髓内血管畸形的血管构筑学及栓塞治疗

Intramedullary arteriovenous malformations: vascular architecture and endovascular embolization

目的 探讨髓内动静脉畸形 (AVM )的血管构型、血管内栓塞的指征及栓塞治疗的效果。方法 15例患者均有不同程度的肢体瘫痪、感觉障碍、括约肌功能障碍行DSA检查和栓塞治疗。栓塞材料选用PVA颗粒及丝线段。结果 15例中 ,球型 3例 ,幼稚型 12例 ;球型AVM均为单支动脉供血 ;幼稚型AVM为多支动脉供血 ,其中 7例为 2支供血动脉 ,5例有 3支以上供血动脉 ,2例伴有动静脉瘘(AVF) ;15例患者经 2 7例次栓塞治疗 ,根据栓塞前后脊髓功能评价 ,痊愈 2例 ,显效 3例 ,好转 6例 ,4例无变化 ,无 1例加重。经 6个月～ 5年随访 ,症状较栓塞前改善者 4例 ;栓塞后症状维持者 2例 ;栓塞后症状再次反复者 7例 ,再次行栓塞治疗 ;失访者 2例。结论 髓内AVM应栓塞畸形血管团 ,减轻静脉压力 ,减少出血机会 ;血管内栓塞治疗脊髓血管畸形是一种创伤小、安全性高、有效的治疗方法。

Objective To study the vascular architecture and the indication of endovascular embolization of intramedullary AVMs and evaluate the therapeutic effect. Methods 15 patients (male 9 and female 6 , 9 to 43 years old) with acute or progressive paralysis were undergone DSA and endovascular embolization. The embolic material was PVA particles and silk suture segments. Lidocaine test was performed before embolization if it was necessary. Results There were 3 glomus AVMs and 12 juvenile AVMs among the 15 cases. The glomus AVM was usually fed by single artery, the juvenile AVM was fed by two or more arteries. Among 15 patients, 2 were cured, 3 had excellent effect, 6 had good effect, 4 showed no changed and no one became worsening. After 6 months to 5 years follow up, 7 patients with recurrency were re embolized,another 2 patients were lost of follow up. Conclusions Endovascular embolization is a mild invasive, safety and effective therapeutic method for curing AVMs by avascularizing the rudus and decreasing the drainage vein pressure and bleeding.