血管内栓塞后伽玛刀治疗大型脑动静脉畸形

目的 探讨血管内栓塞与伽玛刀联合治疗大型脑动静脉畸形的疗效。 方法 选择脑动静脉畸形血管团直径>6 cm的大型脑动静脉畸形患者26例,首先进行血管内栓塞治疗,再行脑血管造影,了解栓塞程度,对于栓塞不完全者在1周内行伽玛刀治疗。 结果 26例患者,随访2-4年,无1例出现再出血,恢复正常生活14例,症状明显改善6例,症状改善不明显4例,2例因放射水肿症状加重,经脱水治疗后好转。MRI、DSA或MRA复查显示:1年畸形团闭塞率为26.9％(7／26);2年为53.9％(14／26);3年为69.2％(18／26);4年为76.9％(20／26)。结论 血管内栓塞结合伽玛刀治疗大型脑动静脉畸形疗效肯定,可提高治愈率,降低并发症及死亡率。

Treatment of the giant cerebral AVM with the gamma knife after embolization

Objective To investigate the therapeutic effects of giant cerebral arteriovenous malformation (AVM) treated with the gamma knife after embolization. Methods 26 cases with diameter of AVM larger than 6cm were treated. The embolizations were supervised with DSA. After embolization, the extent of occlusion were evaluated by DSA. Then the unocclusive part of AVM were treated with the gamma knife within 1 week after embdization. Results Follow-up was accomplished in 26 cases for a duration of 2 - 4 years. It showed that none rebleeding, regaining the normal labor ability in 14 cases, symptoms improved apparently in 6 cases, symptoms had no obvious change in 4 cases. 2 cases were aggravated for radioactive edema, the symptoms were improved after using of corticosteroids and mannitol. The follow-up of DSA or MRA showed: 1-year complete obliteration rate of AVM was 26.9% (7/26); 2-year complete obliteration rate was 53.9% (14/26); 3-year complete obliteration rate was 69. 2% (18/26); 4-year complete obliteration rate was 76. 9% (20/26). Conclusion Combined intravascular embolization with gamma knife is a safe and effective method in treating giant cerebral AVM. This method can increase the curability rate, reduce the complication and mortality rate.