血管内栓塞与伽玛刀结合治疗86例脑动静脉畸形的临床分析

Endovascular embolization combined with Gamma Knife in the treatment of cerebral arteriovenous malformations

目的评价血管内栓塞结合伽玛刀治疗对脑动静脉畸形的治疗作用。方法选择泸州医学院附属医院神经外科从2001年9月至2010年12月86例经数字减影血管造影(digital subtraction angiography,DSA)确诊为脑动静脉畸形的患者,并选择了血管内介入栓塞治疗,其中72例随后又进行了伽玛刀治疗。术后疗效利用DSA/CTA/MRI进行影像学评价。结果 68例获得随访(79.1%),随访时间1～6年,平均2.5年。临床症状康复52例,轻残5例,重残1例,癫痫发作8例,再出血2例,无死亡病例。获得DSA/CTA/MRI影像随访65例(75.6%),其中畸形血管完全消失37例(56.9%),大部分消失20例(30.8%),部分消失8例(12.3%)。结论血管内栓塞结合伽玛刀对脑动静脉畸形的治疗具有疗效较好、并发症少、创伤小、安全性高和可重复性等优点。伽玛刀还可以作为手术切除的前期治疗。

Objective To evaluate the therapeutic effect of endovascular embolization combined with Gamma Knife in the treatment of cerebral arteriovenous malformations（AVMs）.Methods Clinical data of 86 patients suffering from cerebral AVMs confirmed by digital subtraction angiography（DSA） in the neurosurgery department,Affiliated Hospital of Luzhou Medical College from September 2001 to December 2010 were analyzed retrospectively.All the patients were treated with endovascular embolization,after which 72 patients were treated with Gamma Knife.The postoperative therapeutic effects were evaluated by DSA,computed tomography angiography（CTA） and MRI.Results The follow-up was achieved in 68 patients（79.1%） for 1-6 years（average 2.5 years）,with apparent symptom relief in 52 patients,mild disability in 5 patients,severe disability in 1 patient,seizure episodes in 8 patients,recurrent hemorrhage in 2 patients,and no death.The follow-up of DSA,CTA and MRI in 65 patients（75.6%） showed complete AVM disappearance in 37 patients（56.9%）,most AVM disappearance in 20 patients（30.8%） and part AVM disappearance in 8 patients（12.3%）.Conclusion Endovascular embolization combined with Gamma Knife,which is minimally invasive and repeatable,is a safe and effective therapy in treatment of cerebral AVMs,and Gamma Knife can also be applied as an early therapy before the operation.