血管内栓塞治疗脑动静脉畸形合并动脉瘤
|
摘要
目的探讨血管内栓塞治疗脑动脉畸形合并动脉瘤的价值。方法收集46例脑动静脉畸形合并动脉瘤患者,对Redekop分型为Ⅱa型和Ⅲ型患者(A组)以Onyx胶联合弹簧圈进行栓塞,Redekop分型Ⅰ型和Ⅱb型患者(B组)以Onyx胶联合弹簧圈或单纯Onyx胶进行栓塞,以格拉斯哥转归量表(GOS)评分评估手术疗效。术后3个月复查脑血管造影,观察病灶有无复发。结果 A组患者术后GOS评分为(4.70±0.47)分;B组患者中,以Onyx胶联合弹簧圈栓塞患者GOS评分[(4.75±0.45)分]明显高于单纯Onyx胶栓塞者[(4.33±0.49)分;t=2.159,P=0.042]。1例患者死亡,其余45例患者术后3个月后复查脑血管造影均未见复发。结论血管内栓塞治疗脑动静脉畸形合并动脉瘤疗效好,以Onyx胶联合弹簧圈疗效优于单纯Onyx胶栓塞。
Objective To investigate the value of endovascular embolization in treatment of brain arteriovenous malformation(BAVM)combined with aneurysms.Methods Totally 46 patients with brain arteriovenous malformation combined with aneurysm were enrolled.Patients with Redekop typeⅡa andⅢ BAVM were embolized with Onyx combined with coils(group A),while with Redekop typeⅠ andⅡb BAVM were embolized with Onyx combined with coil or only Onyx(group B).Then the effect of embolization was evaluated using Glasgow outcome scale(GOS)score.Cerebral angiography was reviewed 3 months after treatment to observe whether the lesions recurred or not.Results The postoperative GOS of group A was 4.70±0.47.In group B,GOS of patients embolized with Onyx combined with coil(4.75±0.45)was significantly higher than those with only Onyx(4.33±0.49;t=2.159,P=0.042).One patient died,45 patients underwent cerebral angiography after 3 months,and no recurrence was found.Conclusion Endovascular embolization is effective for brain arteriovenous malformation with aneurysms,and embolization using Onyx combined with coil is better than only Onyx embolization.
Objective To investigate the value of endovascular embolization in treatment of brain arteriovenous malformation(BAVM)combined with aneurysms.Methods Totally 46 patients with brain arteriovenous malformation combined with aneurysm were enrolled.Patients with Redekop typeⅡa andⅢ BAVM were embolized with Onyx combined with coils(group A),while with Redekop typeⅠ andⅡb BAVM were embolized with Onyx combined with coil or only Onyx(group B).Then the effect of embolization was evaluated using Glasgow outcome scale(GOS)score.Cerebral angiography was reviewed 3 months after treatment to observe whether the lesions recurred or not.Results The postoperative GOS of group A was 4.70±0.47.In group B,GOS of patients embolized with Onyx combined with coil(4.75±0.45)was significantly higher than those with only Onyx(4.33±0.49;t=2.159,P=0.042).One patient died,45 patients underwent cerebral angiography after 3 months,and no recurrence was found.Conclusion Endovascular embolization is effective for brain arteriovenous malformation with aneurysms,and embolization using Onyx combined with coil is better than only Onyx embolization.
引文
[1]Alshahi R,Warlow C.A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.Brain,2001,124(Pt 10):1900-1926.
[2]Redekop G,Terbrugge K,Montanera W,et al.Arterial aneurysms associated with cerebral arteriovenous malformations:Classification,incidence,and risk of hemorrhage.J Neurosurg,1998,89(4):539-546.
[3]Saeed KM,Izaaryene J,Cohen F,et al.Ethylene vinyl alcohol copolymer(Onyx?)in peripheral interventional radiology:Indications,advantages and limitations.Diagn Interv Imaging,2015,96(4):319-326.
[4]Crowley RW,Ducruet AF,Mcdougall CG,et al.Endovascular advances for brain arteriovenous malformations.Neurosurgery,2014,74(Suppl 1):74-82.
[5]贺红卫.脑动静脉畸形出血相关的血管构筑因素研究.中华神经外科杂志,2005,21(12):717-720.
[6]邱修辉,李光标,罗毅,等.Onyx胶在脑动静脉畸形的介入栓塞治疗中的临床分析.赣南医学院学报,2016,36(2):215-217.
[7]王坤,赵卫,胡继红,等.介入栓塞治疗未破裂动脉瘤合并脑动静脉畸形.中国介入影像与治疗学,2017,14(6):355-359.
[8]白卫星,贺迎坤,李天晓,等.颈内静脉入路血管内根治性栓塞治疗脑动静脉畸形的可行性研究.中华放射学杂志,2018,52(2):131-134.
[9]Gabrieli J,Claren9on F,Di Maria F,et al.Fatal rupture of a brain arteriovenous malformation flow-related aneurysm during microcatheter removal:A rare complication.J Neurosurg,2015,122(4):929-932.
[10]Kano H,Kondziolka D,Flickinger JC,et al.Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations.Stroke,2012,43(10):2586-2591.
[11]Zhu G,Li X,He X,et al.Endovascular treatment of cerebellararteriovenous malformations:Management of associated aneurysms first or later.Neurol Sci,2016,37(1):67-72.
[12]饶强,段传志,刘晓平,等.脑动静脉畸形合并出血相关影响因素分析.中华神经医学杂志,2011,10(4):397-401.
[2]Redekop G,Terbrugge K,Montanera W,et al.Arterial aneurysms associated with cerebral arteriovenous malformations:Classification,incidence,and risk of hemorrhage.J Neurosurg,1998,89(4):539-546.
[3]Saeed KM,Izaaryene J,Cohen F,et al.Ethylene vinyl alcohol copolymer(Onyx?)in peripheral interventional radiology:Indications,advantages and limitations.Diagn Interv Imaging,2015,96(4):319-326.
[4]Crowley RW,Ducruet AF,Mcdougall CG,et al.Endovascular advances for brain arteriovenous malformations.Neurosurgery,2014,74(Suppl 1):74-82.
[5]贺红卫.脑动静脉畸形出血相关的血管构筑因素研究.中华神经外科杂志,2005,21(12):717-720.
[6]邱修辉,李光标,罗毅,等.Onyx胶在脑动静脉畸形的介入栓塞治疗中的临床分析.赣南医学院学报,2016,36(2):215-217.
[7]王坤,赵卫,胡继红,等.介入栓塞治疗未破裂动脉瘤合并脑动静脉畸形.中国介入影像与治疗学,2017,14(6):355-359.
[8]白卫星,贺迎坤,李天晓,等.颈内静脉入路血管内根治性栓塞治疗脑动静脉畸形的可行性研究.中华放射学杂志,2018,52(2):131-134.
[9]Gabrieli J,Claren9on F,Di Maria F,et al.Fatal rupture of a brain arteriovenous malformation flow-related aneurysm during microcatheter removal:A rare complication.J Neurosurg,2015,122(4):929-932.
[10]Kano H,Kondziolka D,Flickinger JC,et al.Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations.Stroke,2012,43(10):2586-2591.
[11]Zhu G,Li X,He X,et al.Endovascular treatment of cerebellararteriovenous malformations:Management of associated aneurysms first or later.Neurol Sci,2016,37(1):67-72.
[12]饶强,段传志,刘晓平,等.脑动静脉畸形合并出血相关影响因素分析.中华神经医学杂志,2011,10(4):397-401.