脑动静脉畸形血管内治疗并发症探讨

Aspect of the complications for endovascular therapy of the brain arteriovenous malformation

目的 通过对３２７ 例脑动静脉畸形血管内治疗的分析， 探索导致各种并发症的相关因素， 以避免或减少血管内治疗并发症的发生。方法 对６０８ 例次采用不同栓塞材料进行血管内栓塞治疗产生不同并发症的分析， 其中胶栓塞后出血４ 例、水肿１５ 例、误栓４ 例、血管痉挛３ 例， 线段栓塞出血２ 例、水肿１２ 例、误栓２ 例、血管痉挛１９ 例， 探讨栓塞治疗中出现不同并发症的因素。探索避免或减少并发症的有效措施。结果 脑动静脉畸形血管内治疗并发症不仅与栓塞技术有关， 更与选用不适当的栓塞材料和栓塞材料的用量有明显关系， 其中线段多导致术中、术后血管痉挛； 多聚体类（ＩＢＣＡ、ＮＢＣＡ） 使用难度较大， 多引起脑水肿及脑出血并发症。结论 要提高脑动静脉畸形栓塞治疗的治愈率， 减少并发症， 除了有熟练的操作技术外还应根据病变的具体情况， 选择合适的栓塞材料、及其用量， 必要时与γ刀、Ｘ刀联合治疗。

Objective The relative factors with series of complications in 327 cases of cerebral AVM treated by endovascular embolizaltion were analyzed. In order to avoid or reduce the incidence of complications. Methods The complications of the 608 times endovascular embolization were including: hemorrhage in 4 cases, brain edemas in 15 cases, mistaken embolizations in 4 cases, vasospasms in 3 cases, for embolization with glues; And hemorrhage in 2 cases, brain edemas in 12 cases, mistaken embolization in 2 cases, vasospasms in 19 cases for embolization with silk segment. Results The cause of the complications not only by embolization technique, but also by mischosen volume of embolization material. The silk segment often lead to vasospasms while glues (IBCA, NBCA) often caused brain edema and hemorrhage. Conclusion To decrease the complications the embolization should be technically skilled and suitale embolizing material must be selected. In some cases, combine use of γ knife or X knife are needed.