Hasegawa Hitoshi
Department of Neurosurgery, Brain Research Institute, Niigata University.
No Shinkei Geka. 2023 Mar;51(2):265-277. doi: 10.11477/mf.1436204742.
Endovascular embolization using liquid materials is a safe and effective treatment option for cerebral arteriovenous malformations(AVM). Onyx and n-butyl cyanoacrylate, currently available in Japan, have specific features. Appropriate embolic agents should be selected based on their characteristics. Transarterial embolization(TAE)is the standard endovascular treatment approach. However, there have been some recent reports regarding the efficacy of transvenous embolization(TVE). TVE is potentially curative for small AVM with hemorrhagic onset, inaccessible arterial feeders, deep location, and/or a single draining vein. In specific cases, TVE may provide a higher chance of complete obliteration of the AVM than TAE. Some unsolved problems need further clarification, such as the relative positions of liquid embolization against direct surgery, dealing with unruptured AVM, and effective treatment for high-grade AVM.
使用液体材料进行血管内栓塞是治疗脑动静脉畸形（AVM）的一种安全有效的方法。目前在日本可用的Onyx和正丁基氰基丙烯酸酯具有特定特征。应根据其特性选择合适的栓塞剂。经动脉栓塞（TAE）是标准的血管内治疗方法。然而，最近有一些关于经静脉栓塞（TVE）疗效的报道。TVE对于出血起病、动脉供血难以到达、位置较深和/或单一引流静脉的小型AVM可能具有治愈性。在特定情况下，TVE可能比TAE提供更高的AVM完全闭塞机会。一些未解决的问题需要进一步阐明，例如液体栓塞相对于直接手术的相对位置、处理未破裂的AVM以及对高级别AVM的有效治疗。
