Jin Hengwei, Liu Zhan, Chang Qing, Chen Chang, Ge Huijian, Lv Xianli, Li Youxiang
1 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China.
2 Beijing Engineering Research Center for Interventional Neuroradiology, China.
Interv Neuroradiol. 2017 Oct;23(5):497-503. doi: 10.1177/1591019917711679. Epub 2017 Jun 14.
Objective Brainstem arteriovenous malformations (AVMs) are rare lesions with a high risk of intracranial hemorrhage and are challenging to treat. We present our experience of endovascular embolization with Onyx in these aggressive lesions. Materials and methods Between 2007 and 2016, 13 patients with brainstem AVMs were embolized with Onyx at our center. Twelve patients presented with intracranial hemorrhage and one with headache. Retrospective examinations of patient demographics, clinical presentation, angiographic features, treatment modalities, postoperative complications and outcomes were carried out. Results The AVMs were in the midbrain in 10 patients (one anterior and nine posterior or dorsal), in the posterior pons in two and pontomedullary in one. Complete occlusion was achieved in three patients. Gamma knife radiosurgery was performed in six patients who were near-completely or partially embolized. Postoperative complications, including five cases of ischemia and one case of hemorrhage, resulted in four cases of neurological deterioration and two deaths. Clinical follow-up was obtained in 10 patients at a mean period of 45.2 months (range 3 to 93 months). During the follow-up, good clinical outcomes were observed in seven patients with posterior or dorsal midbrain AVMs, and one patient with a posterior pons AVM that was partially occluded died of intracranial hemorrhage. Conclusion Endovascular embolization for brainstem AVM with Onyx is a technical challenge and the reflux of Onyx may cause severe complications. Individualized treatment is needed based on the specific subtype of brainstem AVM.
目的 脑干动静脉畸形（AVM）是罕见病变，颅内出血风险高，治疗具有挑战性。我们介绍在这些侵袭性病变中使用Onyx进行血管内栓塞的经验。材料与方法 2007年至2016年，我们中心对13例脑干AVM患者使用Onyx进行栓塞。12例患者出现颅内出血，1例出现头痛。对患者的人口统计学、临床表现、血管造影特征、治疗方式、术后并发症及结果进行回顾性检查。结果 10例患者的AVM位于中脑（1例在前部，9例在后部或背侧），2例在脑桥后部，1例在脑桥延髓部。3例患者实现完全闭塞。对6例接近完全或部分栓塞的患者进行了伽玛刀放射外科治疗。术后并发症包括5例缺血和1例出血，导致4例神经功能恶化和2例死亡。10例患者获得临床随访，平均随访时间为45.2个月（范围3至93个月）。随访期间，7例中脑后部或背侧AVM患者临床结果良好，1例部分闭塞的脑桥后部AVM患者死于颅内出血。结论 用Onyx对脑干AVM进行血管内栓塞是一项技术挑战，Onyx反流可能导致严重并发症。需要根据脑干AVM的具体亚型进行个体化治疗。
