Diagnostic points】
1, Cerebral arteriovenous malformation arises due to abnormal development of the structure and number of cerebral blood vessels during embryonic period, lack of capillaries between cerebral arteries and veins, forming a short circuit between cerebral arteries and cerebral veins, and causing cerebral hemodynamic changes.
2.The main symptoms include hemorrhage, epilepsy, headache and limited neurological dysfunction.
3.Grading: Generally, it is classified into 1-5 grades by Spetzler grading method
AVM size: < 3.0cm 1 point
3.0 – 6.0cm 2 points
>= 6.0cm 3 points
AVM site: in the functional area 1 point
Located in non-functional area 0 points
AVM drainage: deep 1 point
Superficial 0 points
Grading = AVM size score + AVM site score + AVM drainage score
3.Major auxiliary tests before surgery
1) Blood routine, blood type, coagulation items.
2) Complete set of blood biochemistry, heart, lung, liver and kidney function, hepatitis B, hepatitis C antibody.
3)CT and MR and MRA
4)Whole brain angiography
Treatment principles
1. Pre-surgical treatment
1)General treatment: avoid excessive exertion and emotional excitement, keep the bowels unobstructed.
2)Control epilepsy.
3) Prevent rupture and bleeding of arteriovenous malformation.
4) Explain the condition and possible dangers to the family, the suitable treatment methods for the disease, the risks of surgical treatment, the possible conditions during surgery, the possible complications and sequelae after surgery, and the impact on the patient’s life and work.
2. Indications for surgery
1)Unilateral cerebral hemisphere vascular malformation
2)Vascular malformation with recurrent bleeding
3)Intractable epilepsy or intractable headache
4)Posterior cranial recess vascular malformation
5)Vascular malformation with incomplete occlusion after embolization
6) Progressive development of limited neurological dysfunction
7) No obvious contraindication to surgery
3.Treatment methods
1) Surgical resection
2) Interventional treatment
3) Stereotactic radiotherapy (r-knife, x-knife)
4) Combination therapy
4. For giant cerebrovascular malformation, attention should be paid to blood pressure control after surgery to prevent the occurrence of normal perfusion pressure breakthrough syndrome (NPPB).
5.The cerebral angiography should be reviewed 5-7 days after surgery to understand the results of malformation vascular treatment.
6.Discharge management: generally review as an outpatient after 3 months of rest, and visit the clinic whenever necessary.
7.Anti-epileptic drugs
1) Patients without seizures before surgery should still take antiepileptic drugs prophylactically for 3-6 months after surgery, and then gradually reduce the dosage to discontinue the drugs within 3-4 months.
2) Patients who had seizures before surgery, or who developed seizures after surgery, should take the medication for at least 6-12 months after surgery, and then gradually reduce the dosage to discontinue the medication within 3-4 months if there are no seizures, and monitor the blood concentration to guide the medication if necessary.
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