联勤保障部队第九八〇医院神经外科 翻译小组出品
So an AVM is an abnormal tangle vessels 脑动静脉畸形（AVM）是一种异常的血管畸形团，
where arteries connect through a tangle 供血动脉直接通过脆弱的
of weakened vessels to a vein.Normally, 畸形血管团与引流静脉相连。通常情况下，
arteries divide into ever smaller 动脉逐渐分支为越来越小的血管，
vessels until you get to the capillary 直至分支为微动脉到达非常纤细的
level where the vessels are very tiny 毛细血管水平，
and at that level capillaries can unload 在此水平毛细血管释放运输的
oxygen and nutrients and pick up co2, and 氧气和营养物质并回收组织细胞中二氧化碳，
then from there the blood is collected 然后血液通过微静脉
by small veins that go into ever larger 逐级回流，汇入越来越大的静脉，
veins, and then go back to the heart. 最终回流至心脏。
With an AVM however, the arteries connect to a 然而在AVM中，供血动脉直接与
tangle of weakened arteries and that 脆弱的畸形动脉相连接，
flow goes right into a vein. So as a 血流直接进入静脉，因此
result the veins see arterial pressure 静脉直接遭受动脉血液压力的冲击，
Normally venous pressure is much lower 通常情况下静脉压比动脉压
than arterial pressure.When an AVM, the 低得多。在AVM中，
veins are at under high pressure, and 静脉处于高压状态，
veins don't like high pressure, so that 而静脉不能耐受高压，
tends to lead to inflammation, and 从而容易导致血管炎性改变，
sometimes aneurysms can form, and those 甚至有时会形成动脉瘤，而这些
aneurysms can lead to rupture. And when 动脉瘤可能会破裂。而当
an AVM bleeds, that can be occasionally AVM出血时，后果有时可能是
catastrophic or lead to neurological injury. 灾难性的或导致神经功能损伤。
It would be the equivalent of a 这就相当于一根立柱
column that's designed to hold up a 本来被设计用以支撑一个
cardboard roof, putting a cement roof on 纸板屋顶，而此时在立柱上面放
that, on that column will result in the 一个水泥屋顶就会导致
column collapsing. 立柱崩塌。
So one of the challenges with 而了解AVM及其
understanding AVMs and their treatment 治疗方案所面临的
options is the fact that they are very 挑战之一是AVM具有
complicated three-dimensional structures. 非常复杂的三维结构。
That we often see 2d images and we try 如果我们经常看到的是2D图像，那么我们
to you look at 2d images to understand a 就会尝试通过2D图像以理解
three-dimensional problem.So we've been 三维构造。所以我们
using 3D printing and holography to try 一直在使用3D打印和全息技术
to get a better understanding of AVM. 来更好地了解AVM。
One for the benefit of the treating team is 这样做的优势是治疗团队
that we can better think through what we 能更好地思考我们
may or may not be able to do for the patient. 能为患者做什么或不能做什么。
But the second is to also 另外也可以方便告知患者，
educate the patient regarding their problem. 让他们了解自己的病情。
So this is a 3d print of an AVM. 这是AVM的3D打印模型。
Here you can see some normal vessels, and 这里你可以看到一些正常的血管
we can see here is what I would call the 另外这里我们看到的就是我所称谓的
bowl of spaghetti.These are fragile 意大利面碗。它们是脆弱的
vessels that can pop easily.They're not 血管团，极易破裂。它们不习惯
used to or they're not designed to carry 或其构造并不适合承受
high pressure, so they can break and 高压，所以它们会崩溃或
rupture and that can cause brain bleeding. 破裂导致脑出血。
So as we look at this model, we 因此，当我们观察模型时，我们
can start to rotate it and think about 可以旋转它，并思考
what vessels are coming into it. 有哪些血管进入畸形血管团。
That's what we call feeding arteries. Abnormal 也就是我们所说的供血动脉。
vessels that come into this tangle, the 异常血管进入相互缠绕成团
spaghetti bowl so to speak.And what you 也就是我们所说的意大利面碗。你们在
don't see on this model clearly is that 这个模型上看不清楚的是
there's usually a vein coming out. 这里通常有一根引流静脉回流。
And when we go in with surgery, we usually, 当我们进行手术时，通常我们的
our goal is to separate this mass from 目标是将畸形血管团与
the surrounding brain tissue safely 周围的脑组织安全分离
while preserving the normal arteries and 保留正常动脉的同时并将
removing it from the patient.That may or 血管团从患者脑内切除。这种术式
may not be safe depending on the 是否安全取决于
specific anatomy of that patient. 患者动静脉畸形的解剖差异。
Additionally, an AVM of this size for 另外，像模型这种体积的AVM
example, it may be very beneficial to 在术前将一些液体栓塞胶
inject some glue into the AVM before 注入AVM可能会获益颇多，
surgery to make the surgery safer. 这样可以使手术切除更为安全。
So what we would do is under fluoroscopy, we 所以我们要做的是在X线透视下，我们
would navigate a very tiny catheter, and 将驾驭一根非常小的导管，
let's say this artery, and get into an 假设是这个动脉，将微导管置入该
artery where it would be safe to inject 动脉，通过该动脉安全地将
glue into the AVM.We would watch glue 栓塞胶注入AVM。我们将看到
percolate into the AVM, plugging up these 栓塞胶通过动脉渗入AVM，封堵
no abnormal small arteries, and that may 发育正常的小动脉，这可能
make the surgical plan, and execute the 使手术计划，实施
surgical option much much easier to implement. 手术方案更加容易。
Just like snowflakes, are no 就像雪花一样，没有
two AVM that are the same.Every AVM is 任何两个AVM是相同的。每一个AVM
different besides how close it look 都是不同的，无论它们看来有多相像，
And our treatment plans also have to be 我们的治疗方案也必须是
unique and uniquely designed to match 个体化的，唯有个体化的设计才能
the needs of the patient.So the 满足患者的需求。因此，
treatment options for AVM include microsurgery AVM的治疗选择包括显微外科手术，
that's where we through a cranial 在该手术中，我们通过打开
a cranial opening, in using the operating microscope. 颅骨暴露术野，在手术显微镜下进行操作。
we can look at the anatomy of 我们可以观察AVM的
the AVM and disconnect the abnormal 解剖结构，将异常的动脉从
arteries from the surrounding 周围循环中
circulation 切断，
and remove the AVM.The second treatment 切除AVM。第二种治疗
option is embolization, where a catheter 选择是介入栓塞，将一根
the size of an angel hair pasta can be 意大利通心粉大小的微导管置入
placed into the AVM, and glue can be AVM中，注入栓塞胶
injected to occlude those abnormal 堵塞那些异常的
vessels to make them put to plug them up. 血管，使AVM闭塞。
That can be done in some cases to 在一些病例中介入栓塞可以
completely cure an AVM, typically for 完全治愈AVM，主要是
smaller AVM that have one or two feeders. 只有一根或两根供血动脉的小AVM。
The other treatment option for an AVM is AVM的另一种治疗选择是
radiosurgery.Or we use radiation to 放射外科治疗。亦即我们使用射线
shrink an AVM, that treatment has the 来缩小AVM，这种治疗方式
advantage of being minimally invasive 本质上具有创伤小的
essentially, and it's an outpatient procedure. 优势，而且在门诊就可以完成。
But it does take several years 但这种治疗需要几年的时间才能
to work.So patients can continue to have 起效。因此，患者在此期间
risk of bleeding during that period. 仍然存在出血的风险。
But for AVMs that cannot be removed 但是对于无法手术切除
surgically, for AVMs that are in 的AVM，解剖位置
locations that are undesirable for a 不适合手术的
surgical standpoint, or in patients who AVM，或由于
cannot tolerate surgery either due to 年龄或其他合并症而无法
age or other comorbidities, 耐受手术的患者，
radiosurgery may be a good option. 放射治疗可能是一个好的治疗选择。
Another option for larger AVM is to do, 对于较大的AVM，另一种治疗
is to use staged radiosurgery.Where we 方式是分阶段放射治疗。我们
treat the AVM in different pieces.So if 将AVM分为不同的部分进行治疗。如果
an AVM is too big for a single shot of AVM的体积太大，无法一次进行
Radiation, we can potentially break it up 放射治疗，我们可以将它
into two or three pieces and do it over 分为两到三部分，
the course of three to six months. 在三到六个月的时间内完成。
Andfinally, of course though there is an 最后，对于一些特定的AVM
innovative option for some AVMs, and 有一个新兴的治疗选择，
that's proton beam therapy. And proton 那就是质子束治疗，
beam therapy has been used successfully 质子束治疗已经成功地用于
treat certain AVMs. 治疗某些特定的AVM。
But again the treatment does take time, 但是同样，这种治疗也需要时间，
and not all AVMs can be occluded with 而且并不是所有的AVM都能被这种
this technique.So each of these 方式所闭塞。因此，每种
techniques has pros and cons. 治疗方式各有利弊。
It'simportant for every patient who would 对于每一个想要获得治疗
like to treat their AVM, to really 的AVM患者来说，真正
carefully get educated about all those 仔细地了解所有这些
treatment options and how they can 治疗方式以及它们潜在的协同作用
potentially work together.Patients with 至关重要。AVM患者
AVM should have hope, and AVMs can be 应该抱有希望，AVM可能
scary, but with modern treatments, there 令人恐惧，但在现代治疗方式下，
has never been a better time in the 这也是历史上迄今为止最好的
history AVM treatments for patients AVM治疗方式，AVM患者
with AVMs. 应该保持希望。
译者：齐洪武