近端血流阻断增压技术治愈性栓塞颅内动静脉畸形

Pressure cooker technique for curative embolization of intracranial arteriovenous malformation

目的初步分析近端血流阻断增压技术(PCT)栓塞治疗颅内动静脉畸形(AVM)的要点及临床疗效。方法 2015年4至5月,上海德济医院神经外科收治AVM 7例,对2例采用PCT栓塞AVM(均为Spetzler-Martin分级Ⅱ级)。使用sonic和echelon微导管并排置入AVM同一供血动脉内,通过echelon微导管在sonic微导管头端和解脱点之间形成"弹簧圈+α-氰基丙烯酸异丁酯(NBCA)塞子",防止在通过sonic微导管向畸形团内注Onyx胶时返流,达到持续、快速、高效的栓塞效果。结果 2例术后即刻均得到完全栓塞,患者症状在1个月内好转或消失,其中1例患者在栓塞术后4个月复查全脑DSA,提示AVM无复发。至随访时,2例患者无任何并发症或后遗症出现。结论 PCT能提高栓塞效率,适于中小型、表浅、非主要功能区、供血动脉少、畸形团流量不高的AVM。其安全性和临床效果尚需更多样本的观察。

Objective To preliminarily discuss the technical points and clinical efficacy of the ＂ pressure cooker technique＂（ PCT） for embolization of intracranial arteriovenous malformation（ AVM）.Methods From April 2015 to May 2015,7 patients with AVM were treated at the Department of Neurosurgery,Shanghai Deji Hospital. The AVMs of 2 patients were embolized with PCT.（ both were Spetzler-Martin gradeⅡ）. A sonic and an echelon microcatheter were implanted side by side into the same blood supply artery of an AVM. ＂ A coil ＋ α-isobutyl cyanoacrylate（ NBCA） plug＂ was formed between the sonic microcatheter tip and the detachable point through the echelon microcatheter in order to prevent Onyx reflux when the glue was injected into a nidus via a sonic microcatheter,achieving the embolization effect of sustained,rapid and high efficient. Results Two patients achieved complete embolization immediately. The symptoms of the patients improved or disappeared within 1 month. The whole brain DSA showed the AVM of one patient did not have recurrence at 4 month after embolization. Two patients did not have any complications or sequelae at the follow-up study. Conclusion PCT can improve the efficiency of embolization. It is suitable for small,medium,superficial,non-major functional area,less feeding artery AVMs,and AVMs with less blood flow in nidus. Its safety and clinical effect still need to be observed with more samples.