血管内栓塞联合γ刀治疗脑动静脉畸形

Treatment of cranial arteriovenous malformation (cAVM) by endovascular embolization associated with Gamma knife

目的 分析血管内栓塞联合r刀治疗脑动静脉畸型（AVM）的治疗效果及其适应证和并发症。方法 自1997年4月～2000年11月我们对46例脑动静脉畸形患者施行血管内栓塞联合r刀治疗手段,先使用氢丙烯正丁酯（Bucrylate,NBCA）栓塞动静脉畸形,使体积缩小,对高血流体积较大者,采取分次逐步栓塞。所有病例在最后一次血管内治疗一周后行r刀治疗,在MRI定位下,确定AVM的大小和边界,根据病灶大小、部位和类型设计照射的靶点位置、靶点个数（2～8个不等）周边剂量、中心剂量和剂量曲线。本组病例周边剂量为11～27Gy（平均20.3Gy）;中心剂量20～50Gy（平均40.5Gy）。结果 34例（73.9％）患者脑AVM完全闭塞,7例（15.2％）患者病灶明显缩小,病灶大小无变化者为6.5％（3例）,2例（4.3％）术后脑AVM出血,无1例死亡。结论 血管内栓塞联合r刀治疗脑AVM是安全有效的新手段,尤具适合脑AVM体积较大、位于重要功能区、手术难度大、患者不能耐受开颅手术者。

Objective To analyse the results,indications and complications of treatment of cAVM by em-bolization associated with Gamma knife. Methods 46 patients with cAVM were first treated by emboliztion with bucrylate (NBCA) to reduce the volume of AVM. All patients received Gamma knife treatment after one week em-bolization . The peripheral radiation dose was 20. 3 Gy (range 11~27 Gy), central dose was 40. 5 Gy (range 20~ 50 Gy) . Results Complete disappearance of cAVM was observed in 34 patients (73. 9%) , shrinkage in 7 (15. 2%) , stabilization in 3 (6. 5%) and post-therapeutic hemorrhage in 2(4. 5%). No one dead .Conclusions Embolization associated with Gamma knife is a safe and effective method for treatment of cAVM especially suitable for those patients who have large volume cAVM located in functional areas and can not endure surgery.