混合性脑膜－脑动静脉畸形的血管内栓塞治疗

报告１８例大、中型混合性脑膜－脑动静脉畸形的诊断和血管内治疗。本组均经股动脉或同侧颈动脉置入微导管，采用微钨螺旋圈和氰基丙烯酸酯胶（ＮＢＣＡ，ＩＢＣＡ）或聚乙烯醇颗粒等材料栓塞脑内和脑膜的畸形血管。其中７例经两次栓塞后，畸形血管团消除８０％～９５％；随访３个月至３年，临床头痛及癫痫均得到缓解，未再发生蛛网膜下腔出血。本组资料表明，头痛是脑膜－脑动静脉畸形的重要症状之一；微钨螺旋圈与ＮＢＣＡ或１ＢＣＡ混合栓塞脑内畸形血管团有助于提高栓塞效果；分期栓塞和控制术中与术后的体循环血压可预防或减少栓塞并发症。

Endovascular treatment of mixed dural and cerebral arteriovenous malformations

The endovascular treatment and diagnosis of 18 cases with mixed dural cerebral arteriovenous malformation are reported.Superselective embolization of malformated vassels of brain and dura were performed with tungsten microcoils,Isobutyl 2-cyanoacrylate(IBCA) or N-butyl cyanoacrylate(NBCA )and polyvinyl alcohol particles via both routes of transfemoral and ipsolateral carotid artery for catheterizing in all patients;The malformated nidi were eliminated 80%-95%in 7 of 18 cases after second embolization.Following up 3 months to 3 years, headache and epilepsy seizure were clinically relieved and no more subarachnoid hemorrhage was found in our group. The information shows that mixed embo\lization with microcoils and IBCA or NBCA are available for improving effect of treatment. Staged embolization and control the systemic blood pressure during and postoperation could prevent and reduce embolized complication. Headache is a kind of main sympom in mixed dural and cerebral arteriovenous malformation.