体感诱发电位监护下脑动静脉畸形的栓塞治疗

The embolizational treatment of arteriovenous malformation monitored by somatosensory evoked potential

目的:评价在短潜伏期体感诱发电位(SSEP)监护下脑动静脉畸形(AVM)的血管内栓塞治疗(EVET)的效果。方法:回顾性分析我院收治进行EVET的31例患者的资料,其中男17例,女14例,年龄9～67岁,平均37.6岁。结果:①影像学结果:31例AVM病例中,17例(55%)行一期EVET,畸形血管团完全消失;3例行二期栓塞治疗有2例(7%)畸形血管团完全消失;2例行三期栓塞治疗,畸形血管团完全消失;9例行一期EVET时出现SEEP的明显变化,未作进一步的EVET。以最后一期栓塞后的数字减影式血管造影(DSA)资料进行栓塞程度统计:畸形血管团完全消失(100%栓塞)19例,占61%;70%～99%的栓塞7例,占23%;30%～69%的栓塞4例,占13%;≤29%的栓塞1例,占3%;②SSEP结果:术中N20波潜伏期及波幅无变化17例,5例SSEP有变化者治疗好转后作了二、三期EVET。8例出现中枢传导并N20波幅的降低,1例出现N20波消失,此9例未作进一步的EVET;③并发症:共4例,其中2例术中出现血管痉挛,1例术后出现偏瘫等神经功能损害,1例术后出现正常灌注压突破并死亡;④随访结果:良好28例,占90%;中度残废2例,占7%;无重度残废和植物生存者;死亡1例,占3%。此外12例合并有癫者中9例发作停止,3例偶有发作。结论:在AVM的EVET术中SSEP的应用,能减少并发症,改善患者预后。

Objective:To evaluate the efficiency of the endovascular embolizational treatment(EVET)efficacy for cerebral arteriovenous malformation(AVM)monitored by short latency somatosensory evoked potential(SSEP).Methods:Thirty-one patients with AVM,male 17,femail 14,aged from 9 to 67,mean age 37.6,were operated in our hospital through the EVET.Retrospective analysis was perfomed.Results:①EVET:Of 31 patients,17(55%)were treated by EVET at the early stage of AVM,and AVM of all patients disappeared completely;In 3(10%...