颅颌面高流量血管畸形的栓塞治疗:9例报道

Embolizing of High Flow Craniomaxillofacial Arteriovenous Malformations with Superselected Endovascular Catheterization:Report of9Cases

目的观察血管内栓塞治疗颅颌面高流量血管畸形的疗效。方法颅颌面高流量血管畸形患者共9例。手术前全部经CT、MRI、Dopplar超声和DSA血管造影明确诊断。栓塞材料采用PVA颗粒,直径为250～350μm。经血管内导管(微导管)注入畸形血管团。结果本组9例病人,一次完全栓塞者6例,其余3例均经过2次治疗达到完全栓塞。除1例失随访外,其余8例获随访。原有的症状体征基本消失,局部外形未发生进一步改变。9例患者栓塞后均未出现局部皮肤黏膜和牙周组织的缺血和坏死。4例(最长45个月,最短4个月后)经DSA动脉造影复查,未发现动静脉畸形血管团显影,经栓塞的动脉均保持通畅。但是,原病灶组织周围出现较多新生血管;同时,在毛细血管期有原病灶的异常引流静脉显影,但其循环时间接近正常血液循环时间。对1例随访时间最长的病人进行局部定位穿刺,在异常引流静脉内植入游离弹簧圈栓塞,术后无任何局部并发症。结论根据颅颌面高流量血管畸形的供应动脉、异常血管网团和引流静脉的特点,采用PVA颗粒作为栓塞材料,完全能够达到使异常血管网团闭塞的目的,同时具有易于控制栓塞过程,避免误栓正常血管的优点。

Objective Using endovascular embolization to cure and stop the enlargement of craniomaxillofacial AVMs.Methods Nine patients with craniomaxillofacial AVMs were treated with endovascular embolization.Among them four were males and five females.The average age was21years old.The diagnosis was made according to CT,MRI and DSA angiograpy.PVA particles was used via a microcatheter to embolize the AVMs.Results In this group,the lesions in six of nine patients were totally embolized by one procedure.The other three cases underwent two procedures.All the lesions were totally embolized.The follow up of eight in nine patients(except one lost)showed a good recovery of the swollen skin around the focus,the colour and the temperature became normal.No complications were observed.Conclusion Endovascular embolization is an effective method to cure the lesions or to stop the enlargement of craniomaxillofacial AVMs with minimal invasion.It is important that this method can avoid damaging the face by surgical resection.We also find that the venous part or the venous pool of the fistulae is the most important part for the lesions to reoccur.