ONYX胶栓塞治疗颅内动静脉畸形的临床应用

目的:探讨应用Onyx胶栓塞治疗颅内动静脉畸形的应用价值。方法:全麻下经股动脉穿刺插管,微导管超选择插管到达病变部位后,用Onyx栓塞治疗颅内动静脉畸形30例。结果:30例颅内动静脉畸形患者,共行47次栓塞治疗,畸形血管团栓塞达80%以上者8例,其中4例完全栓塞,栓塞50%~80%者15例,栓塞50%以下者7例。发生颅内出血并发症2例,球麻痹1例,经过相应处理后好转。结论:Onyx是治疗脑动静脉畸形较为理想的栓塞材料,血管内栓塞是颅内动静脉畸形综合治疗中重要的组成部分。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾总结 2 4 0例脑动静脉畸形 (AVM)中合并动脉瘤 5 1例的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析研究造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;1 6例供血动脉动脉瘤 ,1 1例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月后第 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标     

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.     

应用Onyx栓塞脑动静脉畸形44例临床分析

目的:探讨用新型非粘附性液体栓塞材料Onyx栓塞脑动静脉畸形(arteriovenous malformation,AVM)的临床疗效。方法:额顶叶15例、顶枕叶11例、颞顶叶9例、基底节区4例、小脑半球5例。畸形团直径小于3cm的14例,3~6cm的21例,大于6cm的9例。均采用Seldingor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,Marathon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:44例脑动静脉畸形都得到了有效的栓塞。畸形团完全栓塞4例,畸形团栓塞80%以上7例,畸形团栓塞50%~80!例,畸形团栓塞50%以下12例。1例栓塞术后发生粘管,2例栓塞术后出现肢体偏瘫,经解痉、促进微循环供血等治疗明显好转,1例术后脑内出血,急症开颅清除血肿,肢体留有偏瘫。其余病例无严重并发症。结论:Onyx由于有良好的非粘附性,可以向畸形团内注入更多的量,提高脑动静脉畸形的栓塞效果,但需注意掌握栓塞技巧,减少并发症的发生。     

脑动静脉畸形介入治疗并发症的观察与护理

目的：探讨脑动静脉畸形（AVM）栓塞治疗并发症的观察与护理。方法：回顾性分析152例脑动静脉畸形介入治疗术中并发症的发生,总结护理观察经验。结果：AVM位于额顶叶87例、顶枕叶34例、颞顶叶17例、基底节区7例、小脑半球7例。畸形团直径小于3cm的56例,3~6cm的72例,大于6cm的24例。注射Onyx栓塞脑动静脉畸形,畸形团完全栓塞42例,畸形团栓塞80%以上62例,畸形团栓塞50%~80%34例,畸形团栓塞50%以下14例。术中并发症：2例栓塞术中发生粘管;8例栓塞术后出现肢体偏瘫,由于护理观察及时,经解痉、降低颅内压、促进微循环供血等治疗好转;1例脑出血急症开颅清除血肿,肢体留有偏瘫。其余病例无严重并发症。结论：术前充分准备,术中预见性观察与处理对保证栓塞的疗效,减少并发症的发生具有重要的意义。     

ONYX在脑血管畸形治疗中的应用

目的　报告采用液态栓塞材料 (Onyx)栓塞治疗脑动静脉畸形的初步经验。方法　采用Onyx对 17例脑动静脉畸形进行血管内栓塞治疗 ,其中 1例选择 3支血管栓塞 ,9例选择 2支血管栓塞 ,7例选择 1支血管栓塞 ,注胶时间 10～ 70min。结果　即可影像结果 :10 0 %栓塞 5例 ,70 %以上 5例 ,70 %以下 7例。并发症 :术后出血 2例 ,微导管不能拔除 1例。结论　ONYX栓塞脑动静脉畸形与NBCA相比具有在畸形团内弥散好、注胶时间长、一次栓塞的畸形团多和安全性高等优点 ,但需要进一步积累经验 ,提高疗效。     

新型液态栓塞剂 (Onyx)栓塞脑动静脉畸形28例临床分析

目的　介绍新型液态栓塞剂Onyx栓塞脑动静脉畸形的技术要点和临床疗效。方法　 18例患者动静脉畸形位于功能区 (运动区、语言区、视觉中枢 ) ,8例位于大脑半球深部 ,2例位于小脑半球。畸形团大小在 3cm左右的 11例 ,3～ 6cm的 12例 ,6cm以上的 5例。均采用Seldingor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 ,Ultraflow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　治疗前后脑动静脉畸形的体积缩小为 2 0 %～10 0 % ,初期平均约 4 0 % ,目前可达 80 %左右 ,其中 4例患者达到影像学完全栓塞 (血管造影动、静脉期均无畸形血管团显影 )。 3例患者栓塞术后有肢体偏瘫并发症 ,1例患者术后出现视野缺损 ,其余病例无严重并发症。结论　Onyx可提高脑动静脉畸形的栓塞效果 ,但应学习正确的栓塞技术和注意预防并发症。单纯栓塞的长期疗效有待随访。     

应用Onyx栓塞治疗脑动静脉畸形的护理

目的:探讨应用Onyx栓塞治疗脑动静脉畸形的护理.方法:回顾性分析44例脑动静脉畸形患者的术前、术后临床资料并总结护理经验.结果:本组完全栓塞4例,栓塞80%以上7例,栓塞50%～80% 21例,栓塞50%以下12例.栓塞术后发生粘管1例,出现肢体偏瘫2例,经解痉、促进微循环供血等治疗明显好转,脑内出血1例,急症开颅清除血肿,肢体留有偏瘫.其余病例无严重并发症.结论:术前充分准备,术后精心护理对保证栓塞的疗效具有重要的意义.     

体部动静脉畸形介入栓塞治疗的临床应用

目的　探讨体部简单动静脉畸形和复杂动静脉畸形的栓塞方法。方法　使用金属钢圈、液性组织胶、可脱离球囊分别对1 0例体部动静脉畸形栓塞。简单动静脉畸形采用金属钢圈或可脱离球囊对供血动脉直接栓塞以闭塞畸形的血管。复杂动静脉畸形采用组织胶栓塞异常血管团 ,阻断多支动脉供血或防止侧枝血管建立引起的复发。结果　 1 0例体部动静脉畸形栓塞后畸形血管完全闭塞 ,经 1～ 6年随访无复发。结论　介入栓塞对体部动静脉畸形是一种方法简便、疗效可靠的治疗方法 ,是临床治疗体部动静脉畸形的首选方法     

Endovascular venous approach in the treatment of ruptured intra-cerebral arterio-venous malformation

Trans-venous approach has been described for endovascular treatment of many vascular lesions namely the intracranial dural, cavernous and intra-orbital malformations. A patient with a ruptured left deep parietal arteriovenous malformation (AVM) treated with primary transvenous Onyx 18 embolization is reported. Trans-arterial approaches were unsuccessful because of the tiny tortuous feeding arteries and hence a transvenous approach was used for embolization. Follow-up angiography at 3 month revealed persistent angiographic cure of the AVM. Our case illustrates that in patients with ruptured small AVM having a single draining vein, transvenous treatment can be utilized to achieve occlusion resulting in AVM cure.     

Endovascular treatment of intracranial arterio-venous malformations with Onyx embolization: preliminary experience

PURPOSE: Intracranial arterio-venous malformations (AVM) often represent a complex clinical problem as regards indications to treatment, the choice of treatment and the technical difficulties related to treatment. In the last twenty years, endovascular treatment of intracranial arterio-venous malformations was primarily based on an acrylic glue (Hystoacril) whose endovascular use is not free from risks. A new product for endovascular embolization, named ONYX, has been recently been made commercially available. It is a bio-compatible liquid polymer that precipitates and solidifies in contact with blood, thus forming a soft and spongy embolus. The aim of this study was to evaluate our preliminary results in the endovascular embolization of intracranial AVM with Onyx. MATERIALS AND METHODS: Ten patients were treated (7 men, 3 women; mean age: 29 years, range: 12-48 years) for a total of 37 embolizations, 22 with Onyx and 15 with acrylic resin. RESULTS: Nidus occlusion was complete in 2 cases, >90% in 2 cases, >50 and <90% in 3 cases and <50% in the remaining 3 cases. The following complications were recorded: two transient and one mild permanent neurological deficits, two clinically silent cases of moderate subarachnoid haemorrhage, four catheters glued to the injection site, three cases of treatment discontinuation due to continuous and massive reflux of Onyx into the afferent artery peduncle. CONCLUSIONS: This early experience showed that while Onyx has good embolization potential it also presents some disadvantages, which need to be overcome before this product can be considered easy and safe to use on a large scale.     

Embolization of high-flow craniofacial vascular malformations with onyx

BACKGROUND AND PURPOSE: Various techniques and materials have been used for the endovascular treatment of craniofacial high-flow arteriovenous vascular malformations, because their rarity precludes standardization of their treatment. The aim of this retrospective review is to assess Onyx as the primary embolic agent in the treatment of these vascular malformations. MATERIALS AND METHODS: Six patients with arteriovenous fistulas and 3 with arteriovenous malformations (AVMs) of the head and neck region were treated with intra-arterial (IA)/direct percutaneous injections of Onyx. Adjunctive maneuvers used during embolization included external compression of the arterial feeders or venous outflow (6 patients), balloon assist (4 patients), and direct embolization of the draining vein remote to the fistula site (1 patient). n-butyl-2-cyanoacrylate (n-BCA) was used in addition to Onyx for rapid induction of thrombosis in a large venous pouch (1 patient) and for cost containment purposes (1 patient). Four patients were treated surgically after the embolization. RESULTS: There were no neurologic complications secondary to the embolization procedure. The arteriovenous shunt was eliminated in all of the fistulous lesions and 2 of the 3 AVMs. The embolization was incomplete in 1 patient with a large AVM who declined further endovascular or surgical procedures. Untoward events included 2 instances of catheter entrapment (of 9 IA injections), blackish skin discoloration necessitating surgical revision in 1 patient, and difficulty of balloon deflation/wire withdrawal during a balloon-assisted embolization. CONCLUSION: Onyx appears to be a safe and effective liquid embolic agent for use in the treatment of craniofacial high-flow vascular malformations with distinct advantages and disadvantages compared with n-BCA.     

Brain AVM embolization with Onyx

BACKGROUND AND PURPOSE: To report the initial experience by using a new liquid embolic agent (Onyx) for embolization of brain arteriovenous malformations (AVMs). METHODS: Between May 2000 and December 2005, 44 patients with brain AVMs were embolized with Onyx. There were 18 women and 26 men with a mean age of 42.4 years (median 44, range 14-71 years). Clinical presentation included seizures in 26 patients (59%), hemorrhage from the AVM in 13 patients (30%), subarachnoid hemorrhage from a concomitant aneurysm in 3 patients (7%), visual disturbances in 1 patient (2.3%), and in 1 patient (2.3%) the AVM was an incidental finding. Mean estimated size of the AVM was 3.9 cm (median 4, range 2-7 cm). RESULTS: In 44 patients, 52 embolization procedures were performed with 138 feeding pedicles embolized, ranging from 1 to 7 per patient. Average estimated size reduction was 75% (median 80%, range 40%-100%). Total obliteration was achieved in 7 AVMs (16%), and partial embolization was followed by surgery in 10 patients and by radiosurgery in 20 patients. Complications occurred in 6 patients, leading to death in 1 patient (mortality 2.3%) and to permanent disability in 2 patients (morbidity 4.6%). CONCLUSION: Onyx is feasible and safe in the embolization of brain AVMs. Complete obliteration can be achieved in small AVMs. Large AVMs can be adequately reduced in size for additional surgical or radiosurgical treatment.     

Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients

BACKGROUND AND PURPOSE: To report our experience in the treatment of brain arteriovenous malformations (BAVMs) using Onyx (ev3, Irvine, Calif). Patients and METHODS: From January 1999 to October 2004, 94 patients with BAVMs were treated endovascularly in our department. They were 51 (54%) men and 43 (46%) women with a mean age of 32 years. A total of 210 endovascular procedures were performed with Onyx as the sole embolic agent in 88 procedures; Onyx and n-butyl cyanoacrylate (n-BCA) were used in combination in 50 procedures, and n-BCA alone was used in 72 procedures. RESULTS: The course of endovascular treatment was completed in 53 patients. In 26 patients (49%, 26/53) an angiographic cure was achieved using embolization as the sole therapeutic technique. Seven (13%, 7/53) patients underwent a surgical resection of the residual BAVM nidus, 20 (38%, 20/53) patients underwent radiosurgical treatment after nidal size reduction <2 cm was accomplished by endovascular treatment. Further endovascular treatment was planned in 33 patients, whereas in 5 patients, the continuation of embolization was aborted due to difficult nidus catheterization. Procedure-related permanent neurologic deficits were observed in 8 (8.5%, 8/94) patients. There were 3 procedure-related deaths. CONCLUSION: Onyx is suitable for brain BAVM embolizations and allows obtaining higher rates of anatomic cures compared with those obtained previously with other embolic agents.     

Curative embolization of cerebral arteriovenous malformations (AVMs) with Onyx in 101 patients

INTRODUCTION: Onyx has emerged in the recent years as a new embolic material. We present our experience with Onyx in the curative embolization of brain cerebral arteriovenous malformations (AVMs). METHODS: We retrospectively reviewed the files of all patients that we had treated with Onyx embolic material for a brain AVM during the last 4 years. We identified 101 patients who underwent a total of 219 sessions of embolization. RESULTS: The treatment has been concluded in 52 patients; in this group, total occlusion was obtained in 28 (53.9%) patients and near-total occlusion was obtained in 18 (34.6%). The respective figures based on the 101 patients of the study cohort are 28/101 (27.7%) and 18/101 (17.8%). More embolization sessions are to be carried out on the remaining 49 patients. There were three deaths, and eight patients had permanent neurological deficits with a resulting morbidity of 8% and mortality of 3%. CONCLUSION: High rates of total or near-total occlusion of brain AVMs can be achieved with multiple sessions of Onyx embolization with acceptable morbidity and mortality.     

出血性脑动静脉畸形的影像特点与血管内治疗

目的：探讨以出血发病的脑动静脉畸形的影像学特点与血管内治疗的技术操作。方法：经脑CT或MRI确认为脑实质内出血的56例病例，经DSA全脑血管造影证实为脑动静脉畸形(AVM)，根据AVM病灶的特点，行经血管内超选择应用α-氰基丙烯酸正丁酯栓塞或结合放射外科治疗。结果：56例在1-3次栓塞后，36例病灶完全消除；1例因AVM中有新生的动脉瘤及1例术后1年发生出血而行第2次栓塞治愈，1例在接受X-刀治疗后3个月再次出血，经手术后痊愈。结论：AVM病灶内或病灶旁存在动脉瘤和动脉囊样扩张、引流静脉细小和脑室内生长的AVM是引起脑出血的主要原因，而在栓塞中优先处理动脉瘤样病变对防止脑出血有重要意义。     

Endovascular treatment of cerebral aneurysms associated with arteriovenous malformations

Background and purpose

In univariate survival analysis, coexisting aneurysms was associated with a significantly increased risk of hemorrhage in AVMs. We report here on our clinical experience with AVMs associated with arterial aneurysms that were managed by endovascular treatment.

Methods

To determine the incidence of associated aneurysms, the authors reviewed 366 consecutive patients with AVMs managed between 1999 and 2009. In 86 (23.5%) of these 366 patients, 55 intranidal aneurysms and 40 proximal aneurysms were observed. Targeted endovascular treatment with coils, n-butylcyanoacrylate(NBCA) and Onyx was performed for patients in this series, using a standard protocol. We reviewed the treatment plans, radiological findings and clinical courses of 86 patients suffering AVM associated with aneurysm.

Results

Ninety-five aneurysms in 86 patients with AVMs were enrolled in this study. Hemorrhage was the most frequent presenting symptom (69 patients, 80.2%). Bleeding was caused by an AVM nidus in 44 cases, aneurysm rupture in 20 and an undetermined origin in 5. Four patients were treated for associated aneurysm with coils followed by AVM embolization and 82 patients were treated with NBCA or Onyx embolization. There were total of 3 complications (3.5%) clinically significant complications in this series. Excellent or good outcomes (Glasgow Outcome Scale ≥ 4) were observed in 63 (73.3%) patients at discharge. Neurological deficits (Glasgow Outcome Scale 1–4) were 16.6% at discharge.

Conclusion

Endovascular treatment can be adequately used for cerebral aneurysms associated with AVMs as an adjunct to microsurgery and radiosurgery.