脑动静脉畸形(AVMs)的NBCA栓塞治疗

评价ＮＢＣＡ栓塞治疗脑ＡＶＭｓ的临床效果。材料和方法：３６例脑ＡＶＭｓ患者（临床表现为脑出血１４例,癫痫１６例,其他６例）,均经完整的血管造影检查、畸形血管的血管构筑学研究和Ｓｐｅｔｚｌｅｒ分级,在供血动脉选择性血管造影后注入ＮＢＣＡ,术后即刻行血管造景,半年后行ＭＲＩ 评估栓塞的近、远期效果。结果：术后即刻血管造影显示闭塞范围大于９０％为１１例（３０．５％）,７０％￣９０％为８例（２２．２％）,     

NBCA血管内栓塞治疗颅内动静脉畸形

目的　观察α 氰基丙烯酸正丁酯 (NBCA)血管内栓塞治疗脑动静脉畸形 (AVM )的疗效。方法　经股动脉插管 ,用微导管技术超选择病灶内注入NBCA栓塞治疗脑AVM ,共 118例。位于大脑半球 116例 ,小脑半球 2例。病变大于 6cm者 5 2例 ,3～ 6cm者 5 9例 ,小于 3cm者 7例。单支供血动脉13例 ,2支 37例 ,3支以上 6 8例。栓塞加手术切除巨大型脑AVM 15例。结果　完全栓塞病变 2 1例 ,栓塞 90 %以上 5 7例 ,70 %～ 90 % 2 7例 ,5 0 %～ 70 % 8例 ,栓塞 <5 0 %者 5例。结论　NBCA为永久性栓塞剂 ,应作为栓塞治疗颅内AVM的首选材料。栓塞加手术切除、栓塞加伽玛刀或X线刀是彻底治愈脑AVM的较有效手段     

Onyx胶治愈性栓塞脑动静脉畸形的临床研究

目的 介绍Onyx胶治愈性栓塞脑动静脉畸形的经验.方法 2008年8月至2012年8月收治40例脑动静脉畸形患者,临床表现为颅内出血18例,癫痫发作8例,头痛7例,神经功能障碍5例和偶尔发现2例.根据S-M分级,I级10例,Ⅱ级15例,Ⅲ级9例,Ⅳ级4例,V级2例.对所有患者均采用Onyx胶液体栓塞剂进行栓塞治疗,并进行随访.结果 栓塞后造影显示22例达到完全栓塞,10例80％～ 90％栓塞,5例60％～70％栓塞,3例50％左右栓塞.未能完全栓塞的1 8例中2例接受立体定向放射治疗痊愈.11例发生并发症,导致1例永久性神经功能障碍,无死亡病例.6个月后血管造影随访,22例患者完全栓塞.结论 血管内栓塞治疗脑动静脉畸形安全性好,损伤小,Onyx胶适合作为脑动静脉畸形的栓塞材料,并能达到较高治愈率.     

非黏附性液体栓塞材料的研究现状

在脑动静脉畸形的血管内介入栓塞治疗中，在畸形血管团内扩散性好，具有栓塞可控性和稳定性，阶段的非黏附性液体栓塞材料进行综述。栓塞材料的选择是极其重要的。非黏附性液体栓塞材料越来越多地应用于临床。对目前应用于临床和处于实验阶段的非黏附性液体栓塞材料进行综述。     

α-氰基丙酸正丁酯血管内栓塞治疗脑动静脉畸形的临床研究

 目的探讨脑动静脉畸形(AVMs)的血管内栓塞治疗.方法回顾性地分析195例AVMs患者的血管内栓塞治疗过程.结果血管内栓塞治疗159例,297次,治疗后临床症状消失,完全恢复正常生活、工作者32例(20%),临床症状明显好转123例(77.4%).结论血管内栓塞治疗是一种AVMs首选并且有效的治疗方法,尤其对于终末型供血者.     

脑动静脉畸形栓塞治疗后控制性低血压护理

我科自 2 0 0 0年 10月～ 2 0 0 1年 2月共对 16例脑动静脉畸形 (ＡＶＭ )患者实施微导管血管内治疗 ,术后收到了满意的效果 ,现将护理体会介绍如下。一、一般资料2 0 0 0年 10月～ 2 0 0 1年 2月治疗ＡＶＭ患者 16例 ,男性 12例 ,女性 4例 ,年龄 2 1～ 4 7岁 ,ＤＳＡ证实ＡＶＭ。术后脑血管造影显示ＡＶＭ已消失 12例 ,畸形血管团缩小 4例 ,患者自诉无任何不适 ,未发生任何并发症。二、护理要点(一 )术前护理　掌握情况 :全面了解患者病情、病程、临床症状、对患者自身正常活动的影响以及患者的心理状态 ,以求达到对不同个体予以针对性的全…     

血管内栓塞治疗脑动静脉畸形新近展

本主要对近年来ＡＶＭ栓塞的基础性研究，导管的选择，栓塞材料性能的研究及选择标准的探讨，并发症的原因及其预防，以及血管内栓塞疗法在ＡＶＭ治疗中的地位等方面作了综述。     

血管内栓塞治疗脑动静脉畸形（附23例分析）

目的：分析报告23例经血管内栓塞治疗的脑动静脉畸形。材料和方法：23例脑动静脉畸形，11例有癫痫发作史，9例蛛网膜下胜或脑内出血，5例有神经功能障碍、头痛，2例有颅内杂音。畸形团小于3cm2例，3一6cm15例，，大于6cm6例。应用Magic导管系统经股动脉行脑动静脉畸形超选择栓塞，应用NBCA或IBCA16例，线段5例，IBCA和线段2例。结果：畸形血管团栓塞90％以上9例，70—90％10例，小于50％4例，3例栓塞后行手术切除。痊愈10例，改善10例，2例有神经功能障碍，1例死亡。结论：栓塞治疗加手术切除是治疗较大的、高血流量、功能区脑动静脉畸形的较好方法。NBCA或IBCA是安全有效的栓塞材料。     

非黏附性液体栓塞材料的研究现状

在脑动静脉畸形的血管内介入栓塞治疗中,栓塞材料的选择是极其重要的.非黏附性液体栓塞材料在畸形血管团内扩散性好,具有栓塞可控性和稳定性,越来越多地应用于临床.对目前应用于临床和处于实验阶段的非黏附性液体栓塞材料进行综述.     

用国产胶体栓塞剂经血管内治疗脑动静脉畸形

报告了经血管内采用微导管超选择导入技术，并应用国产氰基丙烯酸异丁酯（Ｉｓｏｂｕｔｙ１２－ｃｙａｎｏａｃｒｙｌａｔｅ，ＩＢＣＡ）和α－氰基丙烯酸正丁酯（Ｎ－ｂｕｔｙｌｃｙａｎｏａｃｒｙｌａｔｅ，ＮＢＣＡ）栓塞治疗４４例脑动静脉畸形，获较满意效果。文中就栓塞材料的选择、ＩＢＣＡ和ＮＢＣＡ之间的特点比较及应用方法，栓塞术中并发症的预防与处理等进行了讨论。本组资料表明，国产ＩＢＣＡ和ＮＢＣＡ具有与国外产品性能相似的弥散好、易控制、聚合速度快等优点。     

非粘管温敏性液体栓塞材料栓塞猪颅底血管网的初步研究

目的:评价非粘管性温敏性液体栓塞材料,聚(N-异丙基丙烯酰氨-co-N-正丙基丙烯酰氨〔Poly(N-isopropylacry-lamide-co-N-n-propylacrylamide),聚(NIP-co-NNP)〕,栓塞猪颅底血管网(rete mirabile,REM)作为脑动静脉畸形(CAVM)模型的可行性;建立通过微导管注射非粘管性温敏栓塞材料的程序;初步评价栓塞效果及REM病理改变。方法:选家猪为试验动物,共35头。栓塞前行猪REM及相连动脉DSA检查。微导管超选择进入REM,注射聚(NIP-co-NNP)水溶胶直到REM完全不显影为止;另侧注射生理盐水对照;3h后再行血管造影。REM在内脑组织经10%福尔马林固定,恒温箱中37℃恒温保存,待组织学检查。结果:置管检查家猪35头,成功33头。栓塞前血管造影33头猪的REM清晰显影;栓塞后血管造影显示栓塞侧33头猪的REM不再显影,注入生理盐水侧REM无变化;未发生微导管头端与栓塞剂相粘连的情况;栓塞术中及术后未发生动物抽搐、偏瘫;组织学检查:大体观察,水溶胶在REM内均匀弥散,REM栓塞完全,与对侧相比较,质地较硬。光镜检查:REM管腔内红细胞均消失,管壁内膜清晰可见,平滑肌层完整。未见剥脱和血管壁的坏死,血管周围未见炎性反应;栓塞REM效果统计,使用卡方的确切概率法,P<0.001。结论:聚(NIP-co-NNP)不粘管、栓塞REM完全、近期无毒性、易通过不同规格的微导管。初步研究表明非粘管性温敏栓塞材料在临床上使用是可行的,为较理想的治疗CAVM的栓塞材料。     

Clinical and Radiological Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations

The purpose was to evaluate the clinical and radiological long-term results of embolization of pulmonary arteriovenous malformations (PAVMs) and to assess the quality of life after treatment. A clinical follow-up was undertaken after 67 months (mean) in 35 consecutive patients with 106 PAVMs. Outcome parameters at follow-up were PaO₂ and patients’ satisfaction. During follow-up, the patients had a clinical examination, measurement of arterial blood gases, chest X-ray, and contrast echocardiography performed and were asked to fill in a questionnaire exploring experience of the treatment and subjective effect of treatment on physical and social functioning. A significant rise in oxygenation of the blood after embolization was measured. In 77% of the patients symptoms improved, and 71% felt better performance. In eight patients, one of the PAVMs was found insufficiently embolized or recanalized at follow-up angiography and therefore were re-embolized. Endovascular embolization for PAVMs is effective. Clinical parameters and quality of life improved significantly. Regular clinical controls after therapy are necessary to discover insufficiently embolized, recanalized or new PAVMs.     

数字减影技术在肺动静脉畸形介入治疗中的应用

目的 :探讨肺动静脉畸形 (PAVM )的数字减影 (DSA)成像技术 ,评价其在肺动静脉畸形介入治疗中的价值。方法 :搜集 1995年 5月～ 2 0 0 3年 7月我院诊断的PAVM患者 12例 ,经数字减影肺动脉造影 (PA DSA)检查并选择适当的技术参数充分显示肺动静脉畸形通道后行栓塞治疗 ,术后复查DSA评价手术效果 ;并对介入治疗前后图像作回顾性分析。结果 :12例患者经PA DSA确诊病灶 3 0个 ,可清晰显示纡曲扩张的供血动脉和引流静脉 ,引流静脉及左房提前显影 ,病灶呈境界清楚的动脉瘤样、多房囊状或局限性纡曲扩张。介入治疗前后PA DSA成像良好 ,图像清晰 ,手术效果满意。结论 :合理注射参数、恰当的体位、后处理技术和延长采像时间等方法可提高肺动静脉畸形通道的显示率。     

Hereditary hemorrhagic telangiectasia in children: endovascular treatment of neurovascular malformations

Hereditary hemorrhagic telangiectasia (HHT) is a heterogeneous disease that can present with a variety of clinical manifestations. The neurovascular complications of this disease, especially in children, may be potentially devastating. The purpose of this article was to review the therapeutic results of endovascular treatment of neurovascular malformations in children. A total of 31 patients under the age of 16 were included in this retrospective analysis. All children were treated in a single center. Twenty children presented with 28 arteriovenous (AV) fistulae, including seven children with spinal AV fistulae and 14 children with cerebral AV fistulae (one child had both a spinal and cerebral fistulae). Eleven children had small nidus-type AV malformations. All embolizations were performed employing superselective glue injection. Follow-up ranged between 3 and 168 months (mean 66 months). A total of 115 feeding vessels were embolized in 81 single sessions, resulting in a mean overall occlusion rate of the malformation of 77.4% (ranging from 30 to 100%). Two of 31 patients (6.5%) died as a direct complication of the embolization procedure; two patients (6.5%) had a persistent new neurological deficit; eight patients (26.7%) were clinically unchanged following the procedure; in 13 patients (41.9%) an amelioration of symptoms but no cure could be achieved; and six patients (19.4%) were completely asymptomatic following the endovascular procedure. In the surviving patients morphological complete occlusion was possible in twelve patients (38.7%); therapy is still not completed in six patients. Since the natural history of neurovascular manifestations of HHT in children is associated with high morbidity and mortality, therapeutic intervention is mandatory. In most instances a morphological target can be identified; therefore, even partial and staged treatment can be performed. Our results demonstrate that in 27/31 patients these targeted interventions resulted in stabilizing the disease, ameliorating the symptoms or even complete resolution. The endovascular approach employing glue as the embolizing agent represents a safe and efficient way to control the neurovascular phenotypes of HHT.     

Dural arteriovenous fistula of the anterior fossa treated with the Onyx liquid embolic system and the Sonic microcatheter

We report an association of new technologies (the Onyx liquid embolic system and the Sonic microcatheter) for transarterial embolization through the anterior branch of the middle meningeal artery of a dural arteriovenous fistula (DAVF) of the anterior fossa. The place of endovascular treatment in anterior fossa DAVFs is reviewed, and its clinical implications discussed in light of the case of a patient whose management was modified by this association of new technologies.     

颅底及颈段脊髓血管畸形的介入检查

目的 :为介入栓塞治疗及手术治疗提供重要依据 ,从而防止误诊、漏诊病例的发生。方法 :对我院近期 3 0例疑有颅底及颈段脊髓血管畸形患者的临床表现、MRI影像特点、介入检查资料进行分析。结果 :3 0例患者均具有颅底及颈段脊髓血管畸形的临床表现及磁共振影像特点 ,经行选择性全脊髓血管造影、必要时行全脑血管造影证实 2 9例为颅底及颈段脊髓血管畸形 (其中 2 7例畸形团来自颈部血管供血及胸段脊髓血管等多支血管供血 ;2例来自颈外动脉系统供血 )。另外 1例开始被误诊为颅底及颈段脊髓血管畸形 ,后进行全脑血管造影发现为由颈内动脉原始听动脉供血的硬脑膜动静脉瘘向脊髓髓周静脉引流而造成MRI的留空信号。结论 :为了防止误诊及漏诊病例的发生 ,应对双侧的锁骨下动脉、椎动脉、肋颈干、甲状颈干、上胸段肋间动脉或全脊髓血管及颈外动脉进行造影检查 ,必要时还应进行全脑血管造影。     

Angiography and computed tomography in the evaluation of cerebral venous malformations

Summary The information obtained by computed tomography (CT) and cerebral angiography is compared in eight cases of cerebral venous malformation. Angiography was found to be more reliable for detecting the presence and specific nature of these malformations. Pathological and radiographic differential features between the various forms of cerebral vascular malformations are discussed.     

Magnetic resonance imaging and angiography of the brain in embolic left atrial myxoma

Summary A case of left atrial myxoma presenting exclusively with neurological symptoms, studied with magnetic resonance imaging (MRI) combined with cerebral angiography and computed tomography (CT) is reported. Typical angiographic findings suggested the diagnosis of myxoma. MRI showed multiple ischemic lesions disseminated throughout the entire brain, some of which had been clinically asymptomatic. Because of its sensitivity in identifying small cerebral infarcts, MRI should prove in the future to be a first-choice technique in the evaluation of the presence of and extent of cerebral involvement in embolic left atrial myxoma.     

泡沫加液体混合硬化治疗低流量脉管畸形的初步研究

目的：探讨采用聚桂纯泡沫加博莱霉素液体混合硬化的模式治疗低流量脉管畸形的效果。 方法：回顾性分析2013年5月—2015年7月共105例脉管畸形患者资料,年龄3个月~60岁,平均（26.8±2.0）岁。所有患者通过充盈缺损法,经皮穿刺脉管畸形注射聚桂醇泡沫+博莱霉素液混合硬化模式。治疗过程采用超声或透视监控,按照空气∶聚桂醇体积比2∶1制成泡沫硬化剂,单次治疗聚桂纯最大剂量20 ml,博莱霉素液15 mg。对比治疗后症状以及影像变化,疗效评价参照Achauer标准。 结果：研究病例中脉管畸形以静脉畸形最多见,占81.9%,其中硬化治疗的临床治愈率：I型>Ⅱ型>Ⅲ型>Ⅳ型。Ⅳ型静脉畸形,K-T综合征硬化治疗效果较差。105例患者治疗的临床有效率为41.9%,临床治愈率为48.6%,无皮肤坏死、器官功能受损等严重并发症出现。 结论：初步研究表明聚桂纯泡沫加博莱霉素液有协同硬化作用,能提高硬化治疗疗效。充盈缺损法配合超声和透视监控可提高治疗准确性,预防并发症。