脑动静脉畸形合并动脉瘤的血管内治疗

Endovascular treatment of cereral arteriovenous malformation with releted aneurysms

目的：探讨脑动静脉畸形（ Cerebral arteriovenous malformation，AVM）合并动脉瘤治疗策略、治疗方法。方法：经全脑数字减影血管造影（ Digital subtraction angiography DSA）检查确诊出血的10例患者，根据AVM血流动力学及动脉瘤特点，取不同栓塞策略，先栓塞动脉瘤后栓塞动静脉畸形。结果：畸形团内型5例，用Onyx胶、弹簧圈栓塞，单纯弹簧圈栓塞2例；与供血动脉相关型4例，与畸形团无关型1例，弹簧圈栓塞动脉瘤，再Onyx胶栓塞畸形血管。复查DSA，动脉瘤全部栓塞，AVM完全消失5例，3例栓塞80％，2例栓塞60％~80％，1例术后出现病变对例肢体轻度偏瘫。后期再次栓塞畸形血管团2例，行开颅切除畸形血管团1例，立体定向放射治疗2例。结论：动静脉畸形合并动脉瘤的血管内栓塞治疗可取得较好的效果，畸形团供血动脉瘤优先栓塞动脉瘤和载瘤动脉，畸形团内动脉瘤则以闭塞该部血流为主，如技术条件允许也尽量先栓塞带瘤血管巢。

Objective：To investigate the technical strategy and appropriate endovascular therapy for the treatment of cere-bral arteriovenous malformation（ AVM）associated aneurysm. Methods：10 cases with cerebral hemorrhage were diag-nosed by cerebral digital subtraction angiography（ DSA ）,according to the feature of hemodynamics and aneurysm,the methods of superselective endovascular embolization with coils or Onyx. Results：Among 5 intranidal aneurusms,which were occluded with microcoils or Onyx,2 cases with coil,4 cases aneurysms in feeding arteries,1 case aneurysms irrelated AVM,the aneurusm were embolized with coils,than arteriovenous malformation were occluded with Onyx. Results by DSA examination,all of the anenrysms and 5 case of AVM were nonvisulization,3 cases of AVM were embolized in 80%,2 ca-ses were embolized between 60% to 80%,New neurological deficiencies were found in the 1 patient. 2 cases were embo-lized again,1 patient treat by surgical excision,2cases by stereotactic radiotherapy. Conclusion：Cerebral arteriovenous malformation（ AVM）associated aneurysm could be treated by endovascular embolization with satisfied results. To embolize the aneurysm as well as part of the parent artery preferentially for related artery type. To occlude the main flow of the nids for AVM with intranidal aneurysms,if conditions permitted,to embolize the aneurysm first.