Department of Neurological Surgery, University of Washington, Washington, USA.
Department of Radiology, University of Washington, Washington, USA.
J Neurointerv Surg. 2018 Mar;10(3):258-267. doi: 10.1136/neurintsurg-2017-013084. Epub 2017 Jul 14.
Embolization before stereotactic radiosurgery (SRS) for brain arteriovenous malformations (BAVMs) is controversial.
To compare clinical and radiographic outcomes in patients undergoing pre-SRS embolization with ethylene copolymer (Onyx) with outcomes in patients undergoing SRS alone.
Seventy consecutive patients with BAVMs who underwent SRS were retrospectively reviewed. Univariate and multivariate analyses were performed to assess the factors associated with radiographic obliteration and complication.
Forty-one (59%) patients presented without BAVM rupture and 29 (41%) patients presented with rupture. Pre-SRS embolization was used in 20 patients (28.6%; 7 unruptured and 13 ruptured). Twenty-five of 70 (36%) patients sustained a complication from treatment, including 6 (9%) patients with a post-SRS latency period hemorrhage. Ten (14%) patients had persistent neurological deficits after treatment. Functional outcome (as modified Rankin Scale), complication rate, and radiographic obliteration at last follow-up were not significantly different between embolized and non-embolized groups in both unruptured and ruptured BAVMs. For unruptured BAVMs, 3- and 5-year rates of radiographic obliteration were 23% and 73% for non-embolized patients and 20% and 60% for embolized patients, respectively. For ruptured BAVMs, 3- and 5-year rates of radiographic obliteration were 45% and 72% for non-embolized patients and 53% and 82% for embolized patients, respectively.
Pre-SRS embolization with Onyx was not associated with worse clinical or radiographic outcomes than SRS treatment without embolization. Pre-SRS embolization has a low complication rate and can safely be used to target high-risk BAVM features in carefully selected patients destined for SRS.
在立体定向放射外科（SRS）治疗脑动静脉畸形（BAVM）之前进行栓塞存在争议。
比较接受 SRS 前使用乙烯共聚物（Onyx）栓塞与单独接受 SRS 治疗的患者的临床和影像学结果。
回顾性分析了 70 例接受 SRS 的 BAVM 患者。进行单变量和多变量分析，以评估与影像学闭塞和并发症相关的因素。
41 例（59%）患者无 BAVM 破裂，29 例（41%）患者有破裂。20 例患者（28.6%；7 例未破裂和 13 例破裂）接受了 SRS 前栓塞。70 例患者中有 25 例（36%）发生了治疗相关并发症，包括 6 例（9%）患者在 SRS 潜伏期后发生出血。10 例（14%）患者在治疗后存在持续性神经功能缺损。在未破裂和破裂的 BAVM 中，栓塞组和非栓塞组的功能结局（改良 Rankin 量表）、并发症发生率和最后随访时的影像学闭塞率均无显著差异。对于未破裂的 BAVM，未栓塞患者的 3 年和 5 年影像学闭塞率分别为 23%和 73%，栓塞患者分别为 20%和 60%。对于破裂的 BAVM，未栓塞患者的 3 年和 5 年影像学闭塞率分别为 45%和 72%，栓塞患者分别为 53%和 82%。
与未栓塞的 SRS 治疗相比，Onyx 栓塞治疗 SRS 前并不导致更差的临床或影像学结局。SRS 前栓塞的并发症发生率较低，可以安全地用于针对精心挑选的、适合 SRS 治疗的高危 BAVM 特征。
