丙泊酚Wada试验在脑功能区动静脉畸形栓塞中的应用
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摘要
目的探讨超选Wada试验在脑功能区动静脉畸形栓塞中的应用效果。方法回顾性分析2013年5月至2016年5月收治的36例脑功能区动静脉畸形的临床资料,术前进行超选造影并用丙泊酚在超选的动脉完成Wada试验,再选择Onyx胶栓塞畸形血管团。结果 Wada试验中,3例出现抽搐、颤抖或不随意运动而放弃栓塞,7例出现运动障碍、4例语言障碍、2例记忆障碍而放弃栓塞治疗;其余20例共栓塞24次,每例栓塞l~3次,平均1.2次,完全栓塞8例。栓塞的20例中,发生缺血性并发症1例,无出血性并发症;术后随访2~23个月,无死亡病例,轻度神经功能障碍1例。结论动脉超选行Wada试验进后,行脑功能区动静脉畸形的栓塞,可减少术后并发症的发生率。
ObjectiveTo investigate the effect of the super-selective Wada testing with propofol on the embolization of niduese infunctional regions of the cerebral cortex in the patients with cerebral arteriovenous malformations(AVM).MethodThe clinical data of36 patients with cerebral AVM in the functional regions hospitalized from May, 2013 to May, 2016 were analyzed retrospectively. TheWada testing with propofol was performed during the super-selective cerebral artery angiography in all the patients, and then theniduese were embolized with Onyx glue according to the results of the Wada testing.ResultsOf 36 patients with cerebral AVM, 20 received endovascular embolization and 16 did not due to the adverse reactions to Wada testing including convulsions and movementand language disorders. The niduese were completely embolized in 8 patients and incompletely in 12 patients. Of the 20 patients withembolization by Onyx glue, 1 had ischemic stroke, 1 mild neurological dysfunction and 18 were recovered well during the following-upfrom 2 to 23 months after the embolization.ConclusionThe super-selective Wada testing may be helpful to reducing the incidence ofpost-embolization complications in the patients with cerebral AVM in the functional regions.
ObjectiveTo investigate the effect of the super-selective Wada testing with propofol on the embolization of niduese infunctional regions of the cerebral cortex in the patients with cerebral arteriovenous malformations(AVM).MethodThe clinical data of36 patients with cerebral AVM in the functional regions hospitalized from May, 2013 to May, 2016 were analyzed retrospectively. TheWada testing with propofol was performed during the super-selective cerebral artery angiography in all the patients, and then theniduese were embolized with Onyx glue according to the results of the Wada testing.ResultsOf 36 patients with cerebral AVM, 20 received endovascular embolization and 16 did not due to the adverse reactions to Wada testing including convulsions and movementand language disorders. The niduese were completely embolized in 8 patients and incompletely in 12 patients. Of the 20 patients withembolization by Onyx glue, 1 had ischemic stroke, 1 mild neurological dysfunction and 18 were recovered well during the following-upfrom 2 to 23 months after the embolization.ConclusionThe super-selective Wada testing may be helpful to reducing the incidence ofpost-embolization complications in the patients with cerebral AVM in the functional regions.
引文
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[6]Ledezma CJ,Hoh BL,Carter BS,et al.Complications of cerebral arteriovenous malformation embolization:multivariate analysis of predictive factors[J].Neurosurgery,2006,58(4):602-611.
[7]栾立明,葛明旭,薛艳,等.应用Onyx栓塞脑动静脉畸形44例临床分析[J].医学影像杂志,2007,17(7):667-670.
[8]Maimont S,Strauss I,Frolov V,et al.Brain arteriovenous malformation treatment using a combination of Onyx and a new detachable tip microcatheter.SONIC:short-term results[J].Am J Neuroradiol,2010,31(5):947-954.
[9]Blackburn SL,Ashley WW Jr,Rich KM,et al.Combined endovascular embolization and stereotactic radiosurgery in the treatment of large arteriovenous malformations[J].J Neurosurg,201l,114(6):1758-1767.
[10]吴红星,白晋,刘杰,等.Onyx栓塞治疗脑动静脉畸形出血性并发症的初步分析[J].中华神经外科杂志,2012,28(3):264-267.
[11]徐建林,周兵,陈书达,等.脑动静脉畸形介入栓塞后并发症发生的相关危险因素分析[J].浙江医学,2010,32(4):454-456.
[12]Mikuni N,Takayama M,Satow T,et al.Evaluation of adverse effects in intracarotid propofol injection for Wada test[J].Neurology,2005,65(11):1813-1816.
[2]温玉东,魏建军.Onyx在脑动静脉畸形中应用进展[J].介人放射学杂志,2010,19(11):92l-924.
[3]Hauck EF,Welch BG,White JA,et al.Preoperative embolization of cerebral alteriovenous malformations with onyx[J].Am J Neuroradiol,2009,30(3):492-495.
[4]Mounayer C,Hammami N,Piotin M,et al.Nidal embolization of brain arteriovenous malformations using Onyx in 94patients[J].Am J Neuroradiol,2007,28(3):518-523.
[5]Panagiotopoulos V,Gizewski E,Asgari S,et al.Embolization of intracranial arteriovenous malfommations with ethylenevinyl alcohol copolymer(Onyx)[J].Am J Neuroradiol,2009,30(1):99-106.
[6]Ledezma CJ,Hoh BL,Carter BS,et al.Complications of cerebral arteriovenous malformation embolization:multivariate analysis of predictive factors[J].Neurosurgery,2006,58(4):602-611.
[7]栾立明,葛明旭,薛艳,等.应用Onyx栓塞脑动静脉畸形44例临床分析[J].医学影像杂志,2007,17(7):667-670.
[8]Maimont S,Strauss I,Frolov V,et al.Brain arteriovenous malformation treatment using a combination of Onyx and a new detachable tip microcatheter.SONIC:short-term results[J].Am J Neuroradiol,2010,31(5):947-954.
[9]Blackburn SL,Ashley WW Jr,Rich KM,et al.Combined endovascular embolization and stereotactic radiosurgery in the treatment of large arteriovenous malformations[J].J Neurosurg,201l,114(6):1758-1767.
[10]吴红星,白晋,刘杰,等.Onyx栓塞治疗脑动静脉畸形出血性并发症的初步分析[J].中华神经外科杂志,2012,28(3):264-267.
[11]徐建林,周兵,陈书达,等.脑动静脉畸形介入栓塞后并发症发生的相关危险因素分析[J].浙江医学,2010,32(4):454-456.
[12]Mikuni N,Takayama M,Satow T,et al.Evaluation of adverse effects in intracarotid propofol injection for Wada test[J].Neurology,2005,65(11):1813-1816.