Benati A, Beltramello A, Colombari R, Maschio A, Perini S, Da Pian R, Pasqualin A, Scienza R, Rosta L, Piovan E
Department of Neuroradiology, Verona University Hospital, Italy.
AJNR Am J Neuroradiol. 1989 May-Jun;10(3):579-86.
The technique with a wing microcatheter system and the pathologic aspects of 11 cerebral arteriovenous malformations (AVMs) surgically resected after embolization with polylene threads are reported. Embolization was performed once in eight patients and twice in three patients. Resected AVMs were submitted both to routine hematoxylineosin examination and to immunohistochemical workup in order to detect the type of immunologic response to thread emboli. In nine cases, 50% or more of the nidus was obliterated by the embolization. After embolization two patients developed reversible neurologic deficits. Pathologic specimens of resected AVMs demonstrated no vascular necrosis; however, a moderate inflammatory response could be seen, characterized by the presence of both mononuclear cells and foreign-body giant cells, associated with the absence of polymorphonuclear infiltrates. A granulomatous fibrotic process was identified that was present from the first month after embolization. Immunohistochemistry indicated that the immunologic response to thread emboli was cell-mediated, not humoral. Embolization with the wing microcatheter with the use of polylene threads proved to be a safe and efficient system of embolization, as a preoperative procedure. Polylene threads are a nontoxic and biocompatible material that can be used as an embolic agent for brain AVMs.
本文报道了使用翼状微导管系统的技术以及11例经聚乙烯线栓塞后手术切除的脑动静脉畸形（AVM）的病理情况。8例患者栓塞1次，3例患者栓塞2次。切除的AVM既进行常规苏木精-伊红染色检查，也进行免疫组织化学检查，以检测对丝线栓塞的免疫反应类型。9例患者中，栓塞使50%或更多的畸形血管团闭塞。栓塞后2例患者出现可逆性神经功能缺损。切除的AVM病理标本未显示血管坏死；然而，可以看到中度炎症反应，其特征为既有单核细胞又有异物巨细胞，且无多形核白细胞浸润。发现从栓塞后第一个月起就存在肉芽肿性纤维化过程。免疫组织化学表明，对丝线栓塞的免疫反应是细胞介导的，而非体液介导的。术前使用翼状微导管和聚乙烯线进行栓塞被证明是一种安全有效的栓塞系统。聚乙烯线是一种无毒且生物相容性良好的材料，可作为脑AVM的栓塞剂。
