| 王坤,赵卫,胡继红,易根发,石潆.介入栓塞治疗未破裂动脉瘤合并脑动静脉畸形[J].中国介入影像与治疗学,2017,14(6):355-359 |
| 介入栓塞治疗未破裂动脉瘤合并脑动静脉畸形 |
| Embolization of unruptured intracranial aneurysms combined with brain arteriovenous malformations |
| 投稿时间：2016-12-16 修订日期：2017-04-24 |
| DOI：DOI:10.13929/j.1672-8475.201612017 |
| 中文关键词: 动脉瘤 脑 动静脉畸形 栓塞治疗 |
| 英文关键词:Aneurysm Brain Arteriovenous malformations Embolization therapy |
| 基金项目:云南省卫生科技计划项目（2014NS157）。 |
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| 中文摘要: |
| 目的 探讨未破裂的动脉瘤合并脑动静脉畸形（BAVM）的介入治疗价值。方法 回顾性分析23例未破裂的动脉瘤合并BAVM患者的资料。对所有患者均行介入栓塞治疗，根据Redekop分型，选择介入栓塞方式。对近端、远端血流动力型动脉瘤以弹簧圈栓塞，对团内型动脉瘤以Onyx栓塞剂栓塞。术后1周以格拉斯哥转归评分（GOS）评估治疗效果。术后3~6个月行DSA复查病灶是否复发、有无颅内出血。结果 23例患者共36个病灶，其中BAVM合并团内型动脉瘤8个、近端血流动力型动脉瘤16个、远端血流动力型动脉瘤11个、无关血流动力型动脉瘤1个。以弹簧圈栓塞16个近端血流动力型和10个远端血流动力型动脉瘤；以Onyx栓塞剂栓塞8个团内型动脉瘤；1个远端血流动力型动脉瘤因栓塞困难且动脉瘤形态规整未予栓塞，术后第6天患者死于颅内出血引起的脑疝；1个无关血流动力型动脉瘤因易于外科夹闭未予栓塞。23例中，BAVM完全栓塞7例，未完全栓塞16例。19例术后GOS评分为5分，3例为4分，1例死亡病例未评估。除1例死亡外，余22例DSA术后随访均未见复发，无颅内出血。结论 介入栓塞治疗未破裂的动脉瘤合并BAVM较为安全、有效，根据各病灶血流动力学特点制定治疗方案、尽量栓塞所有病灶并积极预防术后出血有助于改善患者预后。 |
| 英文摘要: |
| Objective To explore the value of interventional therapy in unruptured intracranial aneurysms combined with brain arteriovenous malformations (BAVM). Methods Data of 23 patients with unruptured aneurysms combined with BAVM were retrospectively analyzed. All patients were treated with interventional embolization, and the embolization methods were choosen according to the Redekop classification. The proximal or distal hemodynamic aneurysms were embolized with coils, and the intranidal aneurysms were embolized with Onyx. The outcome was assessed by the Glasgow outcome score (GOS) one week after treatment. DSA scan was used to observe whether there was recurrence during 3-6 months after embolization. Results Totally there were 36 aneurysms in 23 patients, including 8 intranidal aneurysms, 16 proximal flow-related aneurysms, 11 distal flow-related aneurysms and 1 unrelated aneurysm. Embolizations of 16 proximal hemodynamic aneurysms and 10 distal hemodynamic aneurysms were done with coils. And embolization of 8 intranidal aneurysms were done with Onyx. One distal hemodynamic aneurysm was not embolized due to the difficulty of embolization and the regular shap of aneurysm; and the patient died of cerebral hernia caused by intracranial hemorrhage on the sixth day after embolization. Because it was more suitable for surgical clipping, 1 unrelated hemodynamic aneurysm was not embolized. In 23 cases, BAVM were completely embolized in 7 cases and incompletely embolized in 16 cases. A week after operation, the GOS score were 5 in 19 cases and 4 in 3 cases. The GOS score was not evaluated in the dead case. Except for 1 cases of death, the other 22 cases were followed up after embolization. No recurrence and intracranial hemorrhage occurred. Conclusion Interventional treatment of unruptured intracranial aneurysms combined with BAVM is safe and effective.Making treatment plan according to the hemodynamic characteristics of lesions and completely embolizing all lesions to prevent postoperative bleeding is helpful to improve the prognosis of patients. |
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