脑动静脉畸形显微手术及其选择性治疗(附73例报告)

目的探讨脑ＡＶＭ显微手术、血管内栓塞及放射外科治疗的选择。方法以综合分级标准分级,对７３例脑ＡＶＭ治疗分析。显微直视手术脑ＡＶＭ６７例;其中行脑ＡＶＭ切除术６０例,畸形血管电凝夹闭术７例。对重要功能区的脑ＡＶＭ分别行血管内栓塞和γ－刀治疗各３例。结果　术后死亡１例,脑ＡＶＭ切除后５９例经造影复查（复查率９８％）,见ＡＶＭ血管团消失。栓塞的病例经ＤＳＡ复查,显示畸形血管１例消失、２例缩小５０％;３例γ－刀治疗半年后复查,畸形血管团染影变淡、缩小。全组随访０．５～１０年,恢复原工作及可做轻工作者６８例占９３％。２例可生活自理。２例Ⅳ级者未能手术切除因再次出血而死亡。结论迄今,脑ＡＶＭ的显微手术仍是不能以其它治疗完全替代的主要方法。血管内栓塞是主要而获显效的方法之一,对大型、复杂的ＡＶＭ栓塞与手术结合是较佳方案。γ－刀治疗对脑ＡＶＭ是行之有效的,特别对小型、深部、功能区难以切除及不能接受手术或栓塞者更具有治疗适应证。     

脊髓动静脉畸形血管内栓塞治疗

目的：经血管内栓塞治疗脊髓动静脉畸形（ＡＶＭｓ）。方法：本组１８例脊髓ＡＶＭｓ，１４例采用干燥硬脑膜粒栓塞，２例采用α－氰基丙烯酸正丁酯（ＮＢＣＡ）胶粘合剂经微导管超选择性栓塞，另２例用３个０真丝线段栓塞。结果：病灶完全栓塞１５例，栓塞８０％～９０％３例。肢体瘫痪症状明显改善１６例，其中２例有手术切除史者症状未改善，平均随访３２个月，有１４例症状完全恢复正常，２例多支供血者经再次栓塞治疗后症状改善，另２例无变化。结论：血管内治疗脊髓ＡＶＭｓ优于手术治疗，应首先采用此法     

脑动静脉畸形显微手术及其选择性治疗

目的 探讨脑ＡＶＭ显微手术,血管内栓塞及放射外科治疗的选择。方法 以综合分级标准分级,对７３例脑ＡＶＭ治疗分析,显微直视手术脑ＡＶＭ６７例;基中行脑ＡＶＭ切除术６０例,畸形血管电凝夹闭术７例。对重要功能区的脑ＡＶＭ分别行血管内栓塞和γ－刀治疗各３例。结果 术后死亡１例,脑ＡＶＭ切除后５９例经造影复查,见ＡＱＶＭ血管团消失。栓塞的病例经ＤＳＡ复查,显示畸形血管１例消失,２例缩小５０％;３例γ－刀治疗     

采用自制线段混悬液血管内治疗脑动静脉畸形

本文报告采用自制真丝线段混悬液血管内治疗脑动静脉畸形（ＡＶＭ）３７例的临床观察。采用栓塞材料以乙醇或雌激素处理的线段混悬液为主。部分病例采用单纯线段混悬液或联合应用线段与ＩＢＣＡ（丁氰酯）ＰＶＡ（聚乙烯醇）和微弹簧圈栓塞治疗。脑ＡＶＭ病灶完全栓塞率为４３．２％（１６例），栓塞面积大于７５％的２９．７％（１１例），栓塞面积在５０～７０％的占１３．５％（５例），小于５０％者占１３．５％（５例）。结果表明我们自制的乙醇或雌激素处理的线段混悬液是血管内治疗脑ＡＶＭ的较理想的栓塞材料之一，其栓塞作用确切可靠，而单纯线段栓塞作用是一种机械性效应，易引起ＡＶＭ复发。本文对栓塞材料的选择、治疗效果观察及并发症的防治进行了探讨。     

采用自制线段混悬液血管肉治疗脑动静脉畸形

本文报告采用自制真丝线段混悬液血管内治疗脑动静脉畸形（ＡＶＭ）３７例的临床观察。采用栓塞材料以乙醇或雌激素处理的线段混悬液为主。部分病例采用单纯线段混悬液或联合应用线段与ＩＢＣＡ（丁氰酯）ＰＶＡ（聚乙烯醇）和微弹簧圈栓塞治疗。脑ＡＶＭ病灶完全栓塞率为４３．２％（１６例），栓塞面积大于７５％的２９．７％（１１例），栓塞面积在５０－７０％的占１３．５％（５例），小于５０％者占１３．５％（５例）。结果表     

直线加速器放射外科治疗脑动静脉畸形

直线加速器放射外科治疗脑动静脉畸形匡永勤，严利春．曾力，胡威夷，陈明中目前治疗脑ＡＶＭｓ有三种主要方法，显微外科手术切除；血管内栓塞；立体定向放射外科。其疗效各有差异，本文总结我院１３例脑ＡＶＭｓ使用直线加速器放射外科治疗结果。本组畸形血管团直径＜３...     

脑动静脉畸形出血危险因素的Cox回归分析

目的：探讨与脑动静脉畸形（ＡＶＭ）出血相关的临床及血管影像学特征，以期对脑ＡＶＭ的出血倾向作出评价和预测。方法：应用Ｃｏｘ回归模型，对５９例脑ＡＶＭ进行出血危险因素的单因素及多因素分析。结果：５９例脑ＡＶＭ中，观察期内出血４８例（占８１％），年平均出血率为２％；病灶大小、供应动脉支数以及引流静脉支数是决定脑ＡＶＭ出血倾向最重要的危险因素；小型ＡＶＭ、多支动脉供应的ＡＶＭ以及仅有单支静脉引流的ＡＶＭ最易破裂出血。结论：建议脑血管造影时着重对此三项指标进行描述；对于出血风险较大的脑ＡＶＭ应及早治疗。     

经颅多普勒对脑动静脉畸形栓塞治疗评价

经颅多普勒对脑动静脉畸形栓塞治疗评价邹建军，孙海峰，谢世荣，胡黎立，周立志，韩景信血管内栓塞治疗脑动静脉畸形（ＡＶＭ）不仅从形态上闭塞畸形血管团，同时还纠正了颅内异常的血流动力学变化，改善病人临床症状。因此，观察栓塞前后脑ＡＶＭ的血流动力学变化，对评...     

血管内栓塞和手术切除大型脑动静脉畸形

本文报道用栓塞和手术切除治疗１２例大型和功能区的脑动静脉畸形（ＡＶＭｓ），并与单纯手术治疗相比，结果表明，对单纯手术切除危险性较高的脑ＡＶＭｓ，用血管内栓塞后手术切降可明显降低术中出危险及术后致残率和死亡率。其理由为：（１）术前栓塞可阻断供血动脉摁流，使病灶缩小，有利于术中病灶暴露分离，避免和减轻对周围脑组织损伤；（２）术前栓塞可使高流量的ＡＶＭｓ血流量减少，防止单纯手术切除后产生脑灌注压急剧升高     

国产α－氰基丙烯酸正丁酯栓塞治疗脑动静脉畸形

目的探讨国产α－氰基丙烯酸正丁酯（ＮＢＣＡ）栓塞治疗脑动静脉畸形（ＡＶＭ）的适应证、技术要点、栓塞剂的配制及术后并发症。方法４０例病人应用微导管插管技术，在数字减影血管造影（ＤＳＡ）监视下，对畸形血管团进行血管内栓塞治疗。结果栓塞５７次，治愈８例，临床症状明显好转３１例，另１例死于其它疾病，无再出血病例。并发症主要为头痛、神经功能障碍及正常灌注压突破（ＮＰＰＢ），１例ＮＰＰＢ开颅清除血肿并切除畸形灶，１例视野缺损未恢复，其他经对症处理后均痊愈。结论ＮＢＣＡ血管内栓塞治疗脑ＡＶＭ是一种有效的治疗方法。国产ＮＢＣＡ性能良好，安全可靠，价格低廉，可代替进口产品。     

Onyx胶栓塞治疗颅内复杂血管畸形

目的探讨Onyx胶在复杂脑动静脉畸形血管内治疗中的应用价值。方法采用Onyx胶栓塞11例复杂脑动静脉畸形,其中6例为巨大血管畸形,5例位于功能区。分析其血管构筑、栓塞技巧等。结果技术成功率100%,2例获90%栓塞,4例获80%以上栓塞,3例获50%~80%栓塞, 2例栓塞小于50%。结论超选择插管Onyx胶栓塞术治疗脑动静脉畸形安全、有效。     

颅后窝动静脉畸形血管内治疗并发症的原因及处理

目的 总结颅后窝动静脉畸形栓塞术并发症的原因与处理方法,为进一步减少栓塞术并发症提供条件。方法 分别对栓塞术出现的主要并发症误栓,正常灌注压突破,颅内出血,血管痉挛,微导管断于血管内进行原因分析及临床处理。结果 各并发症均有其特殊原因及相应的处理方法。结论 根据并发症发生的原因而采取的处理方法正确,可减少并发症发生。     

Endovascular therapy of brain AVMs prior to radiosurgery

Abstract

The purposes of this study were to determine the safety and efficacy of embolization ofbrain A VMs prior to radiosurgery and to evaluate the total obliteration rate achieved. The brain AVMs of 64 patients were subselectively embolized mainly with NBCAI platinum microcoils and/or PVA. The aim of embolization was the reduction of the target volume and/or the elimination of vascljlar structures bearing an increased risk of hemorrhage. Presenting symptoms were intracranial hemorrhage in 33 patientsl a seizure disorder in 21 patients, and headache in 6 patients. Four AVMs had been detected as an incidental finding. The initial AVM volume was in the range of 0.5 to 84 cc (mean 17 cc). Grading of the AVMs according to the Spetzler-Martin scale showed the following distribution: grade II 3x; III 13x; 1111 11 x; IVI 17x; V, 4x; VII 16 x. A total of 300 endovascular procedures including 47 subselective catheterizations without and 253 with embolization were performed. A size reduction of the A VMs between-l0% and 95% (mean 63%1 median 70%) was achieved. Neurological symptoms due to treatment complications were transient in 12 patientsl of minor clinical significance but permanent in 4 patients. Following radiosurgery, one patient died due to recurrent intracerebral hemorrhage. Three patients are doing well but refused final follow-up angiography. A total of30 patients is currently within the latency interval after radiosurgery. Radiosurgery failed to obliterate the embolized AVMs in 16 patients. Angiography confirmed complete nidus obliteration in 14 patients. The endovascular treatment of brain AVMs prior to radiosurgery proved safe and effective and may be considered in either high grade or incidental AVMs. AVM obliteration after embolization and radiosurgery is less frequently achieved than after stereotactic irradiation of primarily small AVMs. [Neural Res 1998; 20: 479-492]     

Clinical features and endovascular treatment of intracranial arteriovenous malformations in pediatric patients

Purpose

The purpose of this study was to characterize clinical features and evaluate the clinical outcome of endovascular embolization treatment intracranial arteriovenous malformations in pediatric patients.

Methods

A cohort of children (age?≤?18 years) with arteriovenous malformations (AVMs) from 2000 to 2012 was included. Predictors studied included patient gender, age, and angioarchitectural features, including AVM location, nidus morphology and size, venous drainage, and associated aneurysms. Treatment method, complications and outcomes were recorded. The features of AVMs were evaluated before the treatment.

Results

One hundred twenty-seven children (77 males, mean age 13.2 years) were included; 90/127 (70.9 %) children were presented with hemorrhage. AVM size and deep venous drainage were independently associated with hemorrhage; 66/127 patients (52 %) treated with endovascular embolization. Complete obliteration at the end of all endovascular procedures was achieved in 14/66 patients (21.2 %), with an average of 78 % (range, 20–100 %) volume reduction. A mean of 2.9 (range, 1–9) feeding pedicles was embolized per patient. Overall, nine complications occurred in a total of 123 procedures (7.3 %). There was no procedure-related death in this study population. There was no significant difference between patients with and without complications in terms of AVM grade, demographic characteristics, or embolization features.

Conclusions

AVM size and deep venous drainage were independently associated with hemorrhage in pediatric patients. Endovascular procedure is feasible and safe for pediatric AVMs, and complete embolization can be achieved in small AVMs, while large AVMs can be adequately reduced in size for additional microsurgery or stereotactic radiosurgery.     

Management of cerebral arteriovenous malformations associated with symptomatic congestive intracranial hypertension

We report on management strategies and clinical outcomes in 4 cases of acute symptomatic congestive intracranial hypertension associated with cerebral arteriovenous malformations (AVMs). Congestion resulted from high-volume shunts exhausting the drainage capacity of the cerebral venous system in 3 patients, and from sudden venous outflow obstruction in 1 patient. Two AVMs were suggested to be surgically accessible, whereas two AVMs were deemed to be inoperable. Surgically accessible AVMs were treated with embolization followed by complete surgical resection. Inoperable AVMs were treated with partial embolization. Both AVM embolization followed by surgical resection and partial AVM embolization effectively reduced intracranial pressure and achieved sustained patient recovery. Hence, an endovascular approach may be considered to manage AVM-related congestive intracranial hypertension either in combination with surgical AVM removal, or as a palliative approach in inoperable AVMs.     

脑AVM的治疗时机和方法的选择

目的 探讨脑AVM的治疗时机和方法的选择。方法 对63例脑AVM的治疗时机和方法进行分析。手术切除50例，除部分急诊手术外均在显微镜下完成；对重要功能区的脑AVM行血管内栓塞8例，3例术前栓塞，3例栓塞完全，2例栓塞不全行伽玛刀治疗；直接行γ-刀治疗2例。结果 44例全切，6例部分切除，均经病理检查证实为脑AVM。8例血管内栓塞治疗显示畸形血管3例消失、5例缩小50％以上；γ-刀治疗4例，见AVM血管影变淡、缩小，周围残留放射反应区。全组随访3个月-9年，效果良好41例，占65．1％；轻残13例，占20．6％；重残6例，占9．5％；术后死亡3例，占4．8％。结论 显微手术是脑AVM的主要治疗方法。血管内栓塞是主要而获显效的方法之一，对大型、复杂的AVM栓塞与手术结合是较佳方案。对小型、深部、功能区难以切除及不能接受手术或栓塞者γ-刀治疗更具有治疗适应证。     

在复合手术室治疗脑动静脉畸形的初步探讨

目的 总结在复合手术室治疗脑动静脉畸形的经验。方法 2013年12月至2014年12月在复合手术室治疗27例脑动静脉畸形患者,均行手术切除,术中造影判断畸形团是否残留,其中3例一期行切除术和血管内栓塞术。结果 27例中,4例（14.8%）术中血管造影显示畸形团残留,再次切除后行术中造影,显示畸形团消失;一期行切除术和血管内栓塞术3例（均为Spetzler-Martin分级Ⅲ级以上）,术中出血明显减少,均完全切除畸形团。所有患者无造影相关的并发症。术后24例随访6个月至1年,失访3例;其中19例恢复良好,5例有轻度神经功能障碍。结论 在复合手术室治疗脑动静脉畸形能够提高疗效,降低手术相关并发症,为脑动静脉畸形治疗提供了一个新的安全有效的平台。     

分次栓塞治疗大型颅内动静脉畸形的疗效分析

目的 评价分次栓塞治疗大型颅内动静脉畸形(AVM)的疗效.方法 23例大型(直径≥6 cm)颅内AVM患者,分次行AVM栓塞术,8例栓塞后行γ-刀治疗,术后随访1-2年,评估治疗效果.结果 14例达到完全栓塞,治疗过程中再次出血3例,脑梗死4例.影像学治愈19例;20例GOS评分较术前无下降,2例GOS评分较术前下降,1例死亡.结论 分次栓塞治疗大型颅内AVM可取得良好的影像学和临床疗效.立体定向放射治疗是较好的辅助治疗手段.     

Endovascular embolization of cerebral arteriovenous malformation (AVM)

The paper presents the technique and outcomes of brain arteriovenous malformation (AVM) endovascular treatment using a glue-lipiodol mixture. Embolization was attempted in 33 AVM patients (18 women). In 6 cases (18%) AVMs were complicated by brain aneurysms. In 20 patients (61% of cases) the presence of AVM was manifested by intracranial bleeding. RESULTS: 87 procedures were performed; the nidus was completely embolized in every case, total occlusion of AVM was obtained in 12 (35%) cases, subtotal (i.e. 75%) in 13 (36%) cases, and 50% occlusion--in 9 (28%) cases. Out of 8 (24%) cases in which complications occurred, one patient (2%) died.     

大脑后动脉远侧段血管病变的栓塞治疗

目的 评估血管内栓塞治疗大脑后动脉(PCA)远侧段血管病变的效果。方法 回顾性分析近年来经血管内治疗的12例PCA远侧段血管病变(其中动脉瘤4个，血管畸形9个)患的临床资料。结果 2个动脉瘤采用GDC栓塞载瘤动脉，2个动脉瘤采用50％NBCA栓塞，均无偏盲等症状出现；6个AVM栓塞后造影不显影；2个P4-AVM80％栓塞；另1个P4-AVM95％栓塞；仅1例出现1／4象限盲，1例原有偏盲加重。临床随访平均15个月，无再出血和再通。结论 血管内栓塞治疗：PCA远侧段血管病变是安全可行的。