血管内栓塞治疗脑动静脉畸形369例

【目的】评价应用α- 氰基丙烯酸正丁酯(NBCA)血管内栓塞治疗脑动静脉畸形(AVMs)的效果。【方法】经股动脉插管用微导管技术超选择注入病灶NBCA栓塞治疗脑AVMs,共369例。男159例,女210例,年龄4~75岁,平均32. 4岁。首发症状头痛头晕246例,癫痫发作48例,意识障碍(昏迷) 36例,肢体麻木16例,肢体无力(偏瘫)23例。AVM的直径1. 5~8cm,其中病变大于6cm者141例, 3 ~6cm者194例,小于3cm者34例。单支供血动脉58例, 2支108例, 3支以上203例。栓塞加手术切除巨大型脑AVMs27例。【结果】完全栓塞病变74例, 90%以上104例, 70% ~90% 129例, 50% ~70% 51例,栓塞<50%者11例。【结论】NBCA应作为栓塞治疗脑AVMs的首选材料。根据脑AVM的部位、大小以及供血动脉数,酌情选择血管内栓塞、手术切除、栓塞加手术切除、γ-刀或栓塞加γ-刀治疗。

The Endovascular Therapy of the Brain Arteriovenous Malformations (AVMs) in 369 Cases

To determine the safety and efficacy of embolization of intracranial arteriovenous malformations (AVMs) with N-Butylcyanoacrylate (NBCA).The treatment of 369 consecutive patients with intracerebral AVMs was retrospectively reviewed. Embolic therapy was conducted by introducing the tip of a microcatheter through femoral artery into the nidus and injecting NBCA. The nidi of 246 cases located in celebral hemisphere,48 casesin cerebellar hemisphere 48 cases.The overall size of the nidus was measured, >6cm in 141cases, 3~6cm in 194 cases, <3cm in 34 cases.With a single arterial territory supply in 58 cases, two in 108 cases, three in 203 cases.Twenty-seven cases of giant AVMs were conducted of the combined use of embolization and surgery.Postembolization angiography confirmed complete nidus obliteration in 74 patients, 104 cases were effectively devascularized (>90%), 70%~90% in 129cases, 50%~70% in 51 cases, <50% in 11 cases.[Conclusion]The embolization of brain AVMs with NBCA is safe and effective, thus NBCA should be considered useful as a first important embolization material. It is likely that the combined uses of endovascular therapeutic embolization with surgical excision or radiosurgery such as gamma knife are very effective methods in treating intracranial arteriovenous malformations.