Gobin Y P, Laurent A, Merienne L, Schlienger M, Aymard A, Houdart E, Casasco A, Lefkopoulos D, George B, Merland J J
Service de Neuroradiologie and Neurochirurgie, Hôpital Lariboisière, Paris, France.
J Neurosurg. 1996 Jul;85(1):19-28. doi: 10.3171/jns.1996.85.1.0019.
Embolization was used to reduce the size of brain arteriovenous malformations (AVMs) prior to radiosurgical treatment in 125 patients who were poor surgical candidates or had refused surgery. Of these patients, 81% had suffered hemorrhage, and 22.4% had undergone treatment at another institution. According to the Spetzler-Martin scale, the AVMs were Grade II in 9.6%, Grade III in 31.2%, Grade IV in 30.4%, and Grades V to VI in 28.8% of the cases. Most embolizations were performed using cyanoacrylate delivered by flow-guided microcatheters. Radiosurgery was performed using a linear accelerator in 62 patients treated by the authors, and 34 patients were treated at other institutions using various methods. Embolization produced total occlusion in 11.2% of AVMs and reduced 76% of AVMs enough to allow radiosurgery. Radiosurgery produced total occlusion in 65% of the partially embolized AVMs (79% when the residual nidus was < 2 cm in diameter). Embolizations resulted in a mortality rate of 1.6% and a morbidity rate of 12.8%. No complications were associated with radiosurgery. The hemorrhage rate for partially embolized AVMs was 3% per year. No patient with a completely occluded AVM experienced rehemorrhage. Angiographic follow-up review of AVMs embolized with cyanoacrylate demonstrated a 11.8% revascularization rate, occurring within 1 year. It is concluded that after partial embolization with cyanoacrylate, the risk of hemorrhage from the residual nidus is comparable to the natural history of AVMs and that the residual nidus can be irradiated with results almost as good as for a native AVM of the same size.
对于125例手术条件差或拒绝手术的患者，在进行放射外科治疗前采用栓塞术缩小脑动静脉畸形（AVM）的大小。这些患者中，81%曾发生过出血，22.4%曾在其他机构接受过治疗。根据斯佩茨勒 - 马丁分级量表，9.6%的AVM为Ⅱ级，31.2%为Ⅲ级，30.4%为Ⅳ级，28.8%的病例为Ⅴ至Ⅵ级。大多数栓塞术采用通过血流导向微导管输送的氰基丙烯酸酯进行。作者对62例患者使用直线加速器进行放射外科治疗，34例患者在其他机构采用各种方法进行治疗。栓塞术使11.2%的AVM完全闭塞，76%的AVM缩小到足以进行放射外科治疗的程度。放射外科治疗使65%的部分栓塞AVM完全闭塞（当残留病灶直径<2 cm时，完全闭塞率为79%）。栓塞术导致的死亡率为1.6%，发病率为12.8%。放射外科治疗未出现并发症。部分栓塞AVM的年出血率为3%。没有完全闭塞AVM的患者发生再出血。对用氰基丙烯酸酯栓塞的AVM进行血管造影随访显示，再通率为11.8%，发生在1年内。结论是，用氰基丙烯酸酯进行部分栓塞后，残留病灶出血的风险与AVM的自然病程相当，并且可以对残留病灶进行放射治疗，其效果几乎与相同大小的原发性AVM一样好。
