摘要
目的探讨Onyx胶主导栓塞脑动静脉畸形(arteriovenous malformation,AVM)的疗效。方法2015年9月~2017年10月我科应用Onyx胶栓塞84例AVM,其中Speztler-Martin(S-M)分级Ⅰ级10例,Ⅱ级32例,Ⅲ级22例,Ⅳ级18例,Ⅴ级2例。单纯Onyx胶栓塞67例,联合Glubran胶和(或)弹簧圈栓塞17例。结果S-MⅠ级完全栓塞治愈率60.0%(6/10),Ⅱ~Ⅲ级33.3%(18/54),Ⅳ~Ⅴ级25.0%(5/20),完全栓塞率34.5%(29/84)。术中微导管断管、留置各1例,术中出血1例,术后出血4例((3例保守治疗成功,1例死亡),无新发神经功能障碍,并发症发生率8.3%(7/84)。83例随访3~30个月,中位随访时间7.5月,再次出血4例,其中死亡1例;完全栓塞的29例无一例复发或再生;栓塞导致出血的5例除1例死亡外,其余均恢复良好。结论Onyx胶联合不同栓塞材料个体化治疗脑AVM,可以获得较为满意的效果。
Objective To investigate the treatment of Onyx embolization for intracranial arteriovenous malformation( AVM).Methods Clinical data of 84 patients with AVM were embolized with Onyx in our hospital from September 2015 to October 2017.Among them,there were 10 cases of Speztler-Martin( S-M) grade Ⅰ,32 cases of grade Ⅱ,22 cases of grade Ⅲ,18 cases of gradeⅣ,and 2 cases of grade Ⅴ. There were 67 cases embolized with Onyx only,and 17 cases treated with combined Glubran and/or coils embolization. Results The complete embolization rate of grate Ⅰ patients was 60. 0%( 6/10),of grade Ⅱ-Ⅲ patients was 33%( 18/54),of grade Ⅳ-Ⅴ patients was 25. 0%( 5/20). And the total embolization rate was 34. 5%( 29/84). There were 1 case of intraoperative microcatheter breaking off,1 case of indwelling microcatheter,1 case of intraoperative bleeding,and 4 cases of postoperative bleeding( conservative treatment was successful in 3 cases and 1 case died). No new neurological deficit or original symptom deterioration was seen. The complication rate was 8. 3%( 7/84). A total of 83 cases were followed up for 3-30 months( median,7. 5 months). There were 4 cases of re-bleeding and 1 case of them died. Among the 28 cases with complete embolization,no recurrence was seen. The patients with hemorrhage caused by embolization recovered well except for 1 fatal case.Conclusion Onyx glue combined with different embolization materials in the treatment of intracranial AVM can achieve satisfactory efficacy.
作者
王威
盖延廷
简新革
李彦江
檀书斌
彭方强
刘旻谛
宋冬雷
Wang Wei;Gai Yanting;Jian Xinge(Department of Neurosurgery,Brain Doctor Group,Shanghai Punan Hospital,Shanghai 200125,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第6期498-501,共4页
Chinese Journal of Minimally Invasive Surgery
基金
上海市浦东新区科技发展基金(PKJ2016-Y06)
关键词
脑血管动静脉畸形
治愈性栓塞
ONYX胶
可解脱微导管
高压锅技术
Cerebral arteriovenous malformation
Curable embolization
Onyx glue
Detachable microcatheter
Pressure cooker technology
