脑动静脉畸形(AVMs)的NBCA栓塞治疗

Embolization Treatment with NBCA of BrainArtero-Venous Malformations(AVMs)

目的 ;评价NBCA栓塞治疗脑AVMs的临床效果。材料和方法 :36例脑AVMs患者(临床表现为脑出血14例 ,癫16例 ,其他6例) ,均经完整的血管造影检查、畸形血管的血管构筑学研究和Spetzler分级 ,在供血动脉选择性血管造影后注入NBCA ,术后即刻行血管造影 ,半年后行MRI检查 ,以评估栓塞的近、远期效果。结果 :术后即刻血管造影显示闭塞范围大于90 %为11例(30.5 %) ,70 %～90 %为8例(22.2 %) ,50 %～69 %为10例(27.8 %) ,小于50 %为7例(19.4 %)。在9例患者 ,术后6个月随访MRI检查显示栓塞区无再通。36例中 ,术后有较严重并发症3例 ,1例为脑干旁AVM ,术后存在永久性轻度共济失调 ;1例为颞巨大AVM ,术中并发蛛网膜下腔出血 ,保守治疗2星期后康复 ;另1例为颞深AVM ,栓塞后出现短暂的神经功能缺失。结论 :脑AVMs血管构筑学研究在NBCA栓塞术中是必需的 ,在单支终末供养动脉的脑AVMs ,NBCA栓塞可获完全治愈。

Purpose: To evaluate the clinical efficacy of embolization with NBCA(n-butyl cyanoacrylate)in brain AVMs. Meterials and Methods: A four-vessels angiography was performed for 36 patients with AVMs clinical presentation with hemorrhage in 14 cases,seizure in 16 cases,and other in 6 cases and the angioarchitecture was analyzed before embolization. The grading of AVM was based on Spetzlar's standard. Superselective feedearthem-angiography was performed and NBCA was then injected. Postembolization angiography was performed immediately and MR imaging was performed 6 months and 1 year after procedure. Results:11 cases(30.5%) were completely cured with embolization alone; 70%～90% reduction of the size of nidus in 8 cases(22.2%); 50%～69% reduction of the size of nidus in 10 cases(27.8%) and less than 50% reduction of the size of nidus in 7 cases(19.4%). Follow-up MR imaging showed norecanalization of embolized area in 9 cases 6 months after embolization. The complication related to endovascular therapy occurred in 3 cases. One case with para-brainstem AVM had a permanent mild ataxia, one case with a large AVM in temporal lobe had a subarachnoid space hemorrhage which recovered two weeks later, and another case with a temporal-deep AVM had a trasient neurologic dificit. Conclusion: Angioarchitecture study is essential in the embothrotherapy with NBCA for AVMs. A complete cure may be obtained with NBCA embolization alone for brain AVMs with a single terminal supply artery.