非黏附性液体栓塞剂治疗脑动静脉畸形

Treatment of cerebral arteriovenous malformations with Onyx

目的 探讨新型液态栓塞剂Onyx栓塞脑动静脉畸形的技术要点和临床效果。 方法 对21例脑动静脉畸形患者采用Seldinger技术在股动脉内置入6 F鞘,6 F导引导管进入颈内动脉或椎动脉,以Ultraflow微导管超选择进入畸形团内,采用"阻断和前推技术"长时间缓慢注射Onyx栓塞脑动静脉畸形。本组患者中有13例动静脉畸形位于功能区(运动区、语言区、视觉中枢),6例位于大脑半球深部,2例位于小脑半球。畸形团大小为3 cm的9例,3-6 em的8例,6 cm以上的4例。 结果 治疗后脑动静脉畸形的体积缩小程度为20％-100％。初期因使用Onyx经验不足,在拔出微导管时有2例患者发生严重脑出血,行外科手术救治,其余19例患者无严重并发症。 结论 Onyx栓塞技术可作为治疗体积较大、位于大脑深部及功能区脑动静脉畸形的重要方法之一,长期疗效有待随访结果的验证。

Objective To discuss the techniques and efficacy of embolization in treating cerebral arteriovenous malformations (AVMs) using a new liquid embolic agent (Onyx) . Methods 6 F sheath was inserted into femoral artery, then 6 F guiding catheter was introduced into the internal carotid artery or vertebral artery, Ultraflow microcatheter was navigated into the nidus of AVMs, Onyx-18 was injected into the nidus of cerebral AVM slowly using the 'plug and push technique' . 13 cases of cerebral AVMs were located in functional area, 6 cases in deep cerebral area, and 2 cases in cerebellar hemisphere. The diameter of AVMs was about 3cm in 9 cases, 3 - 6cm in 8 cases, and larger than 6cm in 4 cases. Results 20% -100% embolization was achieved in all cases, 40% in early stage of treatment, and nearly 80% at present. In the initial stage, there was severe cerebral bleeding induced by microcatheter withdrew in 2 cases because of the lack of enough experience. and underwent surgical treatment. However, the other 19 AVM cases with Onyx embolization were treated successfully without severe complications. Conclusion Onyx has unique and distinctive superiority in treating cerebral AVMs with large size and located in deep or functional areas. However, the long-term efficacy of Onyx embolization needs to be followed up.