α-氰基丙烯酸正丁酯液体胶栓塞治疗脑动静脉畸形

目的 探讨血管内α-氰基丙烯酸正丁酯(NBCA)液体胶栓塞治疗脑动静脉畸形的疗效. 方法 20例经脑血管造影确诊为脑动静脉畸形的患者进行血管内NBCA胶栓塞治疗,分析其疗效,其中Spetzler-Martin分级Ⅰ级3例,Ⅱ级7例,Ⅲ级7例, Ⅳ级3例. 结果 2例Ⅰ级患者、3例Ⅱ级患者和1例Ⅲ级患者完全栓塞,其中完全栓塞的Ⅱ级患者中有1例1 a后复发;1例Ⅰ级患者、4例Ⅱ级患者和2例Ⅲ级患者90%栓塞;2例Ⅲ级患者80%栓塞; 2例Ⅲ级患者60% ～70%栓塞;3例Ⅳ级患者50%栓塞. 结论 血管内NBCA胶栓塞治疗脑动静脉畸形短期疗效确切.     

α-氰基丙烯酸正丁酯液体胶栓塞治疗脑动静脉畸形

目的探讨血管内α-氰基丙烯酸正丁酯(NBCA)液体胶栓塞治疗脑动静脉畸形的疗效。方法20例经脑血管造影确诊为脑动静脉畸形的患者进行血管内NBCA胶栓塞治疗,分析其疗效,其中Spetzler-Martin分级Ⅰ级3例,Ⅱ级7例,Ⅲ级7例,Ⅳ级3例。结果2例Ⅰ级患者、3例Ⅱ级患者和1例Ⅲ级患者完全栓塞,其中完全栓塞的Ⅱ级患者中有1例1 a后复发;1例Ⅰ级患者、4例Ⅱ级患者和2例Ⅲ级患者90%栓塞;2例Ⅲ级患者80%栓塞;2例Ⅲ级患者60%~70%栓塞;3例Ⅳ级患者50%栓塞。结论血管内NBCA胶栓塞治疗脑动静脉畸形短期疗效确切。     

经微导管NBCA栓塞治疗脑动静脉畸形

[目的]研究经微导管血管内α-氰基丙烯酸正丁酯(N-butyl-2-cyanoacrylate,NBCA)栓塞治疗脑动静脉畸形(Cerebral arteriovenous malformations,cAVM)的临床疗效.[方法]在数字减影全脑血管造影监视下,经股动脉插管,采用微导管技术,NBCA栓塞剂对23例cAVM患者行血管内栓塞.[结果]23例患者,一次栓塞6例,分次栓塞17例,共45人次,血管畸形团完全栓塞达6例,＞95%以上4例,70%～95%9例,70%以下4例,术后出现头晕、头痛3例.随访23例,4例仍有癫痫发作,余临床症状均明显改善.[结论]血管内NBCA栓塞治疗cAVM安全有效,单纯栓塞可治愈部分病人.     

脑动静脉畸形的血管内栓塞治疗

目的　通过应用氰丙烯酸正丁酯 (N -Butyl -2 -Cyanoacrylate ,NBCA) ,血管内栓塞脑动静脉畸形 ,探讨NBCA在血管内栓塞治疗脑动静脉畸形中的作用。方法　经股动脉插管应用血流导向漂浮微导管技术超选择性进入畸形血管团内注入不同浓度的NBCA(与碘苯酯混合调制 )。术前、术后即刻全脑血管造影作影像学对比并长期随访。结果　病灶完全栓塞 1例 (单支供血、单支引流 ) ;3例多支供血伴深静脉引流者均大部分栓塞 (栓塞 70 %以上 )。即刻脑血管造影可见畸形团部分或全部不显影 ,循环时间减慢。结论　NBCA作为一种永久性液体栓塞剂 ,可以很好地闭塞动静脉畸形病灶 ,为进一步治疗打下基础     

脑动静脉畸形影像学特点与治疗分析

目的:探讨脑血管畸形的临床影像学特点和治疗方法。方法:对30例经脑血管造影证实的脑动静脉畸形(AVM)的影像学及治疗资料进行回顾性分析。结果:临床以脑出血发病23例,癫痫发病5例,头痛头晕发病2例;AVM病灶位于大脑半球28例,小脑1例,基底节区1例;病灶>6cm9例,3～6cm17例,<3cm4例。10例应用NBCA胶,20例应用GLUBRAN2胶血管内栓塞。血管内栓塞后手术5例,γ-刀治疗16例。血管完全栓塞8例,栓塞90%以上13例,部分栓塞9例。随访完全栓塞8例中2例复发,不全栓塞22例中病灶扩大5例,7例病灶明显缩小,6例病灶消失。结论:血管内栓塞脑血管畸形是一种安全,有效的治疗手段,血管内栓塞结合显微手术,立体定向放射治疗能提高重要功能区和巨大动静脉畸形的治愈率。     

DSA实时影像导引技术在脑血管畸形栓塞术中的应用

目的:探讨DSA实时导引技术在脑血管畸形栓塞术中的应用。方法:回顾性分析我院2008年8月~2010年8月采用DSA实时影像导引技术对51例脑血管畸形患者进行NBCA和ONYX介入栓塞治疗过程,其中NBCA栓塞17例,ONYX栓塞32例,两种混合使用2例,同时评价DSA实时导引技术(重叠透视和路径图)在介入栓塞治疗不同阶段的选择和效果。结果:在所有栓塞治疗过程中,DSA实时影像导引技术帮助术者明确病变部位,减少运动伪影产生,引导微导管超选择到治疗部位,减少了对比剂用量和医患双方的辐射剂量。结论:DSA实时影像导引技术应用在脑血管畸形栓塞术,可提供良好的实时脑血管影像,直观栓塞材料的治疗效果,降低手术风险,在介入治疗颅内血管畸形中起着至关重要的作用。     

NBCA胶栓塞治疗脑动静脉畸形

目的评估用a-氰基丙烯酸正丁酯(NBCA)胶栓塞脑动静脉畸形的安全有效性.方法回顾性分析NBCA胶栓塞的脑动静脉畸形55例,70次栓塞101根供应动脉.结果55例脑动静脉畸形栓塞后,畸形血管团完全消失或栓塞大于90%为16例(29.1%),栓塞70%~90%为23例(41.8%),栓塞50%~69%为9例(16.4%),栓塞＜50%为7例(12.7%).无死亡病例,4例术后出现轻度或严重的神经功能缺损.结论NBCA胶栓塞脑动静脉畸形较为安全有效.     

NBCA血管内栓塞治疗脑动静脉畸形

目的 通过应用氰丙烯酸正丁脂（NBCA）血管内栓塞治疗脑动静脯畸形，探讨NBCA在血管内栓塞治疗脑动静脉畸形的作用及体会。方法 经股动脉插管应用血流导向的微导管技术行畸形病灶内超选置管注入NBCA栓塞脑动静脉畸形。术后全脑血管造影、影像学对比及长期随访，结果 本组2例病人男女各1例、年龄35-45岁、1例以癫痫发作及意识障碍起病，另1例以头痛起病。即刻完全栓塞病灶1例，90％以上栓塞1例，无死亡病例。结论 NBCA作为一种永久性栓塞剂治疗脑动静脉畸形较为安全有效，为进一步治疗打下基础。     

脑动静脉畸形手术前和放射外科治疗前的栓塞治疗

目的：探讨脑动静脉畸形手术前和放射外科治疗前栓塞方法的特点和效果。方法：21例在术前或放射外科治疗前均以α-氰基丙烯酸正丁酯（NBCA）进行栓塞,其中2例先以真丝线段栓塞以减慢血流,再以NBCA栓塞。结果：7例拟行手术患和14例拟行放射外科治疗患栓塞后畸形血管团体积均有不同程度缩小。结论：手术前和放射外科治疗前行畸形血管团的栓塞,可明显提高脑动静脉畸形手术和放射外科治疗的效果。     

外周介入治疗中应用NBCA/Glubran-2胶的临床经验

目的探讨在外周介入治疗中应用NBCA/Glubran-2胶的临床经验。方法 112例患者共184处部位应用NBCA/Glubran-2胶栓塞治疗,根据病变性质分为动脉性（外周动脉病变）、静脉性（食道胃底静脉曲张及门静脉）及肝脾穿刺道三类,其中外周动脉病变19例,静脉性93例（胃底静脉曲张80例,门静脉13例）,肝脾穿刺道72例。根据病变血流速度及血流量不同,配制NBCA/Glubran-2胶与超液化碘油比例为1：2-1：4,对于血流速度较快、血流量较大者,预先用弹簧圈或球囊阻断部分血流后再行组织胶栓塞。根据并发症的严重程度分为轻度和重度并发症,统计此三类病变介入治疗中并发症的差异。结果三类病变（动脉性、静脉性、穿刺道）栓塞有效率分别为100%（19/19）、92.5%（86/93）、100%（72/72）。并发症总例数为16例（8.7%）,其中重度并发症3例,分别为肺栓塞、下肢缺血坏死及肠缺血坏死各1例,轻度并发症13例。三类病变并发症发生率存在统计学差异,由高至低为：动脉性（21.1%）、静脉性（10.8%）、穿刺道（2.8%）。结论在外周病变应用NBCA胶/Glubran-2胶栓塞治疗是一种安全有效的方法,掌握病变的血流特性能提高栓塞治疗的有效率,降低并发症发生率。     

脑动静脉畸形的血管内栓塞治疗

目的:探讨血管内栓塞治疗脑动静脉畸形(AVM)的效果。方法:2002年5月～2004年4月,对27例AVM患者(平均年龄30.1岁)进行了血管内栓塞治疗。13例患者首发症状表现为脑出血,7例首发癫痫。颅内杂音1例。血管畸形团位于幕上者26例,位于幕下者1例。根据Spetzler-Martin分级,I级2例,Ⅱ级10例,Ⅲ级11例,Ⅳ级4例。用氰基丙烯酸酯(NBCA)栓塞了13例,用弹簧圈栓塞了5例,用NBCA及弹簧圈联合栓塞了9例。4例患者栓塞后接受了开颅手术。结果:27例患者血管畸形团栓塞后体积平均减少73.1%,3例血管畸形团经介入治疗完全消失。所有患者术后未出现新的神经功能缺失,无死亡病例。结论:血管内栓塞治疗脑动静脉畸形安全、有效性好、并发症少,可以成为治疗脑AVM的主要手段。同时栓塞Spetzler-Martin高级别AVM的深部供血动脉可以降低手术的风险,提高治愈率。     

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(cAVM)的临床意义。方法:应用血管内栓塞治疗cAVM 23例,栓塞剂为NBCA或Onyx,栓塞后2例行显微手术治疗,4例行咖玛刀治疗。结果:畸形血管团完全消失5例,消失80%以上6例,60%~80%7例,60%以下5例。栓塞后1例发生脑出血。结论:血管内栓塞治疗cAVM的方法是安全的,可治愈部分cAVM,对于大型、重要功能区的cAVM,血管内栓塞联合手术或放疗可提高治愈率,降低致残率和病死率。     

经岩下窦介入栓塞海绵窦区硬脑膜动静脉瘘3例临床分析

目的 探讨经静脉人路栓塞治疗海绵窦区硬脑膜动静脉瘘的效果.方法 经股静脉-岩下窦入路到达病变侧海绵窦,用游离弹簧圈等多种栓塞材料填塞海绵窦,同时闭塞瘘口.结果 3例中全部愈或好转,1例在栓塞治疗后眼部症状消失.栓塞术后最常见症状为头痛伴呕吐.随访3个月到5年未见复发.结论 静脉入路栓塞治疗硬脑膜动静脉瘘是一种安全、有效的方法,应作为首选治疗方法.     

应用新型液体栓塞剂Onyx18治疗脑动静脉畸形

目的:探讨新型液体栓塞剂Onyx18在脑动静脉畸形血管内治疗的应用价值及技术要点。方法:采用Onyx18栓塞5例脑动静脉畸形,畸形血管团<3cm1例,3~6cm3例,>6cm1例;Spetzler-Martin分级:II级1例,III级2例,IV级2例。结果:2例完全栓塞,1例获90%栓塞,2例获75%栓塞。结论:较NBCA相比,Onyx18是治疗脑动静脉畸形较为理想的栓塞材料,需要掌握栓塞的技巧,减少并发症的发生,但是其长期疗效有待随访结果的验证。     

脊髓硬脊膜动静脉瘘的栓塞和手术治疗

目的:探讨硬脊膜动静脉瘘的治疗方法.方法:14例硬脊膜动静脉瘘患者中,6例以微粒栓塞,1例正丁基-2-氰基丙烯酸酯(NBCA)栓塞,7例手术治疗.结果:治疗后短期内症状均改善,随访6个月至5年手术和以胶栓塞患者均无复发,以微粒栓塞患者中有2例复发,其中1例手术治疗.结论:手术夹闭或以胶栓塞瘘口均可作为该病的有效治疗方法.     

Transvenous injection of n-Butyl cyanoacrylate combined with placement of coils in cavernous sinus for treatment of cavernous dural arteriovenous fistulae

Objective： To evaluate the technical aspects, efficacy and safety in the treatment of cavernous dural arteriovenous fistulae （DAVF） by transvenous liquid n-Butyl cyanoacrylate （NBCA） injection combined with coils placement in the cavemous sinus. Methods： Eight patients with cavernous DAVF, treated by transvenous embolization with combination of detachable coils and glue between February 2006 and February 2009 in our hospital, were retrospectively analyzed, including the clinical presentations, patterns of angioarchitecture, methods of treatment and the results of follow-up. Results： In all 8 patients, 9 transvenous and 1 transarterial interventions were carried out. A single endovascular procedure was performed in 6 patients and 2 patients had to be treated twice. Of the nine transvenous approaches, eight approaches were performed via inferior petrosal sinus （IPS） and 1 via the facial vein. Complete angiographic obliteration was achieved in all patients immediately after the embolization. There was no procedure-related morbidity except for mild headache for one to seven days after the embolization. Clinical cure was achieved in all cases during the clinical follow-up periods, ranging from 8 months to 3 years. The follow-up angiography periods averaged 6.6 months with a range of 5-9 months, in which no recurrence was observed. Conclusion： In this small series, embolization with combination of glue and detachable coils by transvenous approaches was a safe, effective and economical method for the treatment of part of symptomatic patients presenting with complex cavernous DAVE     

经动脉途径以低浓度氰基丙烯酸正丁酯栓塞硬脑膜动静脉瘘的疗效分析

目的 探讨经动脉途径以低浓度氰基丙烯酸正丁酯栓塞治疗硬脑膜动静脉瘘的技术方法和疗效。方法 采用低浓度（10％～20％）氰基丙烯正丁酯（NBCA）经供血动脉对18例不同部位硬膜动静脉瘘患者进行栓塞治疗。18例患者中海绵窦区硬膜动静脉瘘12例，顶部硬膜动静脉瘘6例。该技术的关键操作方法是将低浓度NBCA注入静脉端使之闭塞并反流入其他供血动脉。结果 18例患者中17例在栓塞后达到解剖治愈，术后临床症状消失。另1例通过海绵窦区硬膜动静脉瘘栓塞后一度症状好转，2d后症状加重，复查造影发现静脉未完全闭塞，回流静脉发生改变，经压颈10d后症状明显好转。结论 经动脉途径以低浓度NBCA栓塞治疗硬脑膜动静脉瘘对于有些病例是较好的选择，其特点是低廉、快捷，疗效满意。     

Endovascular embolization of pulmonary arteriovenous malformations

Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood oxygen saturation between 85% and 90%. Symptoms of hypoxia never recurred in the other cases. Conclusions Endovascular embolization of pulmonary arteriovenous malformations can significantly improve blood oxygen saturation and reduce serious complications such as cerebral infaction. Therefore, this kind of interventional procedure is a safe and effective treatment method with a low complication rate.