Onyx液态栓塞剂在脑动静脉畸形治疗中的应用及栓塞后处理的探讨

目的 总结探讨Onyx胶在脑动静脉畸形(AVM)栓塞治疗中的应用及栓寨后治疗.方法 共21例DSA确诊的脑AVM患者,采用Onyx胶治疗;根据栓塞程度行栓塞后处理(随访、立体定向放射治疗、显微手术等).结果 影像学完全栓塞8例(38%),其中术后少最蛛网膜下腔出血1例;次全栓塞4例(19%),1例术后重度脑水肿去骨瓣后因颅内感染自动出院失访,随访观察1例,伽玛刀治疗2例;部分栓塞9例(43%),其中5例手术完全切除,2例伽玛刀治疗,另2例随访观察,其中1例术后3个月出现脑室内出血.结论 Onyx液态栓塞剂有较好的弥散性和可控性,能有效改善脑AVM的栓塞效果,对次全栓塞者可选择随访观察或伽玛刀治疗,部分栓塞者应首先考虑手术切除.

Brain AVM embolization with Onyx and post-embolic management

Objective To report our experience in the treatment of brain arteriovenous malformations (BAVMs)with Onyx and discuss the post-embolic management. Methods 21 BAVMs patients confirmed by angiography Were embolized with Onyx and dealed with subsequent treatment(follow-up,stereotactic radiosurgery or microsurgery)according to the embolization results.Results Eight cases (38%)were completely obliterated after embolization while one case suffered a small subarachnoid hemorrhage.Four cases(19%)were subtotally embolized while one patient suffered severe cerebral edema after embolization and further intracranial infection after decompressive craniectomy who was lost for follow-up,2 patients had additional radiosurgery and 1 patient had follow-up.Nine patients(43%)were partially embolized,5 patients had additional surgery,2 patients had additional radiosurgery and 2 patients had follow-up(1 patient had intraventricular hemorrhage 3 months after embolization).Conclusions onyx is suitable in the embolization of BAVMs for its diffuse and controllable properties.Additional radiosurgery or follow-up is suggested after subtotal embolization and additional surgery should be firstly considered after partially embolization.