Onyx胶治愈性栓塞脑动静脉畸形的临床研究

Curative embolization with Onyx for brain arteriovenous malformations: a clinical study

目的介绍Onyx胶治愈性栓塞脑动静脉畸形的经验。方法 2008年8月至2012年8月收治40例脑动静脉畸形患者,临床表现为颅内出血18例,癫痫发作8例,头痛7例,神经功能障碍5例和偶尔发现2例。根据S-M分级,Ⅰ级10例,Ⅱ级15例,Ⅲ级9例,Ⅳ级4例,Ⅴ级2例。对所有患者均采用Onyx胶液体栓塞剂进行栓塞治疗,并进行随访。结果栓塞后造影显示22例达到完全栓塞,10例80%～90%栓塞,5例60%～70%栓塞,3例50%左右栓塞。未能完全栓塞的18例中2例接受立体定向放射治疗痊愈。11例发生并发症,导致1例永久性神经功能障碍,无死亡病例。6个月后血管造影随访,22例患者完全栓塞。结论血管内栓塞治疗脑动静脉畸形安全性好,损伤小,Onyx胶适合作为脑动静脉畸形的栓塞材料,并能达到较高治愈率。

Objective To summarize the experience of using Onyx in the curative embolization for the endovascular treatment of brain arteriovenous malformations （BAVMs）. Methods Between August 2008 and August 2012, a total of 40 patients with BAVMs were admitted to authors＇ hospital. Clinical presentations included intracerebra] hemorrhage （n = 18）, seizure （n = 8）, headache （n = 7）, neurologic deficits （n = 5）, and incidental finding （n = 2）. According to the Spetzler-Martin scale, 10 patients belonged to grade I , 15 belonged to grade Ⅱ , 9 belonged to grade m, 4 belonged to grade IV, and 2 belonged to grade V. Embolization therapy with Onyx was carried out in all patients. Follow-up was conducted. Results After the embolization, angiography showed that complete occlusion of BA VMs was achieved in 22 cases, 80% - 90% occlusion was obtained in 10 cases, 60% ~ 70% occlusion was seen in 5 cases, and about 50% occlusion was found in 3 cases. Of the 18 cases having incomplete embolization, stereotactic radiotherapy was employed in 2 with excellent result. Complieations occurred in 11 patients, leading to permanent neurologic deficits in 1 patient. No death occurred. Follow-up angiography performed at six months after the treatment showed that complete occlusion was obtained in 22 patients. Conclusion Endovascular embolization is an effective, safe and mini- invasive treatment for BAVMs. Onyx is a suitable embolization agent for the treatment of BAVMs with rather higher cure rate.