出血性脑动静脉畸形合并动脉瘤的栓塞治疗

目的 探讨出血性脑动静脉畸形合并动脉瘤的特点与血管内治疗的方法.方法 经CT或MRI确认脑出血的病例,经全脑血管造影证实为脑动静脉畸形(AVM)合并动脉瘤为36例患者,根据AVM病灶和动脉瘤的特点,采取不同的栓塞策略,经血管内超选择应用α氰基丙烯酸正丁酯、ONYX胶或弹簧圈栓塞畸形团和动脉瘤.结果 栓塞后35例动脉瘤完全栓塞,AVM病灶完全消除26例;1例残留AVM因引流静脉狭窄术后1年发生出血,行血肿清除并AVM病灶切除术治愈;另1例因残余病灶接受伽玛刀治疗3个月时发生出血,保守治疗后行2次栓塞治愈.结论 AVM病灶内或病灶旁存在动脉瘤是引起脑出血的重要原因,在栓塞前制定栓塞策略,优先处理动脉瘤样病变对防止脑出血有重要意义.

The strategy of endovascular embolization for aneurysm in hemorrhagic cerebral arteriovenous malformations

Objective To discuss the characters and the technical strategy of endovascular embolization for aneurysm in cerebral AVM with bleeding.Method 36 cases with cerebral hemorrhage,confirmed by CT,MRI,were diagnosed by cerebral DSA.Depending on the feature of the nidus of AVM and the aneurvsms,the methods of superselective endovascular embolization with NBCA,Onyx or coils for nidus and aneurysms were used.Resuits The aneurusms in 35 cases and nidus in 26 cases were eliminated from 36 cases after embolization.The rebleeding was found in 2 cases.one with draining vein stricture,the others accepted gamma radiotherapy,who were cured by nidus resection or reembolization.Conclusions Intranidal or side-nidus aneurysm were the important causes of AVM bleeding.To prevent the brain from bleeding,it is favourable to formulate embolization strategy to eliminate the aneurysm in AVM preferentially during embolization.