脑血管畸形出血后的治疗时机及方法选择

Early Diagnosis and Treatment of Posthemmorrhagic of Vascular Malformation in Brain

目的探讨脑血管畸形出血后的治疗时机及方法的选择。方法56例脑动-静脉畸形患者均采用经股动脉插管行选择性全脑血管造影。出血量大者先开颅手术、血肿清除或去骨瓣减压、颅内动静脉畸形(AVM)切除,然后全脑血管造影,利用Magic微导管及NBCA胶行介入栓塞治疗。结果22例患者7d内仅用NBCA栓塞治愈,且未留下任何后遗症,26例经血肿清除术后30d栓塞治愈,其中8例在血肿清除术中部分切除AVM后7d再栓塞治愈,8例手术全切AVM;14例患者遗留不同程度的偏瘫、失语、智力下降。所有患者随访6个月均无复发。结论早期确诊AVM的关键是尽早行全脑血管造影,NBCA栓塞是治疗AVM理想、安全、可靠的方法,早期治疗能明显减少后遗症。

Objective To investigate the method of earlier diagnosis,treated juncture and treatment of the posthemor- rhagic cerebrovascular malformation.Methods All the patients were treated with digital subtraction angiography (DSA) for en- dovascular assessment.If the hemorrhage was very large,the patient would be first treated by skull disclosure operation to get rid of hematoma,then given DSA and if permission given Magic microcarbeter which made in France or embolization with NBCA or ONYX.Results Twenty-two patients were cured by NBCA embolization without any lingering effects;26 cases who were giv- en embolization in 30d after operation were cured,in which 8 cases were cured embolized in 7d after removal of hematoma and partly vascular malformation excision,and 14 cases who were cured later remained some degree of hemiplegia,aphasia and intel- ligence descent.All the cases were followed up more than 6 months and nobody recurred.Conclusion Taking DSA early is im- portant in order to diagnose cerebrovascular malformation early.NBCA or ONYX embolization is a good and safe therapy to vascu- lar malformation.