摘要
目的探讨与颅内动静脉畸形（AVM）血流相关的动脉瘤血管内治疗的效果。方法回顾性分析20例AVM患者的临床资料。采用Seldinger技术，在栓塞20个动脉瘤的同时，栓塞全部或部分畸形血管团，对残余部分畸形血管团，按计划分期进行再次栓塞治疗（9例）或进行放射治疗（3例）。分析DSA结果及血管内治疗动脉瘤的效果。结果20例与动静脉畸形血流相关的动脉瘤患者中，有18例Spetzler分级在Ⅲ级以上。共发现与颅内动静脉畸形血流相关的动脉瘤22个，其中位于畸形血管团内11个，基底动脉末端2个，病灶同侧颈内动脉C1段2个，后交通动脉起始部3个，供血动脉段4个。共栓塞了20个动脉瘤，其中使用弹簧圈栓塞5个动脉瘤，11个畸形血管团内动脉瘤及供血动脉上的4个动脉瘤，均以Onyx及Glubran胶进行栓塞。颈内动脉C1段及后交通动脉起始部的2个小宽颈动脉瘤未予处理，现尚在随访中。脑血管造影随访9例，随访时间为1．5—13．0个月，9例再次进行残余畸形血管团栓塞时，见动脉瘤栓塞致密，症状较术前改善。3例残留较少的病例术后进行了伽玛刀放射治疗。结论与颅内动静脉畸形血流相关的动脉瘤多见于中、大型血管畸形，血管内治疗是安全、有效的方法。
Objective To evaluate the effect of endovascular treatment for intraeranial arteriovenous malformations （AVM） associated with aneurysms and to investigate the management strategy for such cases. Methods Twenty cases of cerebral AVMs associated with aneurysms were treated in our hospital from Jan. 2007 to Dec. 2008 . With the embolization of aneurysms, the AVM niduses were embolized totally or partially, the remnants of nidus were reembolized （9 cases） or given radiotherapy （3 cases）. The results of treatment were evaluated. Results Eighteen of the 20 AVMs were higher than grade m according to Spetzler＇s grading system. 22 aneurysms were found of them, 11 were located in the nidus of AVM, 2 at the distal segment of basilar artery （ BA）, 2 at the ipsilateral C1 segment of internal carotid artery （ICA）, 3 at the of posterior communicating artery （PoCA）, and 4 at the feeding artery of the AVM. 20 aneurysms were embolized of them, 5 aneuryslns with coils, and the ancurysms in the nidus or feeding artery were obliterated with NBCA glue or Onyx, 2 small wide necked aneurysms of ICA and PoCA were not treated. Nine cases with AVM remnants were followed up by DSA for 1.5 to 13 months, compact embolization of their associated aneurysms were seen, and the symptoms of patients were improved. 3 cases with small nidns remnants received γ knife radiotherapy. Conclusion The aneurysms related to cerebral AVMs often occurred in the medium or large-sized nidus, and endovascular treatment is safe and effective for management of such cases.
出处
《中国脑血管病杂志》
CAS
2009年第4期176-179,共4页
Chinese Journal of Cerebrovascular Diseases
基金
广东省自然科学基金资助项目(8451008004001669)
关键词
颅内动静脉畸形
颅内动脉瘤
放射学
血管内治疗
血流相关动脉瘤
Intracranial arteriovenous malformations
Intracranial aneurysm
Radiology, interven- tional
Blood flow related aneurysms
