脑动静脉畸形--大学总结.ppt

Treatment Options Surgical Resection Endovascular Embolisation Stereotatic Radiosurgery Multimodal Therapy Treatment Options Surgical Resection Endovascular Embolisation Stereotatic Radiosurgery Multimodal Therapy Conservative Management Normal Perfusion Pressure Breakthrough Theory R.F. Spetzler et al CEREBRAL ARTERIOVENOUS MALFORMATIONS AVM: a TLA for the CNS Incidence 0.52% at autopsy Slight male preponderance (1.09 to 1.94) Congenital lesions (although rarely familial) Embryology First half of third week of gestation epiblastic cells migrate to form mesoderm mesodermal cells differentiate to arterial and venous vessels on the surface of the embryonic nervous system Embryology First half of third week of gestation epiblastic cells migrate to form mesoderm mesodermal cells differentaite to arterial and venous vessels on the surface of the embryonic nervous system Seventh gestational week vessels sprout branches penetrate developing brain reach the gray-white interface, either loop back to pial surface or traverse entire neural tube, thus epicerebral transcerebral circn eventually connect arterial and venous systems by around the twelfth week Pathology Pathophysiology absence of normal capillary system Pathology Pathophysiology absence of normal capillary system usual function displaced Pathology Pathophysiology absence of normal capillary system usual function displaced asymptomatic at birth Pathology Pathophysiology absence of normal capillary system usual function displaced asymptomatic at birth vessels change with time may develop aneurysms parenchymal changes within and around the lesion Pathology Pathophysiology absence of normal capillary system usual function displaced asymptomatic at birth vessels change with time may develop aneurysms parenchymal changes within and around the lesion site frequency is proportional to brain volume Pathology Pathophysiology absence of normal capillary system usual function displaced asymptomatic at birth vessels cha