颈内静脉入路血管内根治性栓塞治疗脑动静脉畸形的可行性研究

Feasible study of endovascular embolization for treating cerebral arteriovenous malformations via internal jugular vein approach

目的探讨颈内静脉入路血管内根治性栓塞治疗脑动静脉畸形（bAVM）的可行性。方法回顾性分析2016年11月至2017年4月郑州大学人民医院，bAVM破裂出血、畸形血管具备单一引流静脉特点，经神经外科医师会诊后认为不适合行开颅切除术或患者明确拒绝开颅手术，接受了颈内静脉入路血管内根治性栓塞治疗的6例患者资料。术前5例改良Rankin量表（mRS）评分≤3分。通过旋转DSA和三维重组图像清晰显示引流静脉汇入静脉窦的准确位置。在严格降血压和临时阻断供血动脉情况下，静脉端通过Echelon10导管放置弹簧圈，通过Sonic导管缓慢注入液态栓塞剂，直至畸形血管铸形完全形成。记录术后30 d神经系统及非神经系统并发症及mRS评分。结果6例患者共实施7次栓塞手术，采用颈内静脉入路完成治愈性栓塞。5例微导管留置于颈内静脉。术后30 d随访显示所有患者mRS评分≤1分。无明确操作相关性并发症。结论单一静脉引流途径的bAVM患者经颈内静脉入路栓塞技术可行，长期结果有待随访。

ObjectiveTo evaluate the feasibility of transvenous embolization treatment for cerebral arteriovenous malformations （bAVM）.MethodsFrom November 2016 to April 2017, the information of 6 patients with brain arteriovenous malformation in our center accepting the intravenous radical embolization were collected, who were ruptured bAVM, bAVM with a single drainage vein, not suitable for surgery confirmed by neurosurgeon consultation or explicitly refused craniotomy. The modified Rankin Scale score of five patients were smaller than three before treatment. The location of draining vein flowing venous sinus was shown by rotational DSA and 3D reconstructed images. A liquid embolic agent was injected via Sonic catheter to completely embolism the brain arteriovenous malformation under controlling blood pressure and blocking the blood provisionally. The perioperative complications and modified Rankin Scale score were observed and recorded 30 days after treatment.ResultsThe transvenous embolization treatment was successfully performed in six patients with 7 embolization procedures. There were no definite operation-related complications. the mRS of all cases were ≤1 within 30 days after operation.ConclusionThe embolization technique via the internal jugular vein is feasible for bAVM patients with a single drainage vein, while the long-term outcome need more evaluations.