摘要
目的探讨应用无水乙醇治疗脑动静脉畸形(bAVM)的可行性。方法回顾性分析2018年9月至2019年5月在河南省人民医院颅内血管畸形专科应用无水乙醇治疗的25例bAVM患者的临床资料,男14例,女11例,年龄7~62岁,中位年龄26岁。其中破裂bAVM 18例,未破裂bAVM 7例;Spezler-Martin分级<Ⅲ级14例,Ⅲ级7例,>Ⅲ级4例。观察临床效果及围手术期并发症情况等。结果 25例患者的总体技术成功率为96.0%(24/25),其中1例患者用无水乙醇不能消融靶病变。总体并发症发生率为28.0%(7/25),均为缺血并发症,其中严重并发症发生率为12.0%(3/25),无死亡病例。术后3个月对25例患者进行随访,4例轻度并发症患者中,2例症状完全恢复,2例基本恢复;3例严重并发症患者中,2例基本恢复,1例明显好转,所有并发症患者的脑卒中神经功能恢复状态量表评分≤2分,其余18例患者无新发临床症状。13例接受DSA和MRI的影像学随访,DSA显示无水乙醇消融过的病变部位均无复发,2例术后即刻有畸形巢部分残留的患者,复查时残留畸形完全消失,MRI显示所有患者脑水肿均消失。结论应用无水乙醇消融bAVM技术操作成功率高,临床疗效确切,术后bAVM复发率低,可作为一种探索性的治疗手段。
Objective To investigate the feasibility of absolute ethanol in the treatment of brain arteriovenous malformation(bAVM).Methods The clinical data of 25 patients with bAVM treated with absolute ethanol in the specialty of intracranial vascular malformations in Henan Provincial People′s Hospital from September 2018 to May 2019 were retrospectively analyzed.There were 14 males and 11 females,aged 7-62 years,with a median age of 26 years.Among the 25 patients,18 cases had ruptured bAVM,7 cases had unruptured bAVM.Spezler-Martin grade<Ⅲwere found in 14 cases,Ⅲgrade in 7 cases,and>Ⅲgrade in 4 cases.The clinical effect and perioperative complications were observed.Results Among 25 patients,the overall technical success rate was 96.0%(24/25),one of which the target lesion with anhydrous ethanol could not be ablated.The overall complication rate was 28.0%(7/25)with no death.All complications were ischemic,and the incidence of severe complications was 12.0%(3/25).Twenty-five patients were followed up 3 months after the operation,4 of which had mild complications,2 recovered completely and 2 made reasonable recovery.In the 3 patients with severe complications,2 patients made reasonable recovery and 1 patient had significant improvement.The modified rankin scale(MRS)score of all patients with complications was≤2,and the remaining 18 patients had no new onset clinical symptoms.Thirteen patients were followed up by DSA and MRI.DSA showed no recurrence in the lesions ablated by absolute ethanol.In 2 patients with partial residual malformation after operation,the residual deformities disappeared completely at the time of reexamination.MRI showed that brain edema disappeared in all patients.Conclusions The ablation of absolute ethanol in bAVM has a high operation success rate,definite clinical effect and low recurrence rate of postoperative bAVM.It can be used as an exploratory treatment.
作者
许斌
白卫星
贺迎坤
康晓雨
李天晓
Xu Bin;Bai Weixing;He Yingkun;Kang Xiaoyu;Li Tianxiao(Subspecialty of Intracranial Vascular Malformation,Henan Provincial People′s Hospital,Henan Cerebrovascular Disease Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2020年第12期1202-1206,共5页
Chinese Journal of Radiology
