Weber Werner, Kis Bernhard, Siekmann Ralf, Jans Paul, Laumer Rudolf, Kühne Dietmar
Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Essen, Germany.
Neurosurgery. 2007 Aug;61(2):244-52; discussion 252-4. doi: 10.1227/01.NEU.0000255473.60505.84.
Preoperative embolization in accordance with multimodal therapies for cerebral arteriovenous malformations (AVMs) is generally the first step in treatment and may result in complete obliteration. The Onyx liquid embolic system (Micro Therapeutics, Inc., Irvine, CA) may offer advantages for intranidal targeted embolization and microsurgical resection. We present our experience in the combined treatment of intracranial AVMs using Onyx embolization and neurosurgical resection.
We treated a total of 47 patients for compact intracranial AVMs that were located in the frontal or frontoparietal area (16 patients); temporal, temporoparietal, or temporo-occipital regions (12 patients); parietal or parieto-occipital areas (8 patients); occipital regions (8 patients); had basal ganglia involvement (2 patients); and was cerebellar (1 patient). The Spetzler-Martin grading scale values were as follows: 25 patients were Grades I or II, 10 patients were Grade III, and 12 patients were Grades IV or V. Twenty-three AVMs were located in eloquent brain regions.
After we performed final embolizations, the mean nidus reduction was 84%. Seven patients had new, nondisabling neurological deficits, and four patients had new, disabling neurological deficits after embolization. Periprocedurally, five vessel perforations and four stuck microcatheters were encountered without clinical deficits. In two patients, delayed hemorrhage after embolization occurred with good clinical outcome. We completely resected 46 AVMs; in one patient, we detected an AVM on postoperative angiography. The mean operative time was 4.7 hours, and the mean blood loss was 455 mL. Clinical status worsened postoperatively in 14 patients. Angiographic and clinical follow-up examinations were available for 42 patients (89%); the average follow-up period was 13 months. We found no relapse of arteriovenous shunt. Fourteen patients improved clinically after discharge. Of the 42 patients followed up, 23 individuals had no neurological deficit, 16 had a nondisabling deficit, and three had a disabling deficit.
Preoperative use of the Onyx liquid embolic system in cerebral AVM treatment allows profound occlusion by targeted embolization and provides a basis for safe neurosurgical resection.
按照多模式疗法对脑动静脉畸形（AVM）进行术前栓塞通常是治疗的第一步，可能会导致完全闭塞。Onyx液体栓塞系统（微治疗学公司，加利福尼亚州欧文市）可能为瘤内靶向栓塞和显微手术切除带来优势。我们介绍使用Onyx栓塞和神经外科切除联合治疗颅内AVM的经验。
我们共治疗了47例致密性颅内AVM患者，这些AVM位于额叶或额顶叶区域（16例）；颞叶、颞顶叶或颞枕叶区域（12例）；顶叶或顶枕叶区域（8例）；枕叶区域（8例）；累及基底节（2例）；以及小脑（1例）。斯佩茨勒-马丁分级量表值如下：25例为Ⅰ级或Ⅱ级，10例为Ⅲ级，12例为Ⅳ级或Ⅴ级。23个AVM位于功能区脑区。
在进行最终栓塞后，平均瘤体缩小率为84%。7例患者出现新的、非致残性神经功能缺损，4例患者在栓塞后出现新的、致残性神经功能缺损。在围手术期，遇到5处血管穿孔和4根微导管堵塞，但无临床缺损。2例患者栓塞后发生延迟性出血，临床结局良好。我们完全切除了46个AVM；1例患者术后血管造影发现有AVM。平均手术时间为4.7小时，平均失血量为455毫升。14例患者术后临床状态恶化。42例患者（89%）进行了血管造影和临床随访检查；平均随访期为13个月。我们未发现动静脉分流复发。14例患者出院后临床症状改善。在42例接受随访的患者中，23例无神经功能缺损，16例有非致残性缺损，3例有致残性缺损。
术前使用Onyx液体栓塞系统治疗脑AVM可通过靶向栓塞实现深度闭塞，并为安全的神经外科切除提供基础。
