Wikholm G, Lundqvist C, Svendsen P
Department of Interventional Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Neurosurgery. 1996 Sep;39(3):448-57; discussion 457-9. doi: 10.1097/00006123-199609000-00004.
The aim of this two-part study is to give a full account of all patients referred for embolization of arteriovenous malformations (AVMs) from 1987 to 1993. This article (Part I of II) presents the patient study, including angiographic features and their relation to the immediate outcome of embolization.
Of the 192 patients referred, 150 were subsequently treated. Most patients were referred by neurosurgeons, and 85% of the AVMs were Spetzler-Martin Grade > or = 3. We have accounted for the 42 patients who did not undergo embolization.
Occlusion from embolization alone (total embolization) was obtained in 13% of patients. Full treatment (total embolization or embolization and then stereotactic radiation or surgery) was achieved in two-thirds of all patients (n = 100, 66%), and combined treatment with stereotactic gamma radiation was the most important part of the treatment strategy. The procedural mortality was 1.3%. The total incidence of complications after embolization was high (40%), but only 6.7% of cases were labeled severe. Of all angiographic features that were considered, large size and the presence of deep feeders were predictors of failure to achieve full treatment. Thirty-four patients with AVMs < 8 cc were included in the study. These could have been irradiated as the sole treatment. In this group of small AVMs, the results of embolization were far better than in the whole group. Fourteen of the AVMs had volumes of < 4 cc, and 10 of these (71%) were totally embolized. One patient had a hemianopsia. Among AVMs 4 to 8 cc in volume (n = 20), the total embolization rate was 15%, the full treatment rate in combination with gamma treatment was 75%, and 10% of the patients were operated on after embolization. Severe complications occurred in 15% of patients, but no complications occurred after November 1990.
In a series of AVMs, most of which were regarded as unsuitable for surgical excision, two-thirds were reduced to a size suitable for gamma knife treatment or totally occluded by embolization alone. The total complication rate was high, but the combined rate of death and complications affecting lifestyle was 8.0%, equal to approximately 3.2 years of natural history.
这项分为两部分的研究旨在全面描述1987年至1993年间所有因动静脉畸形（AVM）转诊接受栓塞治疗的患者情况。本文（两篇中的第一篇）介绍了患者研究情况，包括血管造影特征及其与栓塞近期结果的关系。
在转诊的192例患者中，150例随后接受了治疗。大多数患者由神经外科医生转诊，85%的AVM为斯佩茨勒 - 马丁分级≥3级。我们对42例未接受栓塞治疗的患者进行了说明。
仅通过栓塞实现闭塞（完全栓塞）的患者占13%。三分之二的患者（n = 100，66%）实现了完全治疗（完全栓塞或栓塞后进行立体定向放射治疗或手术），立体定向伽马放射联合治疗是治疗策略的最重要部分。手术死亡率为1.3%。栓塞后并发症的总发生率较高（40%），但仅6.7%的病例被列为严重并发症。在所有考虑的血管造影特征中，体积大以及存在深部供血支是未能实现完全治疗的预测因素。研究纳入了34例AVM体积<8立方厘米的患者。这些患者本可仅接受放射治疗。在这组小AVM中，栓塞结果远优于整个研究组。其中14例AVM体积<4立方厘米，其中10例（71%）实现了完全栓塞。1例患者出现偏盲。在体积为4至8立方厘米的AVM中（n = 20），完全栓塞率为15%，联合伽马治疗的完全治疗率为75%，10%的患者在栓塞后接受了手术。15%的患者发生了严重并发症，但1990年11月之后未再出现并发症。
在一系列大多被认为不适合手术切除的AVM中，三分之二的患者经治疗后体积缩小至适合伽马刀治疗的大小，或仅通过栓塞实现完全闭塞。并发症总发生率较高，但死亡和影响生活方式的并发症综合发生率为8.0%，约等于3.2年的自然病程。
