使用乙烯-乙烯醇共聚物栓塞脑动静脉畸形：技术方面。

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects.

机构信息

Department of Neuroradiosugery, Beijing Neurosurgery Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Chin Med J (Engl). 2009 Aug 20;122(16):1851-6.

PMID:19781359

Abstract

BACKGROUND

Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique.

METHODS

From September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed.

RESULTS

The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%).

CONCLUSIONS

Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.

摘要

背景

血管内治疗在脑动静脉畸形（BAVM）的治疗中起着重要作用。乙烯-乙烯醇共聚物（Onyx）是一种新型的液体栓塞材料。本研究旨在总结我们使用 Onyx 栓塞 BAVM 的经验，重点介绍栓塞技术。

方法

2003 年 9 月至 2007 年 11 月，我们科室对 115 例（43 名女性和 72 名男性，平均年龄 29 岁）BAVM 患者进行了血管内 Onyx 栓塞治疗。在治疗前评估了所有 AVM 的以下特征：病灶和分流类型、引流静脉和供血动脉。共进行了 196 次血管内治疗。

结果

88 例患者完成了血管内治疗过程。27 例患者计划进行额外治疗。在 88 例患者中，23 例（26.1%）获得完全闭塞，35 例（39.8%）获得接近完全（>原体积的 80%）闭塞，30 例（34.1%）获得部分闭塞（<原体积的 80%），单纯栓塞作为唯一的治疗技术。115 例患者的平均体积减少率为 72%（范围 30%~100%）。34 例（38.6%，34/88）患者接受了放射外科治疗。27 例患者计划进行额外栓塞治疗。19 例（16.5%，19/115）患者出现并发症，导致 1 例患者死亡（死亡率 0.9%），3 例患者出现永久性残疾（发病率 2.6%）。