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Brain and Nerve No to Shinkei Volume 42, Issue 4 （April 1990）

Brain and Nerve 脳と神経 42巻4号（1990年4月発行）

Japanese English

原著

脳動静脈奇形の手術例，非手術例の比較—長期予後の面からの検討 LONG-TERM RESULTS OF CEREBRAL ARTERIOVENOUS MALFORMATIONS : SURGICAL AND CONSERVATIVE TREATMENT 安藤隆 ¹ , 坂井昇 ¹ , 山田弘 ¹ , 出口一樹 ¹ , 平田俊文 ¹ , 近藤博昭 ² , 田辺祐介 ³ , 船越孝 ⁴ , 高田光昭 ⁵ , 大熊晟夫 ⁶ Takashi Andoh ¹ , Noboru Sakai ¹ , Hiromu Yamada ¹ , Kazuki Deguchi ¹ , Toshifumi Hirata ¹ , Hiroaki Kondoh ² , Yuhsuke Tanabe ³ , Takashi Funakoshi ⁴ , Mitsuaki Takada ⁵ , Akio Ohkuma ⁶ ¹岐阜大学医学部脳神経外科 ²羽島市民病院 ³岐阜市民病院 ⁴総合大雄会病院 ⁵高山赤十字病院 ⁶県立岐阜病院 ¹Department of Neurosurgery, Gifu University, School of Medicine ²Hashima City Hospital ³Gifu City Hospital ⁴Dalyuhkai general Hospital ⁵Takayanta Red Cross Hospital ⁶Gifu Prefectural Hospital キーワード： arteriovenous malformation , conservative treatment , surgery , prognosis Keyword: arteriovenous malformation , conservative treatment , surgery , prognosis pp.367-376

発行日 1990年4月1日 Published Date 1990/4/1

DOI https://doi.org/10.11477/mf.1406900045

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Abstract 文献概要
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　脳動静脈奇形（AVM）を手術例（134例），非手術例（53例）に分け，その成績を比較しさらに，AVMの自然経過，長期予後について検討した。手術例の退院時のmortalityは7.5％，morbidityは12.7％であった。一方，保存療法例のmortalityは12.2％，morbidity10.2％でmortalityの原因のほとんどはgrade不良で手術不能例であった。長期予後は手術例では神経症候の不変99例（80％），改善16例（13％），悪化3例（2％）で保存療法では神経症候の不変32例（68％），改善5例（11％），悪化6例（13％），出血8例（17％）で出血例の半数が致命的出血であった。追跡期間中のAVMの大きさの変化は不変がほとんどであったが，手術例では不完全摘出の2例に増大，3例に縮小がみられた。一方，保存療法例では増大はなく，2例に縮小をみたのみであった。経過中，AVMの流入動脈上に新たに動脈瘤の発生が2例みられ手術困難例を経過観察する場合には追跡血管撮影が大切である。

During the past 20 years, we have treated 187 cases with cerebral arteriovenous malformations (AVMs). These 134 patients were treated surgi-cally and the remaining 53 patients were managed non-surgically. The purpose of this study is to clarify the surgical indications of AVMs. based on a comparison of the long-term follow-up results between the surgical and nonsurgical groups. Con-sequently, good results were obtained in the sur-gical group : the operative mortality was 7. 5% and the morbidity was 12.-7%. The long-term fol-low-up results were as follows : Of the 124 fol-lowed cases in the surgical group, there were 16 cases with improvement of neurological deficits (13%) and 3 cases with neurological aggravation(2%). Of the 47 followed cases in the nonsurgical group, there were 5 cases with improvement of neurological deficits (11%) and 6 cases with neu-rological aggravation (13%). As for the incidence of AVM hemorrhage. there were 8 cases with hemorrhage in the nonsurgical group including 4 cases (3 rebleeding cases) which were fatal (11%), in contrast to one case (subtotal resection) in the surgical group. On follow-up angiography, the size of AVMs were unchanged in the majority of cases in the nonsurgical group, with the exception of 2 cases in which there were slight regressions. In the surgical group, on the other hand, enlargement in 2 cases and spontaneous regression in 3 of re-sidual AVM occurred following incomplete resec-tion. Particularly in 2 cases involving unresec-table AVMs, a newly formed aneurysm was dis-covered in the follow-up angiography, emphasizing the fact that serious follow-up angiography is re-quired in cases of untreated AVMs.