脑动静脉畸形血管构筑学因素与癫的关系及其栓塞治疗效果的研究

Study on relationship between angioarchitectural factors of cerebral arteriovenous malformations and epilepsy and the effect of embolization treatment

目的探讨脑动静脉畸形(AVM)相关血管构筑学因素(AVM的大小、位置、供血动脉)与癫发作的关系以及血管内栓塞治疗的效果。方法采用数字减影血管造影(DSA)对95例脑AVM患者进行全脑血管造影,比较不同AVM大小、位置及供血动脉支数患者的癫疒间发生率。观察血管内注射NBCA或ONYX胶进行AVM栓塞的临床疗效。结果脑AVM3～6cm、>6cm患者的癫疒间发生率(52.5%、57.1%)明显高于<3cm的患者(0)(均P<0.01);AVM位于大脑皮质患者的癫疒间发生率显著高于位于基底节、后颅窝的患者(均P<0.01);不同供血动脉支数患者的癫发生率差异无显著性(均P>0.05);本组43例有癫疒间发作患者,AVM栓塞术后20例症状消失,11例明显改善,总有效率72.1%。结论脑AVM的大小及位置与癫疒间有密切关系,供血动脉的支数与癫疒间发作无关;血管内栓塞治疗AVM的效果较好。

Objective To explore the relationship between angioarchitectures of cerebral arteriovenous malformations（AVM） （the size, location and feeding artery of AVM）and epilepsy and the effect of endovascular embolization treatment. Methods 95 patients had underwent aortocranial angiography by digital subtraction angiography. Seizure ratios were compared in the patients with different size,location and number of feeding artery of AVM. The AVMs were occluded with NBCA or ONYX. Results Seizure ratios of the patients with 3 - 6 cm AVMs （52. 5% ）, 〉 6 cm AVMs （57. 1% ） were much higher than that with 〈 3 cm AVMs （0） （ all P 〈 0. 01 ）. Seizure ratio of the patients with the AVMs located at brain cortex was much higher than those with the AVMs located at basal ganglia or posterior cranial fossa（ all P 〈 0. 01 ） , but there was no significant difference in seizure ratio between the different number of feeding artery （ all P 〉 0.05 ）. Seizure was found in forty-three patients. After embolization the seizure in 20 patients disappeared, 11 patients had been improved greatly. The total effective power was 72. 1%. Conclusions The size and location of AVM is significantly associated with the onset of seizure. The number of feeding artery has no relation with the seizure. Endovascular embolization for the AVMs has got better cure effect.