Han M H, Seong S O, Kim H D, Chang K H, Yeon K M, Han M C
Department of Diagnostic Radiology, Seoul National University Hospital, Korea.
Radiology. 1999 Jun;211(3):661-6. doi: 10.1148/radiology.211.3.r99jn07661.
To evaluate the use of n-butyl cyanoacrylate (NBCA) for preoperative embolization of craniofacial arteriovenous malformation.
Fourteen patients with craniofacial arteriovenous malformation (forehead [n = 9], deep facial [n = 3], occipital [n = 1], or lip [n = 1] lesion) were treated with injection of NBCA. Forehead lesions were supplied by ophthalmic (n = 6) and/or superficial temporal arteries (n = 7); and facial and scalp lesions, by bilateral internal maxillary (n = 4), facial (n = 2), and/or occipital arteries (n = 1). Lesions were percutaneously punctured with a 20-gauge needle in the area of arteriovenous connection. Direct angiography was performed before and after compression of venous drainage, and NBCA diluted 30%-50% with iodized oil was injected during venous compression.
Postembolization arteriograms showed that six lesions were completely devascularized after single or multiple (one to nine) injections, and five were effectively devascularized (> or = 90%). Although three lesions were 60%-70% devascularized after injection, two of these were successfully extirpated with no notable blood loss. In nine patients, the ophthalmic arterial supply had disappeared after embolization. There were no procedure-related complications.
Direct-puncture embolization with NBCA is an effective and safe technique for preoperative devascularization of craniofacial arteriovenous malformation. For safe and effective devascularization, compression of draining venous channels is thought to be important.
评估氰基丙烯酸正丁酯（NBCA）在颅面部动静脉畸形术前栓塞中的应用。
14例颅面部动静脉畸形患者（前额部病变9例、面部深部病变3例、枕部病变1例、唇部病变1例）接受了NBCA注射治疗。前额部病变由眼动脉（6例）和/或颞浅动脉（7例）供血；面部和头皮病变由双侧上颌内动脉（4例）、面动脉（2例）和/或枕动脉（1例）供血。在动静脉连接区域用20号针经皮穿刺病变。在压迫静脉引流前后进行直接血管造影，并在静脉压迫期间注射用碘化油稀释30%-50%的NBCA。
栓塞后血管造影显示，6个病变在单次或多次（1至9次）注射后完全去血管化，5个病变有效去血管化（≥90%）。虽然3个病变在注射后去血管化60%-70%，但其中2个成功切除且无明显失血。9例患者栓塞后眼动脉供血消失。无与手术相关的并发症。
NBCA直接穿刺栓塞是颅面部动静脉畸形术前去血管化的一种有效且安全的技术。为实现安全有效的去血管化，压迫引流静脉通道被认为很重要。
