Department of Interventional Neuroradiology, University of Brasília, Brasília, Brazil.
Neurosurgery. 2011 Jul;69(1):184-93; discussion 193. doi: 10.1227/NEU.0b013e318212bb34.
There is an increasing application of endovascular treatment for brain arteriovenous malformations (BAVMs) using ethylene vinyl alcohol copolymer (Onyx). Historically, this treatment has been performed using a transarterial approach.
To report our experience with transvenous endovascular embolization with Onyx (TVEO).
Five consecutive patients with BAVMs underwent endovascular TVEO between June 2007 and March 2009 at the Interventional Neuroradiology Department of the University Hospital of Limoges. There were 3 men and 2 women with a mean age of 41.8 years (range, 19-57 years). The clinical presentation included symptoms caused by intracerebral hemorrhage (n = 4) and seizures (n = 1). According to the Spetzler-Martin classification scheme, 3 BAVMs (60%) were grade III, and 2 BAVMs (40%) were grade IV. Four BAVMs (80%) were supratentorial and 1 BAVM (20%) was infratentorial. Immediate and mid-term treatment (6 months) outcomes were angiographically and clinically analyzed according to the modified Rankin Scale.
The transvenous approach was used in all patients (100%). The success rate of complete obliteration of the arteriovenous malformation nidus was 80% (4 of 5), confirmed by follow-up angiography performed immediately and at 6 months after TVEO. No procedure-related complications occurred during or after embolization. All patients remained unchanged (modified Rankin Scale score = 0-2) and clinically stable 6 months after TVEO.
The transvenous approach using Onyx for the management of BAVMs is shown to be an efficient and safe alternative treatment in cases with no other conventional therapeutic choice and when some anatomic considerations are respected.
越来越多的脑动静脉畸形（BAVMs）采用乙烯-乙烯醇共聚物（Onyx）进行血管内治疗。从历史上看，这种治疗一直采用经动脉入路。
报告我们使用 Onyx 经静脉血管内栓塞（TVEO）治疗 BAVMs 的经验。
2007 年 6 月至 2009 年 3 月，在利摩日大学医院介入神经放射科，连续 5 例 BAVMs 患者接受了血管内 TVEO。男性 3 例，女性 2 例，平均年龄 41.8 岁（19-57 岁）。临床表现包括脑出血引起的症状（n=4）和癫痫发作（n=1）。根据 Spetzler-Martin 分级方案，3 例 BAVMs（60%）为 3 级，2 例 BAVMs（40%）为 4 级。4 例 BAVMs（80%）位于幕上，1 例 BAVM（20%）位于幕下。根据改良 Rankin 量表，对即刻和中期（6 个月）治疗结果进行了血管造影和临床分析。
所有患者（100%）均采用经静脉入路。TVEO 即刻和 6 个月后行血管造影随访，完全闭塞动静脉畸形巢的成功率为 80%（5 例中有 4 例）。栓塞过程中和栓塞后均无与操作相关的并发症发生。所有患者在 TVEO 后 6 个月，改良 Rankin 量表评分均保持不变（0-2 分）且临床稳定。
对于没有其他常规治疗选择且符合一些解剖学考虑的情况下，使用 Onyx 经静脉入路治疗 BAVMs 是一种有效且安全的替代治疗方法。
