血管内栓塞治疗脑动静脉畸形的临床分析

The clinic analysis of treatment cerebral arteriovenous malformation using endovascular embolization

目的探讨血管内栓塞治疗脑动静脉畸形的技术特点和临床治疗效果。方法经股动脉入路,将微导管头端进入畸形血管团内,缓慢注射Onyx栓塞剂。结果 23例脑动静脉畸形团直径在3.5～11cm,参与供血的小动脉1～4支,栓塞后畸形血管团完全消失者10例,血管团明显变小、瘘口消失、栓塞体积>60%者9例,<60%者4例。栓塞时间持续30～90min(平均50min),Onyx用量2～9.5mL(平均7mL),对未能完全栓塞的13例患者,建议配合立体定向放射治疗。术后24h内脑出血3例,术后住院期间出现脑梗死2例。结论血管内栓塞治疗脑动静脉畸形安全有效,可使部分Spetzler-Martin分级Ⅰ、Ⅱ级的患者达到完全栓塞的治愈效果,未能完全栓塞者也能为手术或立体定向放射治疗创造条件,扩展了可治愈病例的范围。

Objective To analyze the technical characteristics and the clinical treatment effects of arteriovenous malforma- tion of brain with endovascular embolization. Methods Onyx were infused intp vascular malformation cluster through micro- catheter in the approach of femoral artery. Results Among the 23 patients with arteriovenous malformation of brain which the diameter of vascular malformation cluster was 3.5 - 11 cm,and the supplying arteries were 1 -4 branches , after applying endo- vascular embolization 10 patients, vascular malformation cluster were completely disappeared;9 patients＇ vascular malformation cluster were obviously shrinked, stoma vanished , embolism volume was more than 60% ,4 patients were below the level. The operating time expended about 30~90 min, （averaging 50min）, the dosage of Onyx was about 2~9.5ml （averaging 7 ml）. We proposed the 13 patinets without completely embolized associating with the stereotactie radiotherapy. 24h after operation there were 3 patients happening cerebral hemorrhage. 3 patients took the illness of cerebral Infarction during hospitalization after op- eration. Conclusion The treatment arteriovenous malformation of brain using endovascular embolization was safe and effective. It could heal partial patients which the Spetzler-Martin, classification was Ⅰ or Ⅱ grade and could create favourable conditions for the patients which couldfft get a satisfying result through endovascular embolization to do operation or stereotaetic radio- therapy. This technology increased the probability of the patients which could heal the illness.