脑动静脉畸形合并动脉瘤的血管内治疗

Endovascular treatment of cerebral arteriovenous malformation (AVM) combined with related aneurysms

目的 回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法 分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论 从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。

Objective We summarize the experience on endovascular treatment of cerebral arteriovenous malformation combined with aneurysms to investigate its strategy and approaches. Methods Fifty-one cases with cerebral arteriovenous malformation combined with aneurysms were treated from Jan 1996 to Dec 2003. The therapeutic strategy was planed according to the site of aneurysms on angiography and clinical manifestation. We often treated the aneurysms firstly with endovascular approach under general anesthesia. Results Four ruptured aneurysm located at Willis circle were treated before embolization of AVM and 2 remained untreated and were followed-up. Among 16 aneurysms in feeding arteries, 11 were occluded with microcoils, 4 with NBCA and one with Onyx. Twenty-eight intranidal aneurysms were treated with NBCA glue and one with Onyx. Follow-up angiogram in 22 cases showed stable results. Conclusions The results suggested that aneurysms associated with brain AVM should be primary targets of endovascular treatment.