Kim Dong Joon, Suh Dae Chul, Kim Byung Moon, Kim Dong Ik
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
Neurointervention. 2018 Mar;13(1):41-47. doi: 10.5469/neuroint.2018.13.1.41. Epub 2018 Mar 2.
Adjuvant coils may offer advantages in flow control during glue embolization of high flow vein of Galen aneurysmal malformation (VGAM) patients but involves specific issues such as feasibility, durability and coil mass effect. The purpose of this study is to assess the outcome of adjuvant coils in addition to transarterial glue embolization for treatment of these patients.
Five pediatric VGAM patients (age range; 11 weeks to 2 yrs 2 mos) with high flow fistulous angioarchitecture were treated with adjuvant coils 1) in the distal feeding artery and/or 2) in the vein of Galen followed by glue embolization of the shunt. The angiographic / clinical outcomes were assessed.
Adjuvant coils were deployed in the distal feeding artery (n=3), vein of Galen pouch plus distal feeding artery (n=2). Additional transarterial glue embolization of the fistulae was successfully performed (n=4). Complete occlusion was achieved with coils in one case. Complete occlusion was achieved for all mural type cases (n=4). Residual feeders remained in a case of choroidal type of VGAM. No complications were noted related to the treatment. All patients showed normal development on follow up (range: 7.6 to 88.8 mo, mean 49.3 mo). Initial hydrocephalus improved on follow up despite coil mass effect in dilated vein of Galen.
Adjuvant coils for flow control with glue embolization may be a safe and effective treatment method for VGAM patients with high flow fistulous feeders.
辅助性弹簧圈在大脑大静脉动脉瘤样畸形（VGAM）患者的胶水栓塞治疗过程中，可能在血流控制方面具有优势，但也涉及一些特定问题，如可行性、耐久性和弹簧圈的占位效应。本研究的目的是评估在经动脉胶水栓塞治疗这些患者的基础上，辅助性弹簧圈的治疗效果。
5例患有高流量瘘样血管结构的小儿VGAM患者（年龄范围：11周龄至2岁2个月）接受了辅助性弹簧圈治疗，1）在远端供血动脉，和/或2）在大脑大静脉内，随后对分流进行胶水栓塞。评估血管造影/临床结果。
辅助性弹簧圈被放置在远端供血动脉（n = 3）、大脑大静脉囊袋加远端供血动脉（n = 2）。成功对瘘管进行了额外的经动脉胶水栓塞（n = 4）。1例患者通过弹簧圈实现了完全闭塞。所有壁型病例（n = 4）均实现了完全闭塞。脉络膜型VGAM患者有1例存在残余供血。未观察到与治疗相关的并发症。所有患者在随访中均显示发育正常（范围：7.6至88.8个月，平均49.3个月）。尽管扩张的大脑大静脉存在弹簧圈占位效应，但随访时初始脑积水情况有所改善。
对于具有高流量瘘样供血的VGAM患者，使用胶水栓塞并辅以弹簧圈进行血流控制可能是一种安全有效的治疗方法。
