血管内栓塞治疗在脑动静脉畸形治疗中的作用

Role of endovascular embolization in treatment of cerebral arteriovenous malformations

目的 评价血管内栓塞在脑动静脉畸形治疗中的意义 .方法 1999- 0 3/ 2 0 0 1- 0 3采用血管内栓塞治疗脑动静脉畸形 148例 ,其中栓塞后 87例采用显微外科手术切除 ,9例建议行放射外科治疗 .根据 Spetzler- Martin计分标准 , 级 18例 , 级 2 0例 , 级 2 1例 , 级 5 0例 , 级 35例 , 级 4例 .治疗主要采用血管内栓塞治疗 ,及栓塞后显微外科切除和 г-刀或 X-刀治疗 .结果 148例血管内栓塞治疗的脑 AVM,10 0 %闭塞 33例 (2 2 .3% ) ,75 %以上闭塞 6 6例 (4 4.6 % ) ,闭塞 5 0 - 75 %者 2 6例 (17.6 % ) ,闭塞小于 5 0 %者 2 3例(15 .5 % ) ,栓塞后并发症 4例 (2 .7% ) .87例栓塞后接受显微外科手术切除 ,病灶完全切除 82例 (94% ) ,次全或大部切除 5例 (6 % ) ,术后 4例出现并发症 (4 .6 % ) .9例接受放射外科治疗的患者 ,3例照射后 2 a随访造影显示病灶完全闭塞 ,无照射相关的并发症 .结论 包括显微神经外科手术 ,血管内栓塞和放射外科在内的综合治疗是治疗脑 AVM的安全、有效的手段 ,单纯栓塞除可治愈部分病例外 ,通过栓塞可使大部分AVM病灶减少 ,适合于手术切除和放射外科治疗 ,成功率高 。

AIM To evaluate the significance of endovascular embolization in treatment of cerebral arteriovenous malformations. METHODS From March 1997 to March 2001, 148 patients with AVM were treated by endovascular embolization. Of all the patients, microsurgical resection was performed in 87 patients after endovascular embolization. 9 patients were suggested to undergo radiation of radiosurgery. According to Spetzler and Martin grading scale, 18 patients were Grade Ⅰ, 20 as Grade Ⅱ, 21 as Grade Ⅲ, 50 as Grade Ⅳ, 35 as Grade Ⅴ, and 4 as Grade Ⅵ. Therapeutic methods included endovascular embolization, post embolization surgery and post embolization radiation of г knife or X knife. RESULTS Endovascular embolization were performed in all 148 patients with AVM. After embolization, 100% occlusion were obtained in 33 patients (22.3%), obliteration rate more than 75% of AVM nidus in 66 (44.6%), 50~70% of AVM nidus were obliterated in 26 (17.6%), obliteration rate less than 50% of AVM nidus in 23 (15.5%). 4 patients exhibited a new persistent neurological deficit after embolization (2.7%). Microsurgery was performed in 87 patients following embolization. Lesion were totally removed in 82 patients (94%). Subtotal or incomplete removal were achieved in 5(6%). Post operative complication rate was 4.6% (4 cases). Follow up angiogram was taken in 3 of 9 patients who underwent radiosurgery 2 years after radiation. The results showed that the lesion had been completely occluded. No radiation related complication occurred. CONCLUSION Multimodal treatment including microsurgery, endovascular embolization and radiosurgery is a safe and effective method for cerebral AVM. Part of AVM patients can be cured by embolization alone, furthermore most of the AVM nidus can be reduced to a size suitable for surgical resection and radiosurgery with high success rate and low complication.