脑动静脉畸形癫痫的相关血管构筑学及栓塞治疗研究

Epilepsy induced by cerebral arteriovenous malformations:angioarchitectural characteristics and embolization treatment

目的:探讨DSA的超选择造影显示的脑动静脉畸形(AVM)相关血管构筑学(AVM的大小、位置、供血动脉)以及血管内栓塞治疗与癫痫发作的关系,以期预测脑动静脉畸形癫痫发作的危险性及栓塞治疗癫痫的有效性。方法:通过DSA超选择造影显示95例脑动静脉畸形的血管构筑学特点;所有脑AVM应用NBCA或ONYX栓塞治疗;统计学分析采用χ2检验。结果:脑动静脉畸形癫痫发作与AVM的大小、位置有统计学意义(P均<0.01),与供血动脉支数无统计学意义(P>0.05);本组95例患者中43例有癫痫发作,占45%,术后20例症状消失,11例明显减轻,有效率72.1%。结论:AVM越大、位置越近皮层越易发生癫痫,供血动脉支数的多少与癫痫的发作无关;血管内栓塞AVM治疗由其产生的癫痫效果较好。

Objective： To explore the size, location and feeding artery of arteriovenous malformations（AVM ） by DSA and the response of embolization of AVM for epilepsy. Methods： DSA was performed in 95 patients with cerebral AVM and endovascular treatment with NBCA or ONYX was performed in all; chi-square test was used to analyze the resuits. Results： There was a significant association between the seizure induced by cerebral AVM and the size and the location of AVM （all P 〈 0.01）, but no significant association between the number of feeding artery and the seizure （ P 〉 0. 05 ） ; of the 43 patients （43/95,45 % ） were found seizures, 20 had their symptoms disappeared after embolization, 11 had their symptoms relieved; the response rote was 72.1%. Conclusion： The bigger the AVM is and the more close the AVM is to the brain cortex, the more the patient are inclined to tempt seizure. The number of feeding artery has no relation with the epilepsy; and epilepsy has been greatly improved through endovascuiar embolization treatment for epileptogenic AVMs.