Onyx胶栓塞脑动静脉畸形31例

背景：在脑动静脉畸形的血管内栓塞治疗中,栓塞材料的选用在很大程度上决定血管内栓塞治疗的效果。Onyx胶是近年研制的一种新型液体栓塞剂,具有不粘管、弥散均匀及可控性好等优点。目的：总结新型液态栓塞剂Onyx胶栓塞脑动静脉畸形31例的技术要点和临床疗效。方法：应用Onyx胶栓塞脑动静脉畸形31例,均采用Seldinger技术在股动脉内置入6F动脉鞘,6F导引导管插入颈内动脉或椎动脉,Marathon微导管超选择进入畸形血管团内,采用＂注胶-返流-停止-再注胶＂技术长时间缓慢注射Onyx胶栓塞脑动静脉畸形。结果与结论：栓塞后脑动静脉畸形闭塞40%～60%8例,60%～90%7例,90%以上（完全栓塞）16例。未能完全栓塞的15例中,4例接受手术治疗,其中3例痊愈,1例单侧肢体乏力,肌力Ⅳ级;6例患者术后辅以伽玛刀治疗,其中2例1年以后复查DSA显示脑动静脉畸形完全闭塞。提示Onyx可提高脑动静脉畸形的栓塞效果,但应正确采用栓塞技术和注意预防并发症。     

液态栓塞材料Onyx栓塞脑动静脉畸形32例

目的：回顾性分析新型非黏附性液体栓塞材料Onyx栓塞脑动静脉畸形32例的效果。 方法：32例脑动静脉畸形患者为2005—08／2007—08中国医科大学附属盛京医院收治，应用美国MTI公司生产的Onyx液态剂栓塞进行了36次血管内栓塞，栓塞供血动脉56支。栓塞后进行了6个月～2年的随访，了解病灶的闭塞情况，是否出现再出血、抽搐以及材料宿主反应。 结果：32例脑动静脉畸形栓塞后，病巢全部栓塞为8例（25％），栓塞〉90％10例（31％），栓塞70％～90％9例（28％），栓塞50％～69％5例（16％）。完成随访31例，1例失访，栓塞后死亡1例，再出血2例，1例微导留置，栓塞后仍有癫痫发作2例。 结论：Onyx血管内栓塞脑动静脉畸形是完全、永久地闭塞病灶，其治疗周期短、微创、安全、并发症少。     

血管内栓塞治疗脑动静脉畸形

目的 :探讨血管内栓塞治疗脑动静脉畸形 (AVM)的临床效果及安全性。方法 :应用血管内栓塞治疗脑AVM 42例 ,栓塞剂为二氰基丙烯酸正丁酯 (NBCA)。结果 :16例完全闭塞 ,90 %～ 10 0 %闭塞 8例 ,70 %～ 90 %闭塞 11例 ,5 0 %～ 70 %闭塞 6例 ,<5 0 %闭塞 1例。并发症有导管断裂滞留畸形团 3例 ,NBCA意外泄露 1例。结论 :血管内栓塞治疗脑AVM是一种安全、可靠、有效的治疗手段。     

脑动脉畸形血管内栓塞治疗及并发症的临床研究

目的探讨α-氰基丙烯酸正丁酯(NBCA)生物胶血管内栓塞治疗脑动静脉畸形的效果及技术要点,及发生并发症的处理。方法对50例脑动静脉畸形应用微导管技术,在数字减影血管造影监视下行血管内栓塞治疗。结果成功栓塞48例脑动静脉畸形,46例痊愈,2例死亡。50例病人共行150次栓塞,栓塞次数1~6次/例,平均3次。栓塞程度:100%栓塞15例,90%~100%栓塞9例,80%~90%栓塞10例,70%~80%栓塞5例,60%~70%栓塞3例,栓塞60%以下4例。栓塞后行γ刀(或X刀)放射治疗13例、手术切除5例。并发症有脑梗死2例,于尿激酶溶栓后恢复,脑出血4例,2例导管断裂滞留畸形团内。结论血管内栓塞治疗脑动静脉畸形是一种安全、可靠、有效的治疗手段。     

Onyx栓塞治疗复杂型脑动静脉畸形

目的探讨Onyx胶在复杂型脑动静畸形血管(AVM)治疗中的临床应用价值。方法采用Onyx胶栓塞20例复杂型脑AVM,其中位于功能区9例,大脑半球深部5例,小脑半球4例,脑膜脑AVM 2例,AVM大小3~6 cm16例,6 cm以上4例。结果畸形血管团完全栓塞1例,90%栓塞10例,80%栓塞8例,50%~70%栓塞1例。术后复查CT均无脑出血。术后患者随访效果满意。结论Onyx胶的应用能安全有效地提高复杂脑AVM血管内治疗的效果。     

单纯Onyx胶栓塞治疗SM Ⅰ-Ⅳ级脑动静脉畸形疗效的比较

目的探讨单纯Onyx胶栓塞治疗Speztler-Martni Ⅰ-Ⅳ级脑动静脉畸形的疗效及并发症。方法回顾性分析2008年12月到2012年8月单纯Onyx胶栓塞治疗的脑动静脉畸形患者21例,比较单纯Onyx胶栓塞治疗不同Speztler-Martni分级脑动静脉畸形的疗效。结果单纯使用Onyx胶栓塞治疗后,21例患者中,栓塞率100%的患者共9例。其中在Spetzler-Martin各级中所占的比率分别是:Ⅰ级80%;II级44%;Ⅲ级20%;Ⅳ级为0。栓塞1次达到栓塞率100%的患者在Speztler-Martni各级中所占的比率是:1级80%;Ⅱ级33%;Ⅲ级20%;Ⅳ级为0。结论 Onyx胶栓塞治疗是现阶段介入治疗脑动静脉畸形最理想的材料,然而其疗效与Speztler-Martni分级具有可能相关性。脑动静脉畸形Speztler-Martni Ⅲ～Ⅳ级的患者可以采用Onyx胶与其他方法联合治疗的方案。     

Onyx血管内栓塞治疗脑动静脉畸型

目的 探讨Onyx胶在治疗脑动静脉畸形中的应用价值。方法采用Onyx-18胶栓塞治疗17例脑动静脉畸形患者,畸形血管团大小均在3cm以上,其中6cm及以上者11例,所有畸形血管团为多支血管供血。结果17例BAVM中达到完全（100％）栓塞者9例,治愈率为53％,包括Ⅱ级全部和Ⅲ级5例患者;栓塞80％者6例,包括Ⅲ级2例,Ⅳ级3例,Ⅴ级1例;50％者2例,均为Ⅴ级患者。全组无死亡和神经功能缺失等并发症。结论Onyx胶是治疗脑动静脉畸形较为理想的栓塞材料,但需注意掌握栓塞技巧,减少并发症的发生。     

Onyx-18胶或Onyx-34胶血管内栓塞治疗脑动静脉畸形的疗效及围术期护理

目的 探讨Onyx-18胶或Onyx-34胶血管内栓塞治疗脑动静脉畸形的疗效及护理方法.方法 对13例脑动静脉畸形患者在全身麻醉及全身肝素化下应用Onyx-18胶或Onyx-34胶行血管内栓塞治疗.并对其进行护理,包括术前对患者及家属进行有关疾病知识的健康教育、心理护理、术前准备及术后常规护理、特殊护理和并发症的观察与护理等.结果 13例患者治疗结束时均行脑血管造影检查:脑动静脉畸形闭塞为30％～50％5例,脑动静脉畸形闭塞为51％～80％6例,脑动静脉畸形闭塞为81％～95％2例.6例术后头痛,经对症治疗后好转;1例术后遗留中度共济障碍,6例术后均无神经功能障碍.结论 对脑动静脉畸形患者行Onyx-18胶或Onyx-34胶血管内栓塞治疗能取得较好的效果,同时做好术前护理及加强术后病情监测,尤其对血压的监测与控制是保证栓塞治疗效果的关键.     

Onyx胶栓塞颅内动静脉畸形6例并发症的分析及处理

近年来,随着栓塞材料及技术的不断发展,尤其是Onyx胶的出现,使得动静脉畸形的血管内介入治疗更广泛的用于临床。但栓塞治疗过程中仍伴随着诸多风险,比如发生正常灌注压突破、栓塞后出血以及导管滞留体内等[1]。虽然每名医生在血管内介入治疗动静脉畸形时都可能遇到这些情况,但关于这些并发症的发生率、原因及结果的了解还不多。吉林大学第一医院神经外科自2003年6月至2008年6月期间,共使用Onyx胶栓塞颅内动静脉畸形58例,其中7例出现并发症,现将治疗结果报告如下。     

血管内栓塞治疗硬脊膜动静脉瘘

目的探讨硬脊膜动静脉瘘(SDAVF)的血管内栓塞治疗方法。方法对28例SDAVF患者行血管内经导管Onyx胶栓塞治疗,观察疗效。结果 SDAVF完全栓塞率100%。术后随访6个月~3年,治愈20例,改善4例,无明显变化2例,失访2例。结论血管内栓塞技术是治疗SDAVF的有效方法。术后系统的抗凝治疗极其重要,对单瘘口病变患者推荐介入治疗。     

非黏附性栓塞剂治疗脑动静脉畸形的临床护理

目的探讨应用非黏附性栓塞剂（Onyx）治疗脑动静脉畸形（brain arteriovenous malformations,BAVM）的临床护理方法。方珐掌握0nyx栓塞治疗BAVM的相关知识和可能出现的并发症,做好术前宣教、心理护理、各项准备和配合,加强术后观察与护理,及早发现并发症的先兆,及时处理。结果本组12例单纯采用栓塞治疗,12例联合显微手术治疗,出院前无任何并发症,DSA检查未见畸形残留;10例栓塞后放疗,其中6例复查DSA达到解剖治愈;单纯栓塞患者中有2例在观察期问有再次出血,经保守治疗后好转。结论应用Onyx治疗BAVM可获得较高的栓塞率,严密的围术期护理可最大限度减轻患者痛苦,进而提高BAvM治愈率并改善预后。     

Endovascular treatment of arteriovenous malformation in a child

Arteriovenous malformations are direct communications between the arterial and venous circulations without the usual passage through the capillary net. They are the most frequent type of malformations of the intracranial circulation and the second most frequent cause of intracranial hematomas or hemorrhage. We report on a 7-year-old girl with intracerebral hematoma following acute rupture of an arteriovenous malformation. The girl experienced a spontaneous headache and later became unconscious. At the time of admission to the hospital, her neurological status scored 5 on the Glasgow Coma Scale. Computerized tomography of the brain revealed a round hyperdense lesion in the left frontoparietal region. Digital subtractional angiography of the left internal carotid artery confirmed the suspicion of an arteriovenous malformation with one main feeding artery: a distal branch of the left anterior cerebral artery. The nidus was round and about 2 cm in diameter. The venous drainage was of the superficial type, flowing into the left superior sagittal sinus. After consultation with a neurosurgeon, we decided to treat the arteriovenous malformation by means of an endovascular technique. A flow-guided catheter was placed close to the nidus. Control angiography before embolization revealed the proper position for the injection of embolic material. We used the conventional mixture of acrylic polymerization glue, Lipiodol oil contrast medium and particles of tantalum powder. Control angiography at the end of the procedure revealed complete occlusion of the malformation. There were no signs of potential new feeding arteries that could appear as a result of changed hemodynamic conditions after embolization. Endovascular treatment of arteriovenous malformations could become the treatment of choice for these lesions, especially in combination with radiosurgery. The established microsurgical treatment is very effective but carries a higher risk of hemorrhagic complications.     

Embolizing intracranial arteriovenous malformations with Onyx: experience at a single center with 250 patients

Objective The aim of this study is to evaluate the embolization techniques, as well as the effects and complications, using the non-adhesive liquid embolic material Onyx in intracranial arteriovenous malformations (AVMs).Methods The study comprises a retrospective analysis of 250 patients with intracranial AVMs treated with Onyx in Guangdong General Hospital from Jan 2010 to Dec 2017. The therapeutic strategies, as well as embolization effects and complications, of Onyx are summarized.Results Of 250 cases, 170 were male and 80 were female. Following the Spetzler–Martin (S-M) grading system, there were 35 cases of grade I, 77 of grade II, 72 of grade III, 39 of grade IV, and 27 of grade V. All cases were treated with Onyx. In addition, 69 cases were treated with Glubran glue. The injected volume of Onyx per patient ranged from 1 mL to 10 mL. The largest volume of Onyx injected in one procedure was 10 mL. The cure rate was 67.9% (76/112) of grade I–II patients, 15.0% (11/72) of grade III patients, 7.7% (3/39) of grade IV patients, and 0% (0/27) of grade V patients. The total cure rate was 36.0% (90/250). The average number of targeted vascular branches per patient was 2.28. The microcatheter broke off in two cases. There were two patients who suffered an intracranial hemorrhage during the embolic procedure; in one of these two patients, the microcatheter also broke off. There were two patients who suffered an intracranial hemorrhage after the embolic procedure; one of them died. Seven cases suffered new-onset neurological deficits or their original symptoms deteriorated. Six of them improved or recovered within 3–6 months. The total complication rate was 5.2% (13/250).Conclusion The application of Onyx in intracranial AVMs is flexible, effective and safe, and may also reduce the complications.     

颅内深部小型动静脉畸形的血管内介入治疗

目的探讨颅内深部小型动静脉畸形血管内介入治疗的安全性及临床效果。方法回顾分析12例颅内深部小型动静脉畸形患者采用血管内介入治疗的临床资料,其中畸形位于基底节区6例,丘脑．基底节区4例,小脑上蚓部2例;采用Onyx或NBCA进行栓塞治疗。结果完全栓塞7例（58．3％）,次全栓塞3例（25％）,部分栓塞2例（16．7％）,残余畸形者行伽玛刀治疗,随访3个月至2年,平均12个月,无严重并发症及死亡病例。结论颅内深部小型动静脉畸形根据具体情况采用血管内介入栓塞,能收到满意的效果,但栓塞率和畸形血管构筑、供血动脉多少以及血管条件相关。     

血管内Onyx栓塞脑动静脉畸形的护理

目的 探讨Onyx介入治疗的护理方法.方法 回顾14例行Onyx介入治疗脑动静脉畸形患者的护理方法.结果 术后无远期并发症,3～6 d出院.结论 以控制性低血压为核心的整体护理是保证栓塞效果的重要环节.     

Seizures after Onyx embolization for the treatment of cerebral arteriovenous malformation

Onyx embolization of cerebral arteriovenous malformations (AVM) has become increasingly common. We explored the risk of seizures after Onyx use.A retrospective review was conducted of 20 patients with supratentorial brain arteriovenous malformation (AVM) who received Onyx embolization between 2006 and 2009. Baseline demographics, clinical history, seizure history, AVM characteristics and treatment were compared between those who developed post-onyx seizure and those who did not. MRIs were reviewed for edema following Onyx treatment.Of 20 patients who underwent Onyx embolization, the initial AVM presentation was hemorrhage in 40% (N=8). The median number of embolizations was two (range 1-4) and the median final obliteration amount was 90% (range 50-100%). A history of seizure was present in 50% (N=10) of patients pre-embolization and 12 (60%) patients received seizure medications (treatment or prophylaxis) prior to embolization. Seizur post-Onyx embolization occurred in 45% (N=9). The median time to seizur post-Onyx was seven days (range 0.3-210). Four patients (20%) with seizures post-Onyx had no seizure history. Two of these patients (10%) had no other identifiable cause for seizure other than recent Onyx embolization. Seizures in these two patients occurred within 24 hours of Onyx administration. Among patients with post-Onyx seizures, there was a trend toward larger AVM size (P=0.091) and lower percent obliteration (P=0.062). Peri-AVM edema was present in 75% of MRIs performed within one month of Onyx treatment and may represent a possible etiology for seizures.New onset seizures post-Onyx embolization are not uncommon. Further study of seizure prevention is warranted.