脑动静脉畸形血管内栓塞治疗24例临床分析
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摘要
目的：探讨血管内栓塞治疗脑动静脉畸形(AVM)栓塞率的影响因素,初步评价血管内栓塞治疗脑动静脉畸形的临床疗效。
方法：回顾性分析我科2007.3～2010.3三年内在就诊期间进行血管内栓塞治疗的脑动静脉畸形患者共24例,比较分析Spetzler&Matin级别、栓塞材料、AVM供血方式等因素对AVM栓塞率的影响。
结果：24例病例根据Spetzler&Martin分级,6例为Ⅰ级,12例为Ⅱ级,5例为Ⅲ级,1例为Ⅳ。Ⅰ级AVM患者平均栓塞率(93.0±8.2%)与Ⅱ～Ⅲ级(Ⅱ级73.0±17.1%,Ⅲ级77.0±15.2%)相比有显著性差异。Glubran-2胶的平均栓塞率为83.0±16%,Onyx-18胶的平均栓塞率为78.0±21.4%,真丝线段组为60.0±21.6%,两种胶水的栓塞效果明显优于真丝线段,而两种胶水的栓塞效果相比无显著性差异。单支供血动脉的AVM栓塞率(83.0±15.0%)明显好于多支供血动脉(66.0±23.0%),两组比较有显著性差异；小型AVM栓塞率(90.0±10.6%)与中型或大型AVM的栓塞率(中型68.0±15.0%,大型63.0±25.3%)相比亦有显著性差异。
结论：Glubran-2胶与Onyx-18胶是AVM血管内栓塞治疗的理想栓塞材料。对单支动脉供血、分级为Ⅰ级、小型AVM血管内栓塞治疗有较好的疗效。
Objective:This study was undertaken to analyze the influencing factors for the rate of embolization in the endovascular treatment of AVM, and to evaluate the therapeutic effect of endovascular embolization treatment.
Methods:24 cases with anteriovenous malformations which underwent endovascular embolization treatment from March 2007 to March 2010 was studied. A statistical analyse was done to look for relationship between some influencing factors,such as Spetzler&Matin grade,embolization material,ize, feeding arteries, and the rate of embolization in the endovascular treatment of AVM.
Results:24 patients with AVM were underwent endovascular treatment in our department(six Spetzler&Martin grade I, twelve grade II, five grade III and one grade IV). There is a significant difference of the mean rate of embolization betwee Spetzler&Matin grade I and grade II～III.The mean rate of embolization with Glubran-2 glue is 83.0±16%,while 78.0±21.4%with Onyx-18 glue.The group which received embolizalion with silk thread has a low rate of embolization(60.0±21.6%). The rate of embolization with Glubran-2 glue or Onyx-18 are higher than with silk thread. Compared with Glubran-2 glue, Onyx-18 doesn't show statistical difference in the rate of embolization. The rate of embolization of AVM with single supplying arterie is 83.0±15.0%.The rate of embolization is significantly decreased when AVM has complex feeding arteries. There is a significant difference of the mean rate of embolization betwee AVM with different sizes.And small AVM with fewer feeding arteries is more likely to be embolized completely.
Conclusion:Both Glubran-2 glue and Onyx-18 glue are optimal embolization material in the endovascular treatment of AVM. Endovascular embolization treatment has a more ideal therapeutic effcet to AVM which is single feeding arteries, Spetzler&Matin grade I,small sized.
方法：回顾性分析我科2007.3～2010.3三年内在就诊期间进行血管内栓塞治疗的脑动静脉畸形患者共24例,比较分析Spetzler&Matin级别、栓塞材料、AVM供血方式等因素对AVM栓塞率的影响。
结果：24例病例根据Spetzler&Martin分级,6例为Ⅰ级,12例为Ⅱ级,5例为Ⅲ级,1例为Ⅳ。Ⅰ级AVM患者平均栓塞率(93.0±8.2%)与Ⅱ～Ⅲ级(Ⅱ级73.0±17.1%,Ⅲ级77.0±15.2%)相比有显著性差异。Glubran-2胶的平均栓塞率为83.0±16%,Onyx-18胶的平均栓塞率为78.0±21.4%,真丝线段组为60.0±21.6%,两种胶水的栓塞效果明显优于真丝线段,而两种胶水的栓塞效果相比无显著性差异。单支供血动脉的AVM栓塞率(83.0±15.0%)明显好于多支供血动脉(66.0±23.0%),两组比较有显著性差异；小型AVM栓塞率(90.0±10.6%)与中型或大型AVM的栓塞率(中型68.0±15.0%,大型63.0±25.3%)相比亦有显著性差异。
结论：Glubran-2胶与Onyx-18胶是AVM血管内栓塞治疗的理想栓塞材料。对单支动脉供血、分级为Ⅰ级、小型AVM血管内栓塞治疗有较好的疗效。
Objective:This study was undertaken to analyze the influencing factors for the rate of embolization in the endovascular treatment of AVM, and to evaluate the therapeutic effect of endovascular embolization treatment.
Methods:24 cases with anteriovenous malformations which underwent endovascular embolization treatment from March 2007 to March 2010 was studied. A statistical analyse was done to look for relationship between some influencing factors,such as Spetzler&Matin grade,embolization material,ize, feeding arteries, and the rate of embolization in the endovascular treatment of AVM.
Results:24 patients with AVM were underwent endovascular treatment in our department(six Spetzler&Martin grade I, twelve grade II, five grade III and one grade IV). There is a significant difference of the mean rate of embolization betwee Spetzler&Matin grade I and grade II～III.The mean rate of embolization with Glubran-2 glue is 83.0±16%,while 78.0±21.4%with Onyx-18 glue.The group which received embolizalion with silk thread has a low rate of embolization(60.0±21.6%). The rate of embolization with Glubran-2 glue or Onyx-18 are higher than with silk thread. Compared with Glubran-2 glue, Onyx-18 doesn't show statistical difference in the rate of embolization. The rate of embolization of AVM with single supplying arterie is 83.0±15.0%.The rate of embolization is significantly decreased when AVM has complex feeding arteries. There is a significant difference of the mean rate of embolization betwee AVM with different sizes.And small AVM with fewer feeding arteries is more likely to be embolized completely.
Conclusion:Both Glubran-2 glue and Onyx-18 glue are optimal embolization material in the endovascular treatment of AVM. Endovascular embolization treatment has a more ideal therapeutic effcet to AVM which is single feeding arteries, Spetzler&Matin grade I,small sized.
引文
[1]Hartmann A,Pile Spellman J,Stapf C,et al. Risk of endovascular treatment of brain atreriovenous malformations [J]Stroke,2002,33(7):1 816-1820.
[2]Liu HM,Huang YC,Wang YH. Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate [J]J Formos Med Assoc,2000, 99(12):906-913.
[3]Connors JJ, Wojak JC. Interventional neuroradiology strategied and practical techniques [M] Philadlphia Harcourt publishers limited,2001.
[4]Deruty ZR,pelissou Gl,Mord C,et al.Reflctions on the management of cerebral arteriovenous malformation. [J] Surg Neurol,1998,50(3):255-256.
[5]Stefani MA,Porter PJ,Brugge KG,et al. Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presenta-tion [J]Stroke,2002,33(4):920-924.
[6]Zhao JZ,Wang S,Li JS,et al. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations [J] Surg Neurol,2005,63(2):156-161.
[7]Mccormik WF. Pathology of vascular malformations ofthe brain [M] n:WILSON C B,STEIN B M,eds.Intracranial Arteriovenous Malformations. Baltinore: Williams & Wilkins,1984:44-63.
[8]Al-Shahi R,Warlow CA systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. [J] Brain,2001,124 (10):1900-1926.
[9]李铁林.脑动静脉畸形血管内治疗的若干经验.[J]中国神经精神病杂志,2001,27(6)：472-473.
[10]Valavanis A, Yasargil MG. The endovascular treatment of brain ateriovenous Malformations [J]J Neurosurg,1998,24(4):133-146.
[11]李铁林,汪求精,段传志,等.经微导管铸型栓塞治疗脑动静脉畸形[J].中华神经外科杂志,2002,18(2)：122-124.
[12]Andreashartmann,Henningmast,Jae H,et al. Treatment of arteriovenous malformations of the brain [J] Stroke,2007,7:28-34.
[13]Mohr JP,Starf C,Sciaccar R,et al.Treatment outcome versus natural history risk inpatients with unruptured brain arteriovenous malformation [J] Neurology, 2004,62:A101.
[14]Vinuela F,Dion JE,Duckwiler G. Combined endovascylar embolization and surgery in the management of cerebral arteriovenous malformation:experience with 101 cases. [J]J.Neurosurg,1991,75(6):856-864.
[15]Leonardi M,Barbara C,Simonetti L,et al.Glubran 2:a new acrylic gluefor neuroradiological endovascular use experimental study on animals.[J] Interv Neuroradiol,2002,8(1):245-250.
[16]Leonardi M,Cenni P,Simonetti L,et al.Glubran 2:a new acrylic glue for neuroradiological endovascular use. A complementary histological study [J] Interv Neuroradiol,2003,9(1):249-254.
[17]Raffi L,Simonetti L,Cenni P,et al.Use of Glubran 2 acrylic glue in interventional [J]Neuroradiology,2007,49(3):829-836.
[18]Taki W,Yonekawa Y, Iwata H, et a.l A new liquid material for embolization of arteriovenous malformations [J] A JNR,1990,11(1):163.
[19]Akin ED, Perkins E,Ross IB. Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-bu-tyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine [J] J Neurosurg,2003,98(2):366.
[20]Jahan R,Murayama Y,Gobin YP,et al. Embolization of arteriovenous malformations with Onyx:clinopathological experience in 23 patients [J] Neurosurgery,2001,48:984-997.
[21]Yu SC, Chan MS, Lam JM, et a.1.Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization:initial success and rate of permanent cure.[J] AJNR Am J Neuroradiol,2004,25(7): 139-143.
[22]Valavanis A, Yasargil MG. The endovascular treatment of brain arteriovenous malformations [J]. Adv Tech Stand Neurosurg,1998,24(2):131-141.
[23]Sorimachi T,Koike T,Takeuchi S,et al.Embolization of cerebral arteriovenous malformations achieved With Polyviny 1 alcohol Particles:angiographic reappearance and complications.[J] AJNR AM J Neuroradio,1999,20(7): 1323-1328.
[24]Chang SD, Marcellus ML, Marks MP, et al. Multimodality treatment of giant intracranial arteriovenous malformations.[J] Neurosurgery,2003,53(1):121.
[25]Sekhon LH,Morgan MK,Spence L.Normal Perfosion Pressure breakthrough:the role of capillaries. [J]J Neurosurg,1997,86(3):519-524.
[26]Kjellin IB,Boechat MI,Vinuela F,et al.Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children. [J]Pediatr Radiol,2000,30(4):279-283.
[1]Zhao JZ,Wang S,Li JS,et al. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations [J] Surg Neurol,2005,63 (2):156-161.
[2]Mccormik WF. Pathology of vascular malformations ofthe brain. [M] WILSON C B,STEIN B M,eds.Intracranial Arteriovenous Malformations. Baltinore:Williams &Wilkins,1984:44-63.
[3]Hartmann A, Pile Spellman J, Stapf C, et al. Risk of endovascular treatment of brain atreriovenous malformations.[J] Stroke,2002,33(7):1 816-1820.
[4]Langer DJ, LasnerTM, Hurst RW, et al. Hypertension, small size, and deep venous drainage are associatedwith risk of hemorrhagic presentation of cerebral arteriovenous malformations.[J] Neurosurgery,1998,42(3):481-489.
[5]Shen CC, Wang YC. Surgical management of intracranial arteriovenous malformation associated with aneurysms. [J] Chung Hua I Hsueh Tsa Chih(Taipei),1998,61(1):8-16.
[6]Al-Shahi R,Warlow CA systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. [J] Brain,2001,124 (10):1900-1926.
[7]王忠诚主编.王忠诚神经外科学[M].武汉：湖北科学技术出版社,2004,817-820.
[8]Pant B, Sumida M, Arita K, et al. Usefulness of three-dimensional phase contrast of MR angiography on arteriovenous malformations. [J] Neurosurg Rev,1997, 20(3):171-176.
[9]Tanaka H, Numaguchi Y, Konno S, et al. Initial experience with helical CT and 3D reconstruction in therapeutic planning of cerebral AVMs:comparison with 3D time-of-flight MRA and digital subtraction angiography. [J] J Comput Assist Tomogr,1997,21(5):811-817.
[10]Han PP, Ponce FA, Spetzler RF. Intention-to-treat analysis of Spetzler&Martin grades IV and V arteriovenous malformations:natural history and treatment paradigm[J] Neurosurg,2003,98(1):3-7.
[11]Liu HM, Huang YC, Wang YH. Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate [J]J Formos Med Assoc,2000, 99(12):906-913.
[12]Connors JJ, Wojak JC. Interventional neuroradiology strategied and practical techniques [M] Philadlphia Harcourt publishers limited,2001.
[13]Deruty ZR,pelissou Gl,Mord C,et al.Reflctions on the management of cerebral arteriovenous malformation. [J]Surg Neurol,1998,50(3):255-256.
[14]Stefani MA,Porter PJ,Brugge KG,et al. Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presenta-tion [J]Stroke,2002,33(4):920-924.
[15]李铁林.脑动静脉畸形血管内治疗的若干经验.[J]中国神经精神病杂 志,2001,27(6)：472-473.
[16]Sinclair J, Kelly M E, Steinberg G K. Surgical management of posterior fossa arteriovenous malformations. [J].Neurosurgery 2006,58 (4 Suppl 2):189-201.
[17]Han PP, Ponce FA, Spetzler R F. Intention-to-treat analysis of Spetzler-Martin grades IV and V arteriovenous malformations:natural history and treatment paradigm.[J] Neurosurg,2003,98(1):3-7.
[18]Hartmann A, Stapf C, Hofmeister C, et al. Determinants ofneurological outcome after surgery for brain arteriovenous malformation. [J] Stroke,2000,31(10): 2361-2364.
[19]Valavanis A, Yasargil MG. The endovascular treatment of brain ateriovenous Malformations [J]J Neurosurg,1998,24(4):133-146.
[20]李铁林,汪求精,段传志,等.经微导管铸型栓塞治疗脑动静脉畸形[J].中华神经外科杂志,2002,18(2)：122-124.
[21]Andreashartmann, Henningmast,Jae H,et al. Treatment of arteriovenous malformations of the brain [J] Stroke,2007,7:28-34.
[22]Mohr JP,Starf C,Sciaccar R,et al.Treatment outcome versus natural history risk inpatients with unruptured brain arteriovenous malformation [J] Neurology,2004,62:A101.
[23]Vinuela F,Dion JE,Duckwiler G. Combined endovascylar embolization and surgery in the management of cerebral arteriovenous malformation:experience with 101 cases.[J]J.Neurosurg,1991,75(6):856-864.
[24]Liu HM,Huang YC,Wang YH.Embolization of cerebral arteriovenous malformations with n-buty 1-2-cyanoacrylate.[J] J Formos Med Assoe,2000, 99(12):906-913.
[25]Sadato A, Wakhloo AK, Hopkins LN. Effects of a mixture of a low concentration of n-butylcyanoacrylate and ethiodolon tissue reactions and the permanence of arterial occlusion after embolization [J] Neurosurgery,2000,47(5):1197-1203.
[26]Leonardi M,Barbara C,Simonetti L,et al.Glubran 2:a new acrylic gluefor neuroradiological endovascular use experimental study on animals. [J] Interv Neuroradiol,2002,8(1):245-250.
[27]Leonardi M,Cenni P,Simonetti L,et al.Glubran 2:a new acrylic glue for neuroradiological endovascular use. A complementary histological study [J] Interv Neuroradiol,2003,9(1):249-254.
[28]Raffi L,Simonetti L,Cenni P,et al.Use of Glubran 2 acrylic glue in interventional [J]Neuroradiology,2007,49(3):829-836.
[29]Taki W,Yonekawa Y, Iwata H, et a.l A new liquid material for embolization of arteriovenous malformations [J] A JNR,1990,11(1):163.
[30]Akin ED, Perkins E,Ross IB. Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-bu-tyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine [J] J Neurosurg,2003,98(2):366.
[31]Jahan R,Murayama Y,Gobin YP,et al. Embolization of arteriovenous malformations with Onyx:clinopathological experience in 23 patients [J] Neurosurgery,2001,48:984-997.
[32]Sorimachi T, Koike T, Takeuchi S, et al. Embolization of cerebral arteriovenous malformations achieved With Polyviny 1 alcohol Particles:angiographic reappearance and complications. [J] AJNR AM J Neuroradio,1999,20(7): 1323-1328.
[33]Chang SD, Marcellus ML, Marks MP, et al. Multimodality treatment of giant intracranial arteriovenous malformations.[J] Neurosurgery,2003,53(1):121.
[34]Sekhon LH,Morgan MK,Spence L.Normal Perfosion Pressure breakthrough:the role of capillaries. [J]J Neurosurg,1997,86(3):519-524.
[35]Kjellin IB,Boechat MI,Vinuela F,et al.Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children. [J]Pediatr Radiol,2000,30(4):279-283.
[36]Willis AI, Pierre P, Sumpio BE, et al. Vascular smooth muscle migration:current opinion and clinical implications. [J] Vascu Endovascu Surg,2004,38(1):11-23.
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[38]Izawa M, Hayaohi M, Chernov M, et al. Long-term complications after gamma knife surgery for AVMS. [J] Neurosurg,2005,102(1):34-37.
[39]Maruyama K, Shin M,Tago M, et al. Gamma knife surgery for AVMs involving the corpusm. [J] Neurosury,2005,102(1):49-52.
[40]Massager N, Regis J, Kondziolda D, et al. Gamma knife radiosurgery for brainstem AVMs:preliminary results. [J] Neurosurg,2000,93:102-103.
[41]赵刚,梁军潮,王伟民,等.伽玛刀治疗脑动静脉畸形的长期随访.[J]中华神经外科杂志,2008,24(11)：851-853.
[42]Graham GD. Arteriovenous malformations in the brain. [J]Curr Treat Options Neurol.2002,4(6):435-444.
[2]Liu HM,Huang YC,Wang YH. Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate [J]J Formos Med Assoc,2000, 99(12):906-913.
[3]Connors JJ, Wojak JC. Interventional neuroradiology strategied and practical techniques [M] Philadlphia Harcourt publishers limited,2001.
[4]Deruty ZR,pelissou Gl,Mord C,et al.Reflctions on the management of cerebral arteriovenous malformation. [J] Surg Neurol,1998,50(3):255-256.
[5]Stefani MA,Porter PJ,Brugge KG,et al. Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presenta-tion [J]Stroke,2002,33(4):920-924.
[6]Zhao JZ,Wang S,Li JS,et al. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations [J] Surg Neurol,2005,63(2):156-161.
[7]Mccormik WF. Pathology of vascular malformations ofthe brain [M] n:WILSON C B,STEIN B M,eds.Intracranial Arteriovenous Malformations. Baltinore: Williams & Wilkins,1984:44-63.
[8]Al-Shahi R,Warlow CA systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. [J] Brain,2001,124 (10):1900-1926.
[9]李铁林.脑动静脉畸形血管内治疗的若干经验.[J]中国神经精神病杂志,2001,27(6)：472-473.
[10]Valavanis A, Yasargil MG. The endovascular treatment of brain ateriovenous Malformations [J]J Neurosurg,1998,24(4):133-146.
[11]李铁林,汪求精,段传志,等.经微导管铸型栓塞治疗脑动静脉畸形[J].中华神经外科杂志,2002,18(2)：122-124.
[12]Andreashartmann,Henningmast,Jae H,et al. Treatment of arteriovenous malformations of the brain [J] Stroke,2007,7:28-34.
[13]Mohr JP,Starf C,Sciaccar R,et al.Treatment outcome versus natural history risk inpatients with unruptured brain arteriovenous malformation [J] Neurology, 2004,62:A101.
[14]Vinuela F,Dion JE,Duckwiler G. Combined endovascylar embolization and surgery in the management of cerebral arteriovenous malformation:experience with 101 cases. [J]J.Neurosurg,1991,75(6):856-864.
[15]Leonardi M,Barbara C,Simonetti L,et al.Glubran 2:a new acrylic gluefor neuroradiological endovascular use experimental study on animals.[J] Interv Neuroradiol,2002,8(1):245-250.
[16]Leonardi M,Cenni P,Simonetti L,et al.Glubran 2:a new acrylic glue for neuroradiological endovascular use. A complementary histological study [J] Interv Neuroradiol,2003,9(1):249-254.
[17]Raffi L,Simonetti L,Cenni P,et al.Use of Glubran 2 acrylic glue in interventional [J]Neuroradiology,2007,49(3):829-836.
[18]Taki W,Yonekawa Y, Iwata H, et a.l A new liquid material for embolization of arteriovenous malformations [J] A JNR,1990,11(1):163.
[19]Akin ED, Perkins E,Ross IB. Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-bu-tyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine [J] J Neurosurg,2003,98(2):366.
[20]Jahan R,Murayama Y,Gobin YP,et al. Embolization of arteriovenous malformations with Onyx:clinopathological experience in 23 patients [J] Neurosurgery,2001,48:984-997.
[21]Yu SC, Chan MS, Lam JM, et a.1.Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization:initial success and rate of permanent cure.[J] AJNR Am J Neuroradiol,2004,25(7): 139-143.
[22]Valavanis A, Yasargil MG. The endovascular treatment of brain arteriovenous malformations [J]. Adv Tech Stand Neurosurg,1998,24(2):131-141.
[23]Sorimachi T,Koike T,Takeuchi S,et al.Embolization of cerebral arteriovenous malformations achieved With Polyviny 1 alcohol Particles:angiographic reappearance and complications.[J] AJNR AM J Neuroradio,1999,20(7): 1323-1328.
[24]Chang SD, Marcellus ML, Marks MP, et al. Multimodality treatment of giant intracranial arteriovenous malformations.[J] Neurosurgery,2003,53(1):121.
[25]Sekhon LH,Morgan MK,Spence L.Normal Perfosion Pressure breakthrough:the role of capillaries. [J]J Neurosurg,1997,86(3):519-524.
[26]Kjellin IB,Boechat MI,Vinuela F,et al.Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children. [J]Pediatr Radiol,2000,30(4):279-283.
[1]Zhao JZ,Wang S,Li JS,et al. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations [J] Surg Neurol,2005,63 (2):156-161.
[2]Mccormik WF. Pathology of vascular malformations ofthe brain. [M] WILSON C B,STEIN B M,eds.Intracranial Arteriovenous Malformations. Baltinore:Williams &Wilkins,1984:44-63.
[3]Hartmann A, Pile Spellman J, Stapf C, et al. Risk of endovascular treatment of brain atreriovenous malformations.[J] Stroke,2002,33(7):1 816-1820.
[4]Langer DJ, LasnerTM, Hurst RW, et al. Hypertension, small size, and deep venous drainage are associatedwith risk of hemorrhagic presentation of cerebral arteriovenous malformations.[J] Neurosurgery,1998,42(3):481-489.
[5]Shen CC, Wang YC. Surgical management of intracranial arteriovenous malformation associated with aneurysms. [J] Chung Hua I Hsueh Tsa Chih(Taipei),1998,61(1):8-16.
[6]Al-Shahi R,Warlow CA systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. [J] Brain,2001,124 (10):1900-1926.
[7]王忠诚主编.王忠诚神经外科学[M].武汉：湖北科学技术出版社,2004,817-820.
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