脂、高血糖、妊娠以及血管构筑相关风险因素AVM部位、大小、形态、供血动脉类型、引流静脉类型、伴随动脉瘤等的差异,先采用单因素分析,筛选出相关的危险因素,再用多因素logistic回归分析上述因素与脑AVM出血的关系,总结脑AVM出血的主要风险因素及保护性因素。
结果
AVM直径≧6cm(OR2.006,95%C.I1.286-3.128),深部静脉引流(OR1.679,95%C.I1.146-2.460),单支引流静脉引流(OR3.684,95%C.I2.554-5.315)位于深部的(OR2.372,95%C.I1.175-4.787),患有高血压(OR3.433,95%C.I1.812-6.503)是脑动静脉畸形出血的危险因素。
结论
位于深部、大型、单一静脉引流、引流方式为深部引流以及高血压为脑动静脉畸形破裂出血的危险因素。
第二章脑动静脉畸形的血管内栓塞治疗
研究背景
目前对于脑动静脉畸形的治疗手段主要有手术治疗、血管内介入治疗、放射治疗。上述治疗方术即可相互结合,也可单独采取其中之一的治疗方式。随着新型血管内栓塞剂ONXY及Glubran的广泛使用,以及较好的治疗效果,血管内栓塞治疗越来越成为脑动静脉畸形主要的治疗方式。
目的
探讨ONXY和Glubran两种不同栓塞剂在不同分级的脑动静脉畸形的栓塞方法及比较它们的疗效、优缺点。
方法
选取2006年1月一2012年1月在南方医科大学珠江医院神经外科住院行介入治疗的脑动静脉畸138例,均为单一动静脉畸形。其中经Glubran栓塞治疗组78例,总共146次栓塞,ONYX栓塞治疗组60例,112次栓塞,男性86例,女性52例,年龄8-67岁,平均36.5岁。回顾分析患者住院记录、手术记录、脑血管造影资料(包括随访的造影资料),分析比较ONYX和Glubran不同栓塞方法及治疗效果、并发症。
结果
两者栓塞的完全闭塞率,ONYX为29%,glubran为31%,两者之间无显著差异,次全闭塞率为两者对小型、供血类型简单的动静脉畸形都能取得较好的闭塞治疗效果,分级较高供血复杂的动静脉畸形两者治疗效果相似,粘管等并发症ONYX较Glubran高。
结论
在脑动静脉畸形的栓塞治疗中,ONYX及Glubran的总体治愈率相似。两者都可以做为脑AVM血管内栓塞的栓塞剂的选择。
Background
Cerebral arteriovenous malformation is the most common cerebral vascular dysplasia due to the lack of normal capillary bed. Angiographically, AVM is characterized by the performance of feeding arteries expansion and draining veins distorted mutual interlaced closely together clumps. It is characterized by abnormal arteriovenous shunt the angiographical early developing of lesion draining veins.
Its main symptoms are the onset of bleeding, epilepsy, headache and other focal neurological dysfunction. Brown RD reported that the first symptom was bleeding. Among them, the most symptoms was bleeding in brain tissue, the2nd was subarachnoid hemorrhage, and the remaining was intraventricular hemorrhage or mixture of bleeding. C Stapf had the retrospective study of brain arteriovenous malformation at the New York population of8.9million from1996to1999. He found that the1st diagnosed cerebral arteriovenous malformation cases were accounted for33%of all patients. Foster et al found that, once the bleeding lesions, the cAVM is prone to bleeding again due to lesions vascular structure in an unstable state, In this study, we retrospective collected the large number of cAVM cases from 2001-1to2012-1in Zhujiang Hospital and make the statistical analysis on the risk factors of intracranial hemorrhage after embolization of cerebral arteriovenous malformation, and evaluated the therapeutic efficacy using different sembolism materials for the purpose of guiding the clinical prevention and treatment decision making in the future.
The first chapter
Factors of cerebral arteriovenous malformation hemorrhage
Background
The most serious and the most common symptoms of Cerebral AVM is intracranial hemorrhage. There are many kind of reasons for cerebral arteriovenous malformation hemorrhage, which may be related to age, sex, hypertension, high cholesterol, high blood sugar, angioarchitecture factors associated with vascularfactors deformity, the size of the feeding artery of the source, quantity, level of distortion, the diameter of the blood supply to the way the location of the malformation, size, shape, number of draining veins diameter, drainage, drainage path, whether accompanied by hemangiomas, and so on. However, there is lack of systematic research and analysis. It is necessary to the full depth study on brain AVM hemorrhage risk factors.
Objection
To Investigate the clinical and angioarchitecture relevant factors of cerebral arteriovenous malformation hemorrhage.
Methods and materials
312patients with arteriovenous malformations were diagnosed in Zhujiang Hospital, nearly ten years with complete clinical data and imaging data.168cases in hemorrhage group (case group), male86case, female82cases, age range from12to68years old.144cases in non-cerebral hemorrhage group (control group, patients with epilepsy, headache, nerve function missing for the onset of symptoms), male81cases, female63cases, range from8to71years old,. There were compared between the two groups clinically relevant risk factors of age, gender, hypertension, high cholesterol, high blood sugar, pregnancy and angioarchitecture risk factors associated with AVM location, size, shape, type of feeding artery, draining vein type, accompanied by aneurysm differences,and then using logistic regression analysis of the relationship between the above factors with brain AVM bleeding, summarizes the major risk factors and protective factors for cerebral AVM hemorrhage.
Results
AVM diameter is≧6cm (OR2.006,95%CI1.286-3.128), deep venous drainage (OR1.679,95%CI1.146-2.460), single venous drainage (OR3.684,95%CI2.554-5.315) indeep (OR2.372,95%CI1.175-4.787), with high blood pressure (OR3.433,95%CI1.812-6.503) were risk factors for cerebral arteriovenous malformation hemorrhage.
Conclusion
Large and Deep-seated AVM and cAVM with the single deep venous drainage were the independent risk factors of cerebral AVM hemorrhage.
The second chapter
Endovascular embolization of Cerebral artcriovenous malformations
Background
There were four kinds of treatment strategies for cerebral arteriovenous malformation:Surgery, endovascular treatment, radiation therapy and conservative treatment, which can be used alone or combined with each other. With the extensive use of the novel intravascular embolic agent like onyx and Glubran with a wonderful therapeutic effect, endovascular embolization has increasingly become the main treatment of cerebral arteriovenous malformations.
Objection
To investigate the efficacy, advantages and disadvantages between onyx and Glubran in the treatment of brain arteriovenous malformation in different classification.
Method
138cases with arteriovenous malformations Selected from Zhujiang Hospital neurosurgery inpatient, interventional treatment of brain arteriovenous malfomatoin January2006.1to January2012.1.78cases with Glubran embolization in the treatment group, total of146times embolism.60patients with ONYX embolization,112times embolism.86male,52female, age range from8to67years old, an average of36.5years. Recalling the analysis of hospitalization records, surgical records,cerebral angiography (including follow-up angiography), analysis comparing ONYX and different Glubran embolism and treatment effects, complications.
Results
Complete occlusion rate was similar tin both of Glubran and Onyx.29%was in Onyx group and31%in glubran group with no significant difference. Subtotal occlusion rate was simple and small in both of them, the blood supply to the type of arteriovenous malformations can achieve better occlusion The therapeutic effect of graded higher blood supply with the complex arteriovenous malformation was similar in both group. The stick tube complication in Onyx group was higher than in Glubran group.
Conclusion
Onyx and glubran had the same cure rate in the treatment of cerebral AVM. Both of them can be facultative.
脑动静脉畸形是由于缺乏正常的毛细管床,脑的动脉血管和静脉血管之间直接形成血管篓的血管异常,在脑血管造影上,AVM多表现为扩张的供血动脉和扭曲变形的引流静脉相互缠绕紧密结合在一起的团块。动静脉异常分流,病灶引流静脉提前显影是脑动静脉畸形的特点。AVM发病的主要症状是出血、癫痫和头痛及其他局灶性神经功能障碍,可以单独存在,也可合并发生。Brown RD Jr等对特定人群的27年的研究报道,脑AVM的病人中65%首发症状表现为出血,所有出血病人中按出血人数的多少依次为脑实质出血、蛛网膜下腔出血、脑室出血或这些部位的混和性出血。C Stapf等对纽约890万人口在1996年到1999年的脑动静脉畸形诊断病例的回顾性研究的报告中,首次确诊为脑出血的脑动静脉畸形占所有病人的33%。Poyee Tung等人发现,病变一旦出血,说明病灶血管结构已处于不稳定状态,容易发生再次出血。本研究回顾性统计分析珠江医院2001-1至2012-1脑动脉畸形合并出血患者相关危险因素,采用统计学方法,明确动静脉畸形出血原因及有主要预警作用的因素,同时探讨不同治疗栓塞剂型对动静脉畸形治疗效果,及评价其疗效。
第一章脑动静脉畸形出血相关因素分析
研究背景
脑AVM最严重和最常见的症状是颅内出血,导致脑动静脉畸形出血的原因众多,可能与出血相关的临床危险因素有年龄、性别、高血压、高血脂、高血糖,与血管构筑因素相关因素有畸形部位、大小、供血动脉的来源、数量、扭曲程度、直径、供血方式、畸形团的位置、大小、形态、引流静脉的数量、直径、引流方式、引流路径、是否伴随的血管瘤等等,但目前缺乏系统性的研究分析,因此,有必要全面深入探讨脑AVM的出血危险因素。
目的
探讨临床和血管构筑相关因素对脑动静脉畸形出血的影响。
方法
珠江医院近十年以来临床资料及影像学资料齐全的诊断为脑AVM的患者共计312例,脑出血组AVM(病例组)168例,其中男性86例,女性82例,年龄12-68岁,非脑出血组(对照组,患者以癫痫、头痛、神经功能缺失为发病症状)144例,男性81例,女性63例,年龄8-71岁。分析比较两组间临床相关风险因素年龄、性别、高血压、高血脂、高血糖、妊娠以及血管构筑相关风险因素AVM部位、大小、形态、供血动脉类型、引流静脉类型、伴随动脉瘤等的差异,先采用单因素分析,筛选出相关的危险因素,再用多因素logistic回归分析上述因素与脑AVM出血的关系,总结脑AVM出血的主要风险因素及保护性因素。
结果
AVM直径≧6cm(OR2.006,95%C.I1.286-3.128),深部静脉引流(OR1.679,95%C.I1.146-2.460),单支引流静脉引流(OR3.684,95%C.I2.554-5.315)位于深部的(OR2.372,95%C.I1.175-4.787),患有高血压(OR3.433,95%C.I1.812-6.503)是脑动静脉畸形出血的危险因素。
结论
位于深部、大型、单一静脉引流、引流方式为深部引流以及高血压为脑动静脉畸形破裂出血的危险因素。
第二章脑动静脉畸形的血管内栓塞治疗
研究背景
目前对于脑动静脉畸形的治疗手段主要有手术治疗、血管内介入治疗、放射治疗。上述治疗方术即可相互结合,也可单独采取其中之一的治疗方式。随着新型血管内栓塞剂ONXY及Glubran的广泛使用,以及较好的治疗效果,血管内栓塞治疗越来越成为脑动静脉畸形主要的治疗方式。
目的
探讨ONXY和Glubran两种不同栓塞剂在不同分级的脑动静脉畸形的栓塞方法及比较它们的疗效、优缺点。
方法
选取2006年1月一2012年1月在南方医科大学珠江医院神经外科住院行介入治疗的脑动静脉畸138例,均为单一动静脉畸形。其中经Glubran栓塞治疗组78例,总共146次栓塞,ONYX栓塞治疗组60例,112次栓塞,男性86例,女性52例,年龄8-67岁,平均36.5岁。回顾分析患者住院记录、手术记录、脑血管造影资料(包括随访的造影资料),分析比较ONYX和Glubran不同栓塞方法及治疗效果、并发症。
结果
两者栓塞的完全闭塞率,ONYX为29%,glubran为31%,两者之间无显著差异,次全闭塞率为两者对小型、供血类型简单的动静脉畸形都能取得较好的闭塞治疗效果,分级较高供血复杂的动静脉畸形两者治疗效果相似,粘管等并发症ONYX较Glubran高。
结论
在脑动静脉畸形的栓塞治疗中,ONYX及Glubran的总体治愈率相似。两者都可以做为脑AVM血管内栓塞的栓塞剂的选择。
Background
Cerebral arteriovenous malformation is the most common cerebral vascular dysplasia due to the lack of normal capillary bed. Angiographically, AVM is characterized by the performance of feeding arteries expansion and draining veins distorted mutual interlaced closely together clumps. It is characterized by abnormal arteriovenous shunt the angiographical early developing of lesion draining veins.
Its main symptoms are the onset of bleeding, epilepsy, headache and other focal neurological dysfunction. Brown RD reported that the first symptom was bleeding. Among them, the most symptoms was bleeding in brain tissue, the2nd was subarachnoid hemorrhage, and the remaining was intraventricular hemorrhage or mixture of bleeding. C Stapf had the retrospective study of brain arteriovenous malformation at the New York population of8.9million from1996to1999. He found that the1st diagnosed cerebral arteriovenous malformation cases were accounted for33%of all patients. Foster et al found that, once the bleeding lesions, the cAVM is prone to bleeding again due to lesions vascular structure in an unstable state, In this study, we retrospective collected the large number of cAVM cases from 2001-1to2012-1in Zhujiang Hospital and make the statistical analysis on the risk factors of intracranial hemorrhage after embolization of cerebral arteriovenous malformation, and evaluated the therapeutic efficacy using different sembolism materials for the purpose of guiding the clinical prevention and treatment decision making in the future.
The first chapter
Factors of cerebral arteriovenous malformation hemorrhage
Background
The most serious and the most common symptoms of Cerebral AVM is intracranial hemorrhage. There are many kind of reasons for cerebral arteriovenous malformation hemorrhage, which may be related to age, sex, hypertension, high cholesterol, high blood sugar, angioarchitecture factors associated with vascularfactors deformity, the size of the feeding artery of the source, quantity, level of distortion, the diameter of the blood supply to the way the location of the malformation, size, shape, number of draining veins diameter, drainage, drainage path, whether accompanied by hemangiomas, and so on. However, there is lack of systematic research and analysis. It is necessary to the full depth study on brain AVM hemorrhage risk factors.
Objection
To Investigate the clinical and angioarchitecture relevant factors of cerebral arteriovenous malformation hemorrhage.
Methods and materials
312patients with arteriovenous malformations were diagnosed in Zhujiang Hospital, nearly ten years with complete clinical data and imaging data.168cases in hemorrhage group (case group), male86case, female82cases, age range from12to68years old.144cases in non-cerebral hemorrhage group (control group, patients with epilepsy, headache, nerve function missing for the onset of symptoms), male81cases, female63cases, range from8to71years old,. There were compared between the two groups clinically relevant risk factors of age, gender, hypertension, high cholesterol, high blood sugar, pregnancy and angioarchitecture risk factors associated with AVM location, size, shape, type of feeding artery, draining vein type, accompanied by aneurysm differences,and then using logistic regression analysis of the relationship between the above factors with brain AVM bleeding, summarizes the major risk factors and protective factors for cerebral AVM hemorrhage.
Results
AVM diameter is≧6cm (OR2.006,95%CI1.286-3.128), deep venous drainage (OR1.679,95%CI1.146-2.460), single venous drainage (OR3.684,95%CI2.554-5.315) indeep (OR2.372,95%CI1.175-4.787), with high blood pressure (OR3.433,95%CI1.812-6.503) were risk factors for cerebral arteriovenous malformation hemorrhage.
Conclusion
Large and Deep-seated AVM and cAVM with the single deep venous drainage were the independent risk factors of cerebral AVM hemorrhage.
The second chapter
Endovascular embolization of Cerebral artcriovenous malformations
Background
There were four kinds of treatment strategies for cerebral arteriovenous malformation:Surgery, endovascular treatment, radiation therapy and conservative treatment, which can be used alone or combined with each other. With the extensive use of the novel intravascular embolic agent like onyx and Glubran with a wonderful therapeutic effect, endovascular embolization has increasingly become the main treatment of cerebral arteriovenous malformations.
Objection
To investigate the efficacy, advantages and disadvantages between onyx and Glubran in the treatment of brain arteriovenous malformation in different classification.
Method
138cases with arteriovenous malformations Selected from Zhujiang Hospital neurosurgery inpatient, interventional treatment of brain arteriovenous malfomatoin January2006.1to January2012.1.78cases with Glubran embolization in the treatment group, total of146times embolism.60patients with ONYX embolization,112times embolism.86male,52female, age range from8to67years old, an average of36.5years. Recalling the analysis of hospitalization records, surgical records,cerebral angiography (including follow-up angiography), analysis comparing ONYX and different Glubran embolism and treatment effects, complications.
Results
Complete occlusion rate was similar tin both of Glubran and Onyx.29%was in Onyx group and31%in glubran group with no significant difference. Subtotal occlusion rate was simple and small in both of them, the blood supply to the type of arteriovenous malformations can achieve better occlusion The therapeutic effect of graded higher blood supply with the complex arteriovenous malformation was similar in both group. The stick tube complication in Onyx group was higher than in Glubran group.
Conclusion
Onyx and glubran had the same cure rate in the treatment of cerebral AVM. Both of them can be facultative.
引文
1.Rustam Al-Shahi and Charles Warlow. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain, Oct 2001; 124:1900-1926
2.Rustam Al-Shahi and Christian Stapf.The Prognosis and Treatment of Arteriovenous Malformations of the Brain.Practical Neurology, Aug 2005; 5:194-205
3. Cormac O. Maher, David G Piepgras, Robert D. Brown, Jr, Jonathan A. Friedman, and Bruce E. Pollock.Cerebrovascular Manifestations in 321 Cases of Hereditary Hemorrhagic Telangiectasia. Stroke, Apr 2001; 32:877-882.
4. Robert D. Brown, Jr., David O. Wiebers, James C. Torner, and Michael W. O'Fallon .Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992.Neurology, Apr 1996; 46:949-952.
5. C. Stapf, H. Mast, R.R. Sciacca, A. Berenstein, P.K. Nelson, Y.P. Gobin, J. Pile-Spellman, and J.P. Mohr.The New York Islands AVM Study:Design, Study Progress, and Initial Results. Stroke, May 2003; 34:e29-e33.
6. C Stapf, H Mast, R R Sciacca, J Pile-Spellman, and J P Mohr.The New York Islands AVM Study:Detection rates for brain AVM and incident AVM hemorrhage Abstracts of the International Stroke Conference, Jan 2000; 32:368.
7. Poyee Tung, Alexander Kopelnik, Nader Banki, Ken Ong, Nerissa Ko, Michael T. Lawton, Daryl Gress, Barbara Drew, Elyse Foster, William Parmley, and Jonathan Zaroff.Predictors of Neurocardiogenic Injury After Subarachnoid Hemorrhage.Stroke, Feb 2004; 35:548-551.
8. Harry J. Cloft, Gregory J. Joseph, and Jacques E. Dion.Risk of Cerebral Angiography in Patients With Subarachnoid Hemorrhage, Cerebral Aneurysm, and Arteriovenous Malformation: A Meta-Analysis.Stroke, Feb 1999; 30:317-320.
9. A.V. Khaw, J.P. Mohr, R.R. Sciacca, H.C. Schumacher, A. Hartmann, J. Pile-Spellman, H. Mast, and C. Stapf.Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation.Stroke, Mar 2004; 35:660-663.
10. D. Hoang Duong, William L. Young, Meng C. Vang, Robert R. Sciacca, Henning Mast, Hans-Christian Koennecke, Andreas Hartmann, Shailendra Joshi, J. P. Mohr, and John Pile-Spellman. Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations.Stroke, Jun 1998; 29:1167-1176.
11. Marco A. Stefani, Phillip J. Porter, Karel G terBrugge, Walter Montanera, Robert A. Willinsky, and M. Christopher Wallace. Large and Deep Brain Arteriovenous Malformations Are Associated With Risk of Future Hemorrhage.Stroke, May 2002; 33:1220-1224.
12. Bruce E. Pollock, John C. Flickinger, L. Dade Lunsford, David J. Bissonette, and Douglas Kondziolka. Factors That Predict the Bleeding Risk of Cerebral Arteriovenous Malformations. Stroke, Jan 1996; 27:1-6.
13. Microneurosurgery, Volume IIIA:AVM of the Brain, History, Embryology.Mahmut Gazi Yasargil
14. Helen Kim, Charles E. McCulloch, S. Claiborne Johnston, Michael T. Lawton, Stephen Sidney, and William L. Young.Comparison of 2 Approaches for Determining the Natural History Risk of Brain Arteriovenous Malformation Rupture.Am. J. Epidemiol., Jun 2010; 171:1317-1322.
15. Bruce E. Pollock, John C. Flickinger, L. Dade Lunsford, David J. Bissonette, and Douglas Kondziolka.Factors That Predict the Bleeding Risk of Cerebral Arteriovenous Malformations Stroke, Jan 1996; 27:1-6.
1 6.赵继宗,王硕,隋大立,李京生, 张岩, 李健.2086例脑动静脉畸形临床特征和手术治疗结果分析.中华神经外科杂志,2004(3)20,113-117.
17. Rustam Al-Shahi and Charles Warlow.A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.Brain, Oct 2001; 124:1900-1926.
18. Gabrielle G Leblanc, Eugene Golanov, Issam A. Awad, William L. Young, Biology of Vascular Malformations of the Brain.Stroke, Dec 2009; 40:e694-e702.
19. Shunji Matsubara, Jennifer L. Manzia, Karel ter Brugge, Robert A. Willinsky, Walter Montanera, and Marie E. Faughnan.Angiographic and Clinical Characteristics of Patients with Cerebral Arteriovenous Malformations Associated with Hereditary Hemorrhagic Telangiectasia AJNR Am. J. Neuroradiol., Jun 2000; 21:1016-1020.
20. B B Lee, J Lardeo, and R Neville. Arterio-venous malformation:how much do we know? Phlebology, Oct 2009; 24:193-200
21.C. Hofineister, C. Stapf, A. Hartmann, R. R. Sciacca, U. Mansmann, K. terBrugge, P. Lasjaunias, J. P. Mohr, H. Mast, and J. Meisel.Demographic, Morphological, and Clinical Characteristics of 1289 Patients With Brain Arteriovenous Malformation.Stroke, Jun 2000; 31: 1307-1310.
22. A.V. Khaw, J.P. Mohr, R.R. Sciacca, H.C. Schumacher, A. Hartmann, J. Pile-Spellman, H. Mast, and C. Stapf.Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation..Stroke, Mar 2004; 35:660-663.
23. Giovanni Grasso.Editorial Comment—Age-Dependent Brain AVM Characteristics:What is the Evidence?Stroke, Nov 2003; 34:2669-2670.
24. Leodante da Costa, M. Christopher Wallace, Karel G. ter Brugge, Cian O'Kelly, Robert A. Willinsky, and Michael Tymianski.The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations Stroke, Jan 2009; 40:100-105
25. H.T. ApSimon, H. Reef, R.V. Phadke, and E.A. Popovic.A Population-Based Study of Brain Arteriovenous Malformation:Long-Term Treatment Outcomes.Stroke, Dec 2002; 33:2794-2800.
26. Nader M. Banki, Alexander Kopelnik, Michael W. Dae, Jacob Miss, Poyee Tung, Michael T. Lawton, Barbara J. Drew, Elyse Foster, Wade Smith, William W. Parmley, and Jonathan G ZaroffAcute Neurocardiogenic Injury After Subarachnoid Hemorrhage.Circulation, Nov 2005; 112:3314-3319.
27. Marco A. Stefani, Phillip J. Porter, Karel G terBrugge, Walter Montanera, Robert A. Willinsky, and M. Christopher Wallace.Angioarchitectural Factors Present in Brain Arteriovenous Malformations Associated With Hemorrhagic Presentation.Stroke, Apr 2002; 33: 920-924. Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations
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2.Rustam Al-Shahi and Christian Stapf.The Prognosis and Treatment of Arteriovenous Malformations of the Brain.Practical Neurology, Aug 2005; 5:194-205
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5. C. Stapf, H. Mast, R.R. Sciacca, A. Berenstein, P.K. Nelson, Y.P. Gobin, J. Pile-Spellman, and J.P. Mohr.The New York Islands AVM Study:Design, Study Progress, and Initial Results. Stroke, May 2003; 34:e29-e33.
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7. Poyee Tung, Alexander Kopelnik, Nader Banki, Ken Ong, Nerissa Ko, Michael T. Lawton, Daryl Gress, Barbara Drew, Elyse Foster, William Parmley, and Jonathan Zaroff.Predictors of Neurocardiogenic Injury After Subarachnoid Hemorrhage.Stroke, Feb 2004; 35:548-551.
8. Harry J. Cloft, Gregory J. Joseph, and Jacques E. Dion.Risk of Cerebral Angiography in Patients With Subarachnoid Hemorrhage, Cerebral Aneurysm, and Arteriovenous Malformation: A Meta-Analysis.Stroke, Feb 1999; 30:317-320.
9. A.V. Khaw, J.P. Mohr, R.R. Sciacca, H.C. Schumacher, A. Hartmann, J. Pile-Spellman, H. Mast, and C. Stapf.Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation.Stroke, Mar 2004; 35:660-663.
10. D. Hoang Duong, William L. Young, Meng C. Vang, Robert R. Sciacca, Henning Mast, Hans-Christian Koennecke, Andreas Hartmann, Shailendra Joshi, J. P. Mohr, and John Pile-Spellman. Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations.Stroke, Jun 1998; 29:1167-1176.
11. Marco A. Stefani, Phillip J. Porter, Karel G terBrugge, Walter Montanera, Robert A. Willinsky, and M. Christopher Wallace. Large and Deep Brain Arteriovenous Malformations Are Associated With Risk of Future Hemorrhage.Stroke, May 2002; 33:1220-1224.
12. Bruce E. Pollock, John C. Flickinger, L. Dade Lunsford, David J. Bissonette, and Douglas Kondziolka. Factors That Predict the Bleeding Risk of Cerebral Arteriovenous Malformations. Stroke, Jan 1996; 27:1-6.
13. Microneurosurgery, Volume IIIA:AVM of the Brain, History, Embryology.Mahmut Gazi Yasargil
14. Helen Kim, Charles E. McCulloch, S. Claiborne Johnston, Michael T. Lawton, Stephen Sidney, and William L. Young.Comparison of 2 Approaches for Determining the Natural History Risk of Brain Arteriovenous Malformation Rupture.Am. J. Epidemiol., Jun 2010; 171:1317-1322.
15. Bruce E. Pollock, John C. Flickinger, L. Dade Lunsford, David J. Bissonette, and Douglas Kondziolka.Factors That Predict the Bleeding Risk of Cerebral Arteriovenous Malformations Stroke, Jan 1996; 27:1-6.
1 6.赵继宗,王硕,隋大立,李京生, 张岩, 李健.2086例脑动静脉畸形临床特征和手术治疗结果分析.中华神经外科杂志,2004(3)20,113-117.
17. Rustam Al-Shahi and Charles Warlow.A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.Brain, Oct 2001; 124:1900-1926.
18. Gabrielle G Leblanc, Eugene Golanov, Issam A. Awad, William L. Young, Biology of Vascular Malformations of the Brain.Stroke, Dec 2009; 40:e694-e702.
19. Shunji Matsubara, Jennifer L. Manzia, Karel ter Brugge, Robert A. Willinsky, Walter Montanera, and Marie E. Faughnan.Angiographic and Clinical Characteristics of Patients with Cerebral Arteriovenous Malformations Associated with Hereditary Hemorrhagic Telangiectasia AJNR Am. J. Neuroradiol., Jun 2000; 21:1016-1020.
20. B B Lee, J Lardeo, and R Neville. Arterio-venous malformation:how much do we know? Phlebology, Oct 2009; 24:193-200
21.C. Hofineister, C. Stapf, A. Hartmann, R. R. Sciacca, U. Mansmann, K. terBrugge, P. Lasjaunias, J. P. Mohr, H. Mast, and J. Meisel.Demographic, Morphological, and Clinical Characteristics of 1289 Patients With Brain Arteriovenous Malformation.Stroke, Jun 2000; 31: 1307-1310.
22. A.V. Khaw, J.P. Mohr, R.R. Sciacca, H.C. Schumacher, A. Hartmann, J. Pile-Spellman, H. Mast, and C. Stapf.Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation..Stroke, Mar 2004; 35:660-663.
23. Giovanni Grasso.Editorial Comment—Age-Dependent Brain AVM Characteristics:What is the Evidence?Stroke, Nov 2003; 34:2669-2670.
24. Leodante da Costa, M. Christopher Wallace, Karel G. ter Brugge, Cian O'Kelly, Robert A. Willinsky, and Michael Tymianski.The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations Stroke, Jan 2009; 40:100-105
25. H.T. ApSimon, H. Reef, R.V. Phadke, and E.A. Popovic.A Population-Based Study of Brain Arteriovenous Malformation:Long-Term Treatment Outcomes.Stroke, Dec 2002; 33:2794-2800.
26. Nader M. Banki, Alexander Kopelnik, Michael W. Dae, Jacob Miss, Poyee Tung, Michael T. Lawton, Barbara J. Drew, Elyse Foster, Wade Smith, William W. Parmley, and Jonathan G ZaroffAcute Neurocardiogenic Injury After Subarachnoid Hemorrhage.Circulation, Nov 2005; 112:3314-3319.
27. Marco A. Stefani, Phillip J. Porter, Karel G terBrugge, Walter Montanera, Robert A. Willinsky, and M. Christopher Wallace.Angioarchitectural Factors Present in Brain Arteriovenous Malformations Associated With Hemorrhagic Presentation.Stroke, Apr 2002; 33: 920-924. Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations
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