Xiaochuan Huo, Yuhua Jiang, Xianli Lv, Hongchao Yang, Yang Zhao, Youxiang Li
Beijing Neurosurgical Institue, Tiantan Hospital, Capital Medical University; Beijing, China.
Beijing Neurosurgical Institue, Tiantan Hospital, Capital Medical University; Beijing, China
Interv Neuroradiol. 2015 Feb;21(1):80-7. doi: 10.15274/inr-2014-10090.
This study investigated the effect and safety of targeted embolization in partially embolized cerebral arteriovenous malformation (AVM) followed by gamma knife surgery (GKS). We retrospectively analyzed 86 AVM patients who were targeted embolized by Onyx followed by GKS for residual nidus. Embolization-related complications were collected and the clinical effect was evaluated. During targeted embolization, intranidus or hemodynamic aneurysms and AVM-related fistula were evaluated and targeted embolized. Patients with AVM-related aneurysms and fistula were divided into a targeted embolization group and non-targeted embolization group based on the retrospectively determined treatment strategy. The effect of targeted embolization on hemorrhage risk was evaluated. The overall annual hemorrhage rate was 1.66% with 2.26% for ruptured AVMs and 1.08% for unruptured lesions. The annual mortality rate was 0.4%. Only one in 16 patients with embolization-related complications had permanent neurologic deficit. Twenty-four of 29 cases with intranidus aneurysms were targeted embolized, four of five cases with hemodynamic aneurysms were targeted embolized and eight of nine cases with arteriovenous fistula were targeted embolized. Chi square results showed the hemorrhage complications in the target embolization group were significantly lower than those in the non-target embolization group (p < 0.01). Targeted embolization combined with GKS treatment decreased the annual hemorrhage rate and improved clinical outcome with low permanent complications in partially embolized AVMs. This method could be proposed for the treatment of large brain AVMs when a single-technique treatment is not feasible.
本研究探讨了在部分栓塞的脑动静脉畸形（AVM）中先行靶向栓塞，再行伽玛刀手术（GKS）的疗效及安全性。我们回顾性分析了86例接受Onyx靶向栓塞治疗后因残留病灶而行GKS的AVM患者。收集栓塞相关并发症并评估临床疗效。在靶向栓塞过程中，对病灶内或血流动力学性动脉瘤以及AVM相关瘘进行评估并靶向栓塞。根据回顾性确定的治疗策略，将患有AVM相关动脉瘤和瘘的患者分为靶向栓塞组和非靶向栓塞组。评估靶向栓塞对出血风险的影响。总体年出血率为1.66%，破裂AVM的年出血率为2.26%，未破裂病灶的年出血率为1.08%。年死亡率为0.4%。在16例有栓塞相关并发症的患者中，仅1例有永久性神经功能缺损。29例病灶内动脉瘤患者中有24例接受了靶向栓塞，5例血流动力学性动脉瘤患者中有4例接受了靶向栓塞，9例动静脉瘘患者中有8例接受了靶向栓塞。卡方检验结果显示，靶向栓塞组的出血并发症明显低于非靶向栓塞组（p＜0.01）。对于部分栓塞的AVM，靶向栓塞联合GKS治疗可降低年出血率并改善临床结局，永久性并发症发生率低。当单一技术治疗不可行时，可采用这种方法治疗大脑AVM。
