Onyx胶栓塞治疗脑动静脉畸形的临床应用

Clinical application in the embolization of cerebral arteriovenous malformation with onyx

目的总结新型液态栓塞剂Onyx栓塞脑动静脉畸形21例的技术要点和临床疗效。方法Onyx栓塞脑动静脉畸形21例,均采用Seldinger技术在股动脉内置入6F鞘,6F导引导管进入颈内动脉或椎动脉,Ultraflow、Marathon或Rebar微导管超选择进入畸形血管团内,采用"注胶-返流-停止-再注胶"技术长时间缓慢注射Onyx栓塞脑动静脉畸形。结果栓塞前后脑动静脉畸形闭塞30%～50%7例,50%～80%8例,80%以上6例。10例患者术后辅以伽玛刀治疗,其中2例一年以后复查DSA显示AVM完全闭塞。结论Onyx可提高脑动静脉畸形的栓塞效果,但应正确采用栓塞技术和注意预防并发症,长期疗效需要进一步随访。

Objective To summarize the embolization techniques and efficacy of cerebral arteriovenous malformation （CAVM） with a new liquid embolic agent （Onyx）. Methods 6F sheath was inserted into femoral artery followed by 6F guiding catheter introduced into the internal carotid artery or vertebral artery, Ultraflow or Marathon micro-catheter could be navigated into the nidus of AVMs, then the Onyx was injected slowly into the cerebral AVM with the＂inject-back flow-stop-reinject＂ technique. Results 30% -50% embolization were achieved in 7 cases, 50% -80% in 8 cases, more than 80% in 6 cases, 10 cases were treated by ＂γ-knife after embolization. 2 cases showed complete occlusion after radiosurgery. Conclusions Onyx has unique and distinctive superiority in treating cerebral AVMs. However, the embolization techniques should be well trained to get good results and avoid complications. The long-term efficacy of Onyx embolization needs to be followed up.