介入栓塞治疗未破裂动脉瘤合并脑动静脉畸形

目的探讨未破裂的动脉瘤合并脑动静脉畸形(BAVM)的介入治疗价值。方法回顾性分析23例未破裂的动脉瘤合并BAVM患者的资料。对所有患者均行介入栓塞治疗,根据Redekop分型,选择介入栓塞方式。对近端、远端血流动力型动脉瘤以弹簧圈栓塞,对团内型动脉瘤以Onyx栓塞剂栓塞。术后1周以格拉斯哥转归评分(GOS)评估治疗效果。术后3~6个月行DSA复查病灶是否复发、有无颅内出血。结果 23例患者共36个病灶,其中BAVM合并团内型动脉瘤8个、近端血流动力型动脉瘤16个、远端血流动力型动脉瘤11个、无关血流动力型动脉瘤1个。以弹簧圈栓塞16个近端血流动力型和10个远端血流动力型动脉瘤;以Onyx栓塞剂栓塞8个团内型动脉瘤;1个远端血流动力型动脉瘤因栓塞困难且动脉瘤形态规整未予栓塞,术后第6天患者死于颅内出血引起的脑疝;1个无关血流动力型动脉瘤因易于外科夹闭未予栓塞。23例中,BAVM完全栓塞7例,未完全栓塞16例。19例术后GOS评分为5分,3例为4分,1例死亡病例未评估。除1例死亡外,余22例DSA术后随访均未见复发,无颅内出血。结论介入栓塞治疗未破裂的动脉瘤合并BAVM较为安全、有效,根据各病灶血流动力学特点制定治疗方案、尽量栓塞所有病灶并积极预防术后出血有助于改善患者预后。     

Onyx胶栓塞治疗颅内动静脉畸形

目的观察采用Onyx胶栓塞治疗颅内动静脉畸形（CAVM）的效果。方法应用Onyx胶栓塞治疗31例CAVM患者,评价治疗效果,并对21例患者术后随访3~18个月。结果 31例CAVM患者中,6例一次性栓塞畸形血管团〉90%,其中畸形血管团完全消失4例,其余2例3个月内DSA复查畸形血管团完全消失;25例一次性栓塞≤90%,均接受多次栓塞或联合放射、手术治疗,其中单纯多次栓塞10例,多次栓塞后放射治疗7例、手术治疗8例。26例栓塞治疗后癫痫、头痛、头晕改善;3例术后出现头痛;2例并发颅内出血,其中1例左小脑动静脉畸形栓塞术后24 h出血,急诊手术治疗无效死亡。结论 Onyx胶用于血管内栓塞治疗CAVM疗效较好,是较为理想的血管内栓塞剂。     

应用控制性降压降低脑动静脉畸形术后脑过度灌注

目的：应用手术切除脑动静脉畸形（ＡＶＭ）病灶后给予控制性低血压的方法,观察病灶周围脑组织的灌流情况,探讨术后脑肿胀发生的可能防治措施。方法：选择病灶最大径≥６ｃｍ的ＡＶＭ病人８例,在术中ＡＶＭ切除后,激光多普勒血流测定仪显示病灶周围脑组织高灌注时给予静脉推注２．５％硫喷妥钠－５￣１０ｍｇ／ｋｇ促使血压在原基因上下降２５％左右,观察病灶周围脑组织的灌注情况。结果：８例ＡＶＭ的基础平均血压为７７．６３     

Onyx胶栓塞治疗高速血流外周先天性血管畸形

目的评价Onyx胶栓塞治疗高速血流型外周先天性血管畸形(CVM)的效果。方法对22例经超声和CT检查确诊的高速血流外周CVM患者,以Onyx胶为栓塞剂,行经导管血管内及经皮穿刺血管内Onyx胶栓塞治疗;术后随访1~36个月,评价疗效,观察并发症。结果 8例接受1次栓塞、10例接受2次栓塞、4例接受3次栓塞;Onyx胶用量共76ml,每次平均(3.24±1.08)ml。治愈6例(6/22,27.27%),良好14例(14/22,63.64%),好转1例(1/22,4.55%),无效1例(1/22,4.55%)。1例导管折断于瘤腔内,经手术取出,无其他严重并发症发生。结论采用Onyx胶栓塞治疗高速血流型外周CVM安全、有效,具有广阔临床应用前景。     

脑血管

神经导航辅助早期微侵袭治疗高血压性壳核出血；尿激酶灌注术治疗脑室内出血的疗效及风险分析；59例颅内动脉瘤显微手术疗效分析；应用Onyx液态栓塞剂治疗脑动静脉畸形的探讨；引起脊髓功能障碍的硬膜动静脉瘘的临床特点[编者按]     

血管内栓塞治疗脑动静脉畸形合并动脉瘤

目的探讨血管内栓塞治疗脑动脉畸形合并动脉瘤的价值。方法收集46例脑动静脉畸形合并动脉瘤患者,对Redekop分型为Ⅱa型和Ⅲ型患者(A组)以Onyx胶联合弹簧圈进行栓塞,Redekop分型Ⅰ型和Ⅱb型患者(B组)以Onyx胶联合弹簧圈或单纯Onyx胶进行栓塞,以格拉斯哥转归量表(GOS)评分评估手术疗效。术后3个月复查脑血管造影,观察病灶有无复发。结果 A组患者术后GOS评分为(4.70±0.47)分;B组患者中,以Onyx胶联合弹簧圈栓塞患者GOS评分[(4.75±0.45)分]明显高于单纯Onyx胶栓塞者[(4.33±0.49)分;t=2.159,P=0.042]。1例患者死亡,其余45例患者术后3个月后复查脑血管造影均未见复发。结论血管内栓塞治疗脑动静脉畸形合并动脉瘤疗效好,以Onyx胶联合弹簧圈疗效优于单纯Onyx胶栓塞。     

液态栓塞剂Onyx治疗脑动静脉畸形

目的总结液态栓塞剂Onyx治疗脑动静脉畸形（cerebral arteriovenous malformation,cAVM）的应用和经验。方法 2006年7月～2011年3月应用液态栓塞剂Onyx成功治疗cAVM23例,畸形团的大小〈3 cm7例,3～6 cm（含3cm和6cm）12例,〉6 cm 4例。均采用Seldinger技术在股动脉置入动脉鞘,导管通过动脉鞘进入颈内动脉或椎动脉,微导管和微导丝超选择进入畸形血管团,缓慢注入Onyx液态栓塞剂栓塞动静脉畸形。结果栓塞后cAVM 5例完全消失,8例达90%以上,7例达80%～90%,3例在80%以下,5例在行Onyx胶栓塞术后3个月再次行Onyx胶栓塞,8例Onyx胶栓塞后3个月改行γ刀放射治疗。1例颅内血肿遗留,对侧肢体偏瘫,其余病例术后无神经功能障碍。结论 Onyx液态胶对cAVM的栓塞具有明显的效果,具有创伤小,患者恢复快的优点,但应正确采用栓塞技术和注意防止并发症。     

新型液态栓塞剂栓塞脑动静脉畸形70例经验总结

目的介绍新型液态栓塞剂（Onyx）栓塞脑动静脉畸形的临床疗效和应用体会。方法本组共70例患者,均采用Seldinger技术在股动脉内置入6F鞘,6F导引导管进入颈内动脉或椎动脉,微导管超选择进入畸形团内,采用“阻断和前推技术”长时间缓慢注射Onyx栓塞脑动静脉畸形。结果13例（18．6％）患者达到影像学完全栓塞,半年时随访造影5例无复发;38例（54．3％）患者达到大部或次全栓塞;19例（27．1％）为部分栓塞。4例患者因术中脑出血行急诊手术治疗,其中2例术后有肢体偏瘫,1例死亡;1例中央前回巨大动静脉畸形患者术后肢体偏瘫加重,2例患者术后出现视野缺损。结论Onyx可提高脑动静脉畸形的栓塞效果,但应积累经验预防和减少并发症。     

超选择性动脉栓塞联合手术切除治疗体表巨大血管畸形

笔者9年间手术治疗体表巨大血管畸形62例，对其中14例蔓状血管瘤患者术前在DSA下行超选择性供瘤动脉栓塞，栓塞后48h手术切除。经上述方法栓塞后，瘤体体积和血流量明显减少，病变边界清楚，可最大限度保留正常组织，术中未发生大出血，完整地切除了巨大蔓状血管瘤。术后随访患者3个月至9年，无复发，生活工作均正常。提示沿病灶周围“安全平面”进行手术是保证巨大蔓状血管畸形根治性切除的前提。术前超选择性供瘤动脉栓塞联合手术切除是治疗巨大蔓状血管畸形的有效方法。     

复杂脑动静脉畸形的治疗策略及显微手术治疗

目的 探讨复杂脑动静脉畸形(CAVM)的治疗策略和手术要点.方法 2004年6月至2011年5月共显微手术切除27例复杂CAVM,占同期病例的67.5％,其中功能区CAVM 25例,非功能区2例.27例中,大型12例,中型8例,小型7例.CAVM Spetzler-Martin分级:Ⅱ级8例,Ⅲ级5例,Ⅳ级9例,V级5例.2例行术前栓塞治疗,均行CAVM切除术.术后定期进行随访.结果 23例患者全切除,全切除率85.2％.4例少量残留,其中3例行放射外科治疗.19例恢复良好,偏盲2例,肌力下降4例,2例术前昏迷者术后昏迷变浅.随访2个月至6年,格拉斯哥预后评分(GOS)5分22例,4分3例,2例术前昏迷患者意识好转.结论 显微外科手术全切除是CAVM最有效的治疗方法,掌握相关的显微外科手术方法,可以使多数复杂CAVM获得良好的效果.术前栓塞和残余畸形血管团放射外科治疗是治疗的良好补充.     

Increased cerebral blood flow after brain arteriovenous malformation resection is substantially independent of changes in cardiac output

Brain arteriovenous malformation (BAVM) resection can result in an acute increase in cerebral blood flow (CBF) of unclear etiology. This observational study investigated the relationship between changes in CBF and cardiac output (CO) in patients undergoing microsurgical resection of BAVMs. In 20 patients undergoing a BAVM resection during an isoflurane-based anesthesia, we measured CBF and systemic cardiovascular parameters immediately before and after BAVM resection. CBF was measured on the hemisphere ipsilateral to the lesions and on the contralateral side, using intravenous cold 133Xe washout. Cardiac output was measured using thermodilution technique via a pulmonary artery catheter. There was an increase in global CBF after resection (25 +/- 8 versus 31 +/- 13 mL/100 g/min, preresection versus postresection, mean +/- SD, P =.002), ipsilateral CBF (25 +/- 8 versus 31 +/- 13 mL/100 g/min, P =.002), and contralateral CBF (24 +/- 7 versus 30 +/- 13 mL/100 g/min, P =.003). There was no change in CO, mean systemic arterial pressure, central venous pressure, or pulmonary artery diastolic pressure. The change in CBFGLOBAL was not correlated with changes in CO (r =.154, P =.517). BAVM resection resulted in global increases in CBF that was not substantially related to changes in CO or other systemic parameters.     

Experience with bucrylate (isobutyl-2-cyanoacrylate) embolization of cerebral arteriovenous malformations during surgery

The clinical experience with five patients selected for embolization of cerebral arteriovenous malformations with bucrylate (isobutyl-2-cyanoacrylate) during surgery is described. Bucrylate embolization was used to obliterate one arteriovenous malformation with a dominant nutrient arterial network, and to facilitate surgical resection in two other cases. The extent of the embolization in one of these cases was limited because of segmental perfusion of the AVM nidus by different nutrient arteries. Histological examination of this arteriovenous malformation, resected 56 days after embolization, suggested bucrylate has minimal histotoxicity. Two arteriovenous malformations were found at operation to be unsuitable for embolization because of technical problems with access and exposure of nutrient arteries, and also because of vagaries in the angiographic data before surgery. In two cases, rapid polymerization of bucrylate resulted in gluing of the injection catheters into the arterial lumen. Two patients experienced transient postoperative neurological deficits after bucrylate embolization. Because of the potential hazards of the technique, direct bucrylate embolization of cerebral arteriovenous malformations should only be considered for those lesions felt unsuitable for direct microsurgical excision, and where facilities exist for recording angiographic data before surgery.     

破裂出血的脑动静脉畸形的治疗分析(附42例病例报告)

目的总结单用onyx胶栓塞或结合显微手术治疗以颅内出血为表现的动静脉畸形(AVM)的经验。方法选择2010—2013年临床表现为自发性颅内出血的42例患者,造影明确为脑动静脉畸形,单使用onyx胶栓塞或结合显微手术治疗,进行疗效及并发症分析。结果自发性颅内血肿量较少的I-II级AVM患者中17例仅使用onyx胶栓塞,获得痊愈机会。5例部分栓塞及复查显影的行Y刀治疗。10例颅内血肿量较大,在1~5 d内开颅手术的II-III级AVM患者,术前部分栓塞,降低开颅手术风险。5例IV级AVM,急性期栓塞瘤巢内动脉瘤,降低短期再出血几率,为后期续贯栓塞提供机会。结论对表现为颅内出血的AVM患者,识别血管构筑学特点,并行完全或靶向性栓塞,可获得较好临床疗效。     

Clinicopathological evaluation of EVAL embolization in arteriovenous malformations]

The clinical and pathological aspects of two large arteriovenous malformations which were removed totally after preoperative embolization using ethylene vinyl alcohol copolymer (EVAL) were studied. The material, which is not adhesive, is handled easily during the procedure of embolization. However, it involves some risks because it might migrate to and occlude the normal branches of the brain and pass through the nidus to the venous system. Histopathological study of AVM nidus which was removed showed embolic materials within the vessels and inflammatory reaction of the vessel wall and its surrounding tissue. There were patchy hemorrhages within the AVM nidus and its surrounding brain tissue. Recanalization was also found within the occluded vessels. These findings suggest that preoperative embolization has some risk of causing intracerebral hemorrhage after the embolization. AVM should be removed surgically as a radical treatment if the patient is able to tolerate the operation.     

A new apparatus using the Micro Ultra-Sonic Aspirator (MUSA) system for microneurosurgery

Matsumoto was the first to present the NIIC UltraSonic Aspirator for CT guided stereotactic aspiration of intracerebral hematoma. Based on the NIIC Aspirator, the authors have developed a useful tool for microsurgery by adapting conventional ultrasonic aspirators. This was done by making the aspirator lighter and more handy for use during microsurgical procedures. A newly devised apparatus using the Micro Ultra-Sonic Aspirator (MUSA) was applied clinically to surgical treatment for brain tumors, arterio-venous malformations (AVMs) and intracerebral hematomas. Using the MUSA system, it became easier to remove successfully tumorous mass and the nidus of AVM, because it minimized the risk of injury to the normal structures such as the surrounding brain tissue, vascular systems and the cranial nerves.     

脑动静脉畸形的血管内治疗

１９９３年６月至１９９６年３月，作者应用血管内技术治疗脑动静脉畸形（ＡＶＭｓ）１８例。其中２例完全闭塞，８例闭塞７０％～９０％，５例闭塞５０％～７０％，３例闭塞少于５０％。２例栓塞后出现轻度神经功能缺失。栓塞后１周，４例位置表浅的ＡＶＭ进行了手术治疗。２例位于深部的ＡＶＭ栓塞后１个月进行了γ－刀治疗。１８例患者中，１４例得到随访，１２例临床症状减轻或缓解，１例癫痫发作较栓塞前频繁，１例栓塞后６个月发生颅内再出血。脑ＡＶＭ经血管内栓塞治疗，可使部分患者治愈，对于大型及重要功能区的ＡＶＭ，血管内栓塞治疗可为手术及放疗提供条件。     

Effects of magnesium sulfate on traumatic brain edema in rats

svarietyofneuroprotectiveagentshavebeensynthesized .However ,besidessomeagentspresentlybeingevaluatedinclinicaltrails ,mostofthesecompoundshavelimitedclinicalusebecauseofneurotoxicityandbehavioralsideeffects .Recently ,severalstudiesdemonstratedthattraumaticinjurytothebraincausesadecreaseinmagnesiumconcentrationcorrelatedwithinjuryseverity .1Sincethen ,moreandmoreattentionhasbeen paidtoMgSO4 foritsneuroprotectiveeffects .Magnesiumsulfatehasbeenwidelyusedinclinicalpracticeforalmost 10 0 years.…     

Spontaneous disappearance of brain arteriovenous malformation: A case series

ObjectiveBrain arteriovenous malformation (BAVM) is defined as abnormal communication between cerebral of arteries and veins, without capillaries. Clinically, it may involve intracranial hemorrhage or seizures. Complete spontaneous resolution, known as BAVM disappearance, has been reported in rare cases.MethodsWe retrospectively collated all cases of BAVM in Lille University Hospital, from 2005 to 2018, and identified all cases of spontaneous BAVM disappearance on angiography (nidus and early venous drainage).ResultsThere were 4 cases of spontaneous BAVM disappearance, in 3573 patients: i.e., prevalence of 0.1%. Sex ratio was 2:2; ages ranged from 14 to 46 years; nidus size was generally small (< 20 mm); 3 of the 4 patients had superficial venous drainage. Revelation of BAVM was by hemorrhage in 3 cases and by seizure in 1. There were no cases of recanalization at 1 year's follow-up.ConclusionSpontaneous BAVM disappearance is rare. Associated factors may include small nidus, superficial venous drainage and hemorrhage.     

Onyx embolization for the treatment of brain arteriovenous malformations

Background  

Onyx has emerged in recent years for the endovascular treatment of brain arteriovenous malformations (AVMs). However, the role of Onyx embolization is still under discussion. We report our initial experiences in the treatment of brain AVMs with Onyx embolization.